Is Flonase Prescribed for Post-Nasal Drip?
Yes, Flonase (fluticasone propionate) is highly effective for treating post-nasal drip, particularly when caused by allergic rhinitis or post-viral rhinosinusitis, and is recommended as first-line therapy. 1
Evidence for Flonase in Post-Nasal Drip
Intranasal corticosteroids like fluticasone propionate significantly reduce post-nasal drip symptoms compared to placebo. 1 In clinical trials of post-viral rhinosinusitis, mometasone furoate nasal spray (a similar intranasal corticosteroid) demonstrated significant improvement in post-nasal drip at 8 and 12 weeks of treatment. 1 While the evidence specifically mentions mometasone, fluticasone propionate works through the same mechanism and has comparable efficacy. 1
Mechanism of Action
Fluticasone propionate works directly in the nasal passages to block multiple inflammatory substances (histamine, prostaglandins, cytokines, tryptases, chemokines, and leukotrienes) that cause post-nasal drip and other nasal symptoms. 2 This multi-mediator approach makes it more comprehensive than antihistamines alone, which only block histamine. 2
Dosing for Post-Nasal Drip
Adults and Adolescents ≥12 Years
- Standard dose: 2 sprays per nostril once daily (200 mcg total daily dose) 3, 2
- For severe symptoms: May use 2 sprays per nostril twice daily initially, then reduce to maintenance dosing once symptoms are controlled 3
Children 4-11 Years
Special Considerations for Asthma Patients
Fluticasone nasal spray is NOT a treatment for asthma itself, but it is safe to use in patients with both asthma and post-nasal drip. 2 Patients should continue their prescribed asthma medications separately. 2 If you are already using an inhaled corticosteroid for asthma, consult your doctor before adding intranasal fluticasone to ensure the combined steroid exposure remains appropriate. 2
Timeline for Symptom Relief
Expect delayed onset of action—approximately 12 hours for initial effect, with maximal efficacy reached over several days to weeks. 3, 2 This is why regular daily use is essential rather than as-needed dosing. 3, 2 Do not discontinue treatment when symptoms improve; continue regular use to maintain symptom control. 3
Proper Administration Technique
To maximize effectiveness and minimize side effects:
- Prime the bottle before first use 3
- Shake the bottle before each use 3
- Blow your nose before spraying 3
- Keep head upright during administration 3
- Use contralateral hand technique (hold spray in opposite hand from the nostril being treated) to direct spray away from the nasal septum—this reduces epistaxis risk by four times 3
- Do not close the opposite nostril during spraying 3
Common Side Effects and Safety
The most common side effects include headache, pharyngitis, epistaxis (nosebleeds), nasal burning/irritation, nausea, and cough. 3, 2 These are generally mild and can be minimized with proper spray technique. 3
Long-term use is safe: Studies demonstrate no suppression of the hypothalamic-pituitary-adrenal axis at recommended doses, even with continuous use for up to 52 weeks. 3, 5 There is no evidence of growth suppression in children at recommended doses. 3, 4
When to Consider Alternatives
If fluticasone is not tolerated, alternative intranasal corticosteroids include:
- Triamcinolone acetonide (Nasacort) - available over-the-counter with different formulation 6
- Mometasone furoate (Nasonex) - excellent efficacy and safety profile 6, 7
- Budesonide (Rhinocort) - aqueous formulation that may be better tolerated 6
If intranasal corticosteroids cannot be tolerated at all, intranasal antihistamines like azelastine may be considered, though they are less effective for post-nasal drip. 1, 6
Important Caveats
Do not use fluticasone for cold symptoms—only for allergic or inflammatory conditions causing post-nasal drip. 2 If uncertain whether symptoms are from allergies or a cold, consult your physician. 2
Check with your doctor before using if you are taking: ritonavir (HIV medication), ketoconazole pills (antifungal), or other steroid medications for any condition. 2