Flonase Use During Pregnancy
Flonase (fluticasone propionate) is safe to use during pregnancy for allergic rhinitis, and if you were already using it before pregnancy, you should continue without interruption. 1
Safety Evidence
Multiple guidelines from the American Academy of Allergy, Asthma, and Immunology and the American College of Allergy, Asthma, and Immunology confirm that intranasal corticosteroids, including fluticasone, budesonide, and mometasone, are safe during pregnancy at recommended doses. 1
A meta-analysis demonstrated no increased risk of major malformations, preterm delivery, low birth weight, or pregnancy-induced hypertension with intranasal corticosteroid use during pregnancy. 1, 2
The only randomized controlled trial specifically evaluating fluticasone propionate nasal spray in 53 pregnant women showed:
- No detectable influence on maternal cortisol levels 1, 3
- No differences in fetal growth on ultrasound 1, 3
- No adverse pregnancy outcomes 1, 3
Clinical Decision Algorithm
If Already Using Flonase Before Pregnancy:
Continue your current regimen without interruption, as discontinuing effective therapy can significantly impact quality of life and potentially worsen comorbid conditions like asthma. 1, 2
If Starting Therapy During Pregnancy:
While fluticasone is safe, intranasal budesonide is technically preferred as first-line therapy when initiating treatment during pregnancy due to its FDA Pregnancy Category B classification based on more extensive human safety data. 1, 2
However, the American College of Allergy, Asthma, and Immunology states there is no substantial difference in efficacy and safety among available intranasal corticosteroids (fluticasone, budesonide, mometasone). 1
Dosing Strategy
Use the lowest effective dose that adequately controls your symptoms. 1, 2
Do not exceed manufacturer-recommended dosing. 2
Critical Distinction: Intranasal vs. Oral Corticosteroids
This is a common and dangerous pitfall: Intranasal corticosteroids like Flonase have negligible systemic absorption and are NOT the same as oral corticosteroids. 2, 4
Oral corticosteroids carry significantly different and more substantial risks, including:
- Increased risk of cleft lip/palate 2
- Preeclampsia 2
- Preterm delivery 2
- Low birth weight 2
- Gestational diabetes 2
Intranasal corticosteroids have much lower systemic exposure than even inhaled corticosteroids used for asthma, making the safety profile even more reassuring. 1
Alternative Intranasal Corticosteroids
If you prefer to switch or are initiating therapy:
- Budesonide (Rhinocort): Most extensive human safety data, Pregnancy Category B 1, 2, 4
- Mometasone (Nasonex): Explicitly listed as safe by expert panels at recommended doses 1, 2, 4
- Beclomethasone: Demonstrated no convincing evidence of congenital defects 1
Breastfeeding Compatibility
The American Academy of Pediatrics considers fluticasone compatible with breastfeeding, though it is unknown whether fluticasone is excreted in human breast milk. 2
What NOT to Use
Avoid oral decongestants (pseudoephedrine, phenylephrine) during the first trimester, as they have been associated with increased congenital malformations such as gastroschisis and small intestinal atresia. 1
First-generation antihistamines should be avoided due to their sedative and anticholinergic properties. 1