Does Fluticasone (fluticasone) nasal spray cause constipation?

Fluticasone Nasal Spray Does Not Cause Constipation

Fluticasone nasal spray does not cause constipation—this side effect is not associated with intranasal corticosteroids. The medication works through direct topical effects on the nasal mucosa with minimal systemic absorption, making gastrointestinal side effects extremely unlikely 1.

Documented Side Effects of Fluticasone Nasal Spray

The actual side effects of fluticasone nasal spray are well-characterized and limited primarily to local nasal effects:

Common Local Side Effects

• Epistaxis (nasal bleeding) is the most frequent adverse event, typically presenting as blood-tinged nasal secretions rather than frank bleeding, occurring in 4-8% of patients in short-term studies and up to 20% with year-long use 1
• Nasal irritation and burning, particularly with propylene glycol-containing formulations 1
• Headache is reported as a common side effect 1, 2
• Pharyngitis (throat irritation) occurs in some patients 1, 2
• Nasal septal perforation is rare but has been reported with long-term use 1

Why Systemic Side Effects Like Constipation Don't Occur

Fluticasone propionate's efficacy results from direct topical effects rather than systemic absorption 3. A controlled study comparing intranasal fluticasone (200 mcg) to oral fluticasone (5-10 mg daily) demonstrated that:

• Patients receiving nasal spray had significantly lower or undetectable plasma fluticasone concentrations compared to oral administration 3
• Only the nasal spray provided therapeutic benefit for rhinitis symptoms, while oral doses 25-50 times higher showed no efficacy 3
• This confirms the medication acts locally at the nasal mucosa with negligible systemic effects 3

Systemic Safety Profile

Multiple studies confirm the absence of systemic effects at recommended doses:

• No hypothalamic-pituitary-adrenal axis suppression in children or adults at standard doses 1, 4
• No effect on growth in children when used at recommended doses 1, 4
• No ocular effects (cataracts or glaucoma) with long-term use 1
• No bone density effects with intranasal administration at standard doses 1

Common Pitfalls and Clinical Considerations

If a Patient Reports Constipation While Using Fluticasone Nasal Spray

• Look for alternative causes: The constipation is coincidental, not causally related to the nasal spray 1
• Consider other medications the patient may be taking, particularly oral antihistamines (which can cause constipation through anticholinergic effects) 1
• Evaluate dietary factors, hydration status, and other common causes of constipation

Proper Administration to Minimize Actual Side Effects

• Use contralateral hand technique (right hand for left nostril, left hand for right nostril) to direct spray away from the nasal septum, reducing epistaxis risk by four times 2, 5
• Periodically examine the nasal septum during long-term use to detect mucosal erosions that may precede perforation 1, 2
• Counsel patients that blood-tinged mucus is common and generally tolerable if minimal 2

Long-Term Safety Reassurance

Fluticasone nasal spray is safe for continuous long-term use:

• Studies demonstrate safety for up to 52 weeks of continuous treatment 2, 6
• Nasal biopsies after 1-5 years of continuous therapy show no evidence of mucosal atrophy or pathological tissue changes 1, 2
• The medication does not cause rhinitis medicamentosa (rebound congestion) unlike topical decongestants 2