Avamys (Fluticasone Furoate) Dosing for Allergic Rhinitis
For adults and children ≥12 years with allergic rhinitis, use Avamys (fluticasone furoate) 2 sprays per nostril once daily (110 mcg total daily dose), and for children ages 2-11 years, use 1 spray per nostril once daily (55 mcg total daily dose). 1
Age-Specific Dosing Recommendations
Adults and Adolescents (≥12 years)
- Initial dose: 2 sprays (27.5 mcg each) per nostril once daily = 110 mcg total daily dose 1
- This represents the standard therapeutic dose for both seasonal and perennial allergic rhinitis 1
- Onset of symptom relief begins within 12 hours, though maximal efficacy requires days to weeks of regular use 2, 3
Children (2-11 years)
- Recommended dose: 1 spray per nostril once daily = 55 mcg total daily dose 1
- Fluticasone furoate is FDA-approved for children as young as 2 years of age 1
- Clinical trials demonstrated efficacy in reducing nasal symptoms of both seasonal and perennial allergic rhinitis in children aged 6-11 years after 2-4 weeks of treatment 1
Administration Technique to Maximize Efficacy and Minimize Side Effects
Proper Spray Technique
- Prime the bottle before first use and shake before each administration 3
- Have the patient blow their nose prior to using the spray 3
- Keep the head in an upright position during administration 3
- Use the contralateral hand technique (hold spray in opposite hand relative to the nostril being treated) to direct spray away from the nasal septum—this reduces epistaxis risk by four times 2
- Breathe in gently during spraying 3
- Do not close the opposite nostril during administration 3
Timing Considerations
- If using nasal saline irrigations, perform them prior to administering the steroid spray to avoid rinsing out the medication 2
Safety Profile and Long-Term Use
Systemic Safety
- Fluticasone furoate has enhanced glucocorticoid receptor affinity with low systemic exposure, making it particularly safe for long-term use 1
- Studies demonstrate no suppression of the hypothalamic-pituitary-adrenal axis at recommended doses, even with prolonged administration 2, 4
- Growth studies with fluticasone formulations show no effect on growth at recommended doses compared to placebo in children 2
Common Side Effects
- The overall incidence of adverse events is similar to placebo 1
- Most common side effects include headache, pharyngitis, epistaxis (typically blood-tinged secretions), and nasal burning or irritation 3
- Local side effects are rare and can be minimized with proper administration technique 3
Contraindications
- Hypersensitivity to fluticasone furoate or any component of the formulation 3
Treatment Duration and Monitoring
Initial Treatment Period
- Continue therapy for at least 2 weeks, as full benefit may not be evident during this initial period 2
- Patients must understand this is maintenance therapy, not rescue therapy, and should not be discontinued when symptoms improve 2
Long-Term Use
- Intranasal corticosteroids do not cause rhinitis medicamentosa and are safe for long-term daily use, unlike topical decongestants which must be limited to 3 days maximum 2
- For perennial allergic rhinitis, daily year-round therapy is often required due to unavoidable ongoing allergen exposure 2
- Periodically examine the nasal septum (every 6-12 months) to detect mucosal erosions that may precede septal perforation, though this complication is rare 2
Clinical Context and First-Line Status
Why Fluticasone Furoate is Preferred
- Intranasal corticosteroids are the most effective first-line treatment for allergic rhinitis, superior to oral antihistamines and leukotriene receptor antagonists for controlling all four major nasal symptoms 2
- Fluticasone furoate's novel delivery device features a side-actuated design with a short nozzle designed for ease of use 1