What is the recommended dose of Vaamys (fluticasone) nasal spray for an 8-year-old patient?

Vaamys (Fluticasone Furoate) Nasal Spray Dosing for an 8-Year-Old

For an 8-year-old child, administer Vaamys (fluticasone furoate) nasal spray at a dose of 1 spray (27.5 mcg) per nostril once daily (55 mcg total daily dose). 1

Age-Appropriate Dosing

• Fluticasone furoate (Veramyst/Vaamys) is FDA-approved for children as young as 2 years of age, making it appropriate for your 8-year-old patient 1
• The recommended pediatric dose is 1-2 sprays per nostril daily for children aged 2-11 years, with 1 spray per nostril (55 mcg total) being the typical starting dose 1
• This contrasts with fluticasone propionate (Flonase), which requires children ages 4-11 years to use 1 spray (50 mcg) per nostril once daily (100 mcg total) 2, 3

Administration Technique

• Prime the bottle before first use and shake before each administration 2, 4
• Have the child blow their nose prior to using the spray 2, 4
• Keep the head in an upright position during administration 2, 4
• Use the contralateral hand technique (hold the spray in the opposite hand relative to the nostril being treated) to direct the spray away from the nasal septum, which reduces epistaxis risk by four times 2
• Instruct the child to breathe in gently during spraying 2, 4
• Do not close the opposite nostril during administration 2

Expected Timeline and Efficacy

• Onset of action may be delayed by 12 hours, with maximal efficacy reached in days to weeks 2, 4
• Counsel parents that regular daily use is essential rather than as-needed dosing to maintain optimal symptom control 2, 4
• Fluticasone furoate has demonstrated an 8-hour onset of therapeutic effect in clinical trials, providing 24-hour symptom control 5
• The medication is effective for both nasal and ocular symptoms of allergic rhinitis 5

Safety Profile in Children

• Studies demonstrate no effect on growth at recommended doses compared to placebo, even at up to twice the recommended doses 2
• No clinically meaningful suppression of the hypothalamic-pituitary-adrenal axis occurs at recommended doses 2, 6
• The adverse event profile is similar to placebo in pediatric populations 7

Common Side Effects

• Most common side effects include headache, pharyngitis, epistaxis (nose bleeds), and nasal burning or irritation 2, 4, 1
• Epistaxis typically presents as blood-tinged secretions and can be minimized with proper spray technique 2
• Nausea, vomiting, asthma symptoms, and cough may also occur but are less common 4, 1

Important Contraindications

• Do not use if the child has a history of hypersensitivity to fluticasone or any component of the formulation 2, 4, 1

Long-Term Use Considerations

• Intranasal corticosteroids are safe for long-term daily use and do not cause rhinitis medicamentosa (rebound congestion), unlike topical decongestants 2
• For children requiring chronic therapy, use at the lowest effective dose but continue long-term when clinically indicated 2
• Periodically examine the nasal septum (every 6-12 months during long-term use) to detect mucosal erosions that may precede septal perforation, though this complication is rare 2

Clinical Advantages of Fluticasone Furoate

• Fluticasone furoate has the highest affinity and selectivity for glucocorticoid receptors and the longest tissue retention compared to other intranasal steroids 8
• This enhanced pharmacology provides potent and prolonged anti-inflammatory activity at the target site 8
• The formulation is free of chlorofluorocarbon propellants, alcohol, benzalkonium chloride, and scents 9