Flonase (Fluticasone Propionate) for Patients Over Age 11
For patients 12 years and older, use fluticasone propionate nasal spray at 2 sprays per nostril once daily (total 200 mcg/day), administered in the morning with proper contralateral hand technique. 1, 2
Dosing Recommendations
Standard Dosing for Ages 12+
- 2 sprays per nostril once daily (200 mcg total daily dose) 1, 2
- Administer in the morning for optimal symptom control 3
- Maximum duration before physician consultation: 6 months of continuous daily use 2
When to Consider Dose Adjustment
- For severe nasal congestion unresponsive to standard dosing, may use 2 sprays per nostril twice daily initially, then reduce to maintenance dosing once symptoms controlled 4
- Once-daily dosing is as effective as twice-daily dosing for maintenance therapy 3
Administration Technique
Critical Steps to Maximize Efficacy
- Use contralateral hand technique: Hold spray bottle in opposite hand from nostril being treated 4
- Aim laterally toward outer nasal wall, away from nasal septum—this reduces epistaxis risk by 4-fold 4
- Keep head upright during administration 5, 4
- Prime bottle before first use by shaking and actuating test sprays until fine mist appears 5, 4
- Blow nose to clear secretions before spraying 5
- Breathe in gently during spraying 5
Common Administration Errors to Avoid
- Improper spray angle toward septum is the most common error, increasing epistaxis risk and reducing efficacy 4
- Never spray in eyes or mouth 2
- Do not share bottles between patients due to infection risk 2
Expected Timeline and Efficacy
Onset of Action
- Delayed onset: approximately 12 hours, with maximal efficacy reached over days to weeks 1, 5, 4
- Counsel patients to continue therapy for at least 2 weeks after initiation to adequately assess benefit 4
- Regular daily use (not as-needed) is essential to maintain optimal symptom control 1, 5
Symptom Coverage
- Relieves nasal congestion, sneezing, itchy nose, runny nose, and itchy/watery eyes 2
- Effective for both seasonal and perennial allergic rhinitis 5
- Objectively reduces mucosal area of lower turbinates and nasal mucosa thickness in turbinate hypertrophy after 3 months 4
Side Effect Profile
Common Side Effects
- Headache 1, 5
- Pharyngitis 1, 5
- Epistaxis (nosebleeds) 1, 5
- Nasal burning or irritation 1, 5
- Nausea, vomiting, asthma symptoms, cough 1, 5
Rare but Serious Side Effects
- Local effects (nasal irritation, bleeding, nasal septal perforation) are rare and minimized with proper technique 1, 5
- At recommended doses (200 mcg/day), no clinically significant effects on growth, bone density, or HPA axis 1
Safety Monitoring
- At low-to-medium doses (where most patients derive maximum benefit), fluticasone has a wide safety margin 6
- High doses may affect bone mineral density and cataract formation; monitor predisposed patients appropriately 6
Contraindications and Drug Interactions
Absolute Contraindications
Important Drug Interactions
- HIV protease inhibitors (e.g., ritonavir): Consult physician before use 2
- Ketoconazole: Consult physician before use 2
- Other systemic corticosteroids (for asthma, allergies, skin conditions, eye conditions): Consult physician before use 2
Duration of Therapy
Long-Term Use Guidelines
- Safe for continuous use up to 6 months in patients ≥12 years before requiring physician consultation 2
- Long-term continuous use demonstrated safe and effective for up to 52 weeks 4
- For year-round allergies, check with physician after 6 months of daily use 2
When Medical Therapy May Be Insufficient
- If no improvement after 3 months of intranasal corticosteroid therapy, medical treatment may not successfully shrink nasal mucosa; consider surgical options 4
Special Considerations
Timing with Other Nasal Treatments
- If using nasal saline irrigations, perform them prior to administering fluticasone to avoid rinsing out medication 4
Blood Pressure
- When used as directed, fluticasone propionate does not increase blood pressure 2