What is Flonase (fluticasone propionate)?

What is Flonase?

Flonase (fluticasone propionate) is an over-the-counter intranasal corticosteroid nasal spray that works directly in the nose to block allergic reactions at their source by acting on multiple inflammatory substances, providing 24-hour relief of nasal and eye allergy symptoms. 1

Active Ingredient and Mechanism

• The active ingredient is fluticasone propionate, a glucocorticoid (a type of steroid naturally produced by the body to fight inflammation) that is completely different from anabolic muscle-building steroids. 1
• Fluticasone propionate works by blocking multiple inflammatory mediators including histamine, prostaglandins, cytokines, tryptases, chemokines, and leukotrienes—whereas most common OTC allergy pills only act on histamine alone. 1
• The medication works topically in the nasal passages rather than systemically, with barely any traveling through the body, which accounts for its excellent safety profile. 1, 2
• It has been prescribed by doctors for over 20 years and used effectively by millions of patients. 1

Symptoms Relieved

Flonase provides comprehensive relief for a broad range of allergy symptoms caused by pollen, mold, dust, and pet dander: 1

• Nasal congestion (a key advantage over oral antihistamines, including congestion upon awakening) 3, 4
• Runny nose (rhinorrhea) 1
• Sneezing 1
• Itchy nose 1
• Itchy, watery eyes 1

Clinical Positioning

• Intranasal corticosteroids like Flonase 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. 3, 4
• Flonase is more effective than oral antihistamines specifically for nasal congestion relief. 4
• The onset of therapeutic effect occurs between 3-12 hours after administration, though maximum effect requires several days to weeks of regular daily use. 4, 5

Dosing by Age

• Children 4-11 years: 1 spray per nostril once daily (50 mcg per spray, 100 mcg total daily dose) 3, 1
• Adolescents ≥12 years and adults: 2 sprays per nostril once daily (200 mcg total daily dose) 3, 5
• For severe nasal congestion unresponsive to standard dosing, 200 mcg twice daily may be used temporarily, then reduced once symptoms are controlled. 5

Safety Profile

• No hypothalamic-pituitary-adrenal (HPA) axis suppression occurs at recommended doses in children or adults. 3, 4, 5
• No effect on growth in children when used at recommended doses, even at up to twice the recommended doses. 3, 4
• No ocular effects (cataracts or glaucoma) with long-term use. 4
• Safe for long-term daily use without causing rebound congestion (unlike topical decongestants which must be limited to 3 days). 3
• Common side effects include headache, pharyngitis, epistaxis (typically blood-tinged nasal secretions), and nasal burning/irritation. 3, 5

Important Usage Considerations

• Regular scheduled use is superior to as-needed use for optimal symptom control—it should be used daily throughout the allergen exposure season rather than stopping when symptoms resolve. 5
• Not for treating colds or asthma—Flonase is specifically for allergic rhinitis only. 1
• Contraindicated in patients with hypersensitivity to fluticasone propionate or any of its components. 3, 5
• Patients taking HIV medications (such as ritonavir) or ketoconazole pills should consult their doctor before using Flonase. 1

Proper Administration Technique

• Use the contralateral hand technique (opposite hand for each nostril) to reduce epistaxis risk by 4-fold. 3, 5
• Keep head upright, breathe in gently during spray, and avoid closing the opposite nostril during administration. 3, 5
• Prime the bottle before first use and shake before each use. 3