Fluticasone Nasal Spray for Chronic Allergic Rhinitis in Patients ≥12 Years
Fluticasone propionate nasal spray 200 mcg once daily in the morning is highly effective for chronic allergic rhinitis in patients aged 12 years and older, providing significant relief of all nasal symptoms including congestion, rhinorrhea, sneezing, itching, and sinus pain/pressure. 1, 2, 3
Recommended Dosing
- Standard dose: 200 mcg (2 sprays per nostril) once daily in the morning 3
- This once-daily regimen is as effective as twice-daily dosing with fluticasone propionate or beclomethasone dipropionate 3
- For fluticasone furoate (newer formulation): 110 mcg once daily is effective 1
- Symptom relief begins within 7 days and is sustained throughout long-term treatment (up to 6 months studied) 3
Administration Technique
- Administer in the morning as a single daily dose 3
- The once-daily dosing provides 24-hour symptom control, with significant reductions in both morning and evening symptom scores 1
- Instantaneous morning predose symptom scores confirm efficacy of once-daily administration throughout the dosing interval 1
Efficacy Profile
Fluticasone demonstrates superior efficacy across all nasal symptoms:
- Nasal congestion: Significantly more effective than placebo and superior to combination antihistamine plus leukotriene antagonist therapy 4, 2
- Rhinorrhea, sneezing, and nasal itching: All significantly reduced compared to placebo 4, 3
- Sinus pain and pressure: Significantly relieved, addressing a common reason patients seek medical attention 2
- Nasal eosinophilia: Significantly reduced in blood and nasal lavage, indicating anti-inflammatory efficacy 4, 3
Comparative Effectiveness
Fluticasone monotherapy is more effective than combination therapy with cetirizine plus montelukast for total symptom scores and nasal congestion 4. Adding cetirizine to fluticasone provides only marginal additional benefit for nasal itching but no substantial advantage for other symptoms 4.
Safety Considerations
Fluticasone propionate demonstrates an excellent safety profile:
- No evidence of hypothalamic-pituitary-adrenal axis suppression: Morning plasma cortisol concentrations remain normal even with long-term use 5, 3
- Adverse events similar to placebo except for blood in nasal mucus, which occurs more frequently with twice-daily dosing (avoided by using once-daily regimen) 3
- Well-tolerated in long-term use: Safety confirmed over 6-month treatment periods 3
- Drug-related adverse events are comparable between active treatment and placebo groups 1, 5
Common Pitfalls to Avoid
- Do not use twice-daily dosing unnecessarily: Once-daily administration is equally effective and has lower incidence of nasal bleeding 3
- Do not add antihistamine-leukotriene combinations routinely: Fluticasone monotherapy is more effective for nasal congestion, the most bothersome symptom 4
- Do not delay treatment: Intranasal corticosteroids are recommended as first-line therapy, not second-line after antihistamine failure 1, 4