What is the recommended dose of intranasal fluticasone furoate (fluticasone furoate) for an adult patient with allergic rhinitis?

Recommended Dose of Intranasal Fluticasone Furoate for Adult Allergic Rhinitis

For adults and adolescents ≥12 years with allergic rhinitis, use fluticasone furoate nasal spray 110 mcg (2 sprays per nostril) once daily. 1

Standard Dosing Regimen

• The established dose is 110 mcg administered as 2 sprays (27.5 mcg per spray) in each nostril once daily, for a total daily dose of 110 mcg. 2, 3
• This once-daily dosing has been validated in multiple randomized controlled trials for both seasonal and perennial allergic rhinitis in adults and adolescents aged ≥12 years. 2, 3, 4, 5
• Morning administration is standard, though the specific time of day is less critical than consistent daily use. 1

Clinical Efficacy Evidence

• Fluticasone furoate 110 mcg once daily significantly reduces reflective total nasal symptom scores compared to placebo (p = 0.005 for perennial allergic rhinitis, p = 0.003 for seasonal allergic rhinitis). 2, 4
• The medication demonstrates efficacy for both nasal symptoms (rhinorrhea, congestion, itching, sneezing) and ocular symptoms (redness, watering, itching) associated with allergic rhinitis. 4, 5
• Onset of therapeutic effect occurs within 12 hours, with some patients experiencing benefit as early as 3-4 hours, though maximal efficacy requires days to weeks of regular use. 6, 1

Important Administration Considerations

• Continuous daily use is more effective than as-needed dosing for optimal symptom control. 6, 1
• If severe nasal congestion prevents adequate spray delivery, consider using a topical decongestant for 3-5 days maximum while initiating the corticosteroid. 6, 1
• Proper technique is essential: direct the spray away from the nasal septum using the contralateral hand technique (right hand for left nostril, left hand for right nostril) to minimize epistaxis risk. 1, 7

Safety Profile

• Long-term use (up to 12 months studied) shows no clinically significant systemic corticosteroid effects, including no suppression of the hypothalamic-pituitary-adrenal axis or effects on 24-hour urinary cortisol excretion. 8, 1
• The most common adverse event is epistaxis (nasal bleeding), typically presenting as blood-tinged secretions rather than frank bleeding, with incidence similar to other intranasal corticosteroids. 8, 1
• Plasma concentrations of fluticasone furoate are not quantifiable in the majority of patients following intranasal administration, indicating minimal systemic absorption. 8
• No effects on growth, bone density, or ocular parameters (cataracts, glaucoma) have been demonstrated at recommended doses. 6, 1

Common Pitfalls to Avoid

• Do not prescribe higher doses than 110 mcg once daily for routine allergic rhinitis management—this is the established effective dose and higher doses do not provide additional benefit for standard allergic rhinitis. 2, 3, 4, 5
• Avoid confusing fluticasone furoate with fluticasone propionate, which has different dosing (typically 200 mcg daily for adults). 6, 1
• Do not discontinue therapy prematurely—counsel patients that full benefit may take several days to weeks and that continuous use is superior to intermittent use. 6, 1
• Ensure patients understand this is maintenance therapy, not rescue therapy like decongestants. 1

When to Consider Alternative Approaches

• If no improvement occurs after 2-4 weeks of proper use at 110 mcg once daily, consider adding an intranasal antihistamine (such as azelastine) rather than increasing the corticosteroid dose. 1
• For very severe intractable symptoms unresponsive to intranasal corticosteroids, a short 5-7 day course of oral corticosteroids may be appropriate, but long-term oral or parenteral corticosteroids are contraindicated. 6, 1