Flonase (Fluticasone Propionate) Dosing for Children
For children aged 4–11 years, use 1 spray per nostril once daily (total 100 mcg/day), and for adolescents 12 years and older, start with 2 sprays per nostril once daily (total 200 mcg/day) for the first week, then reduce to 1–2 sprays per nostril once daily as needed. 1
Age-Specific Dosing Recommendations
Children 4–11 Years
- Administer 1 spray (50 mcg) per nostril once daily for a total daily dose of 100 mcg 2, 1
- An adult should supervise administration 1
- This lower pediatric dose (100 mcg) is as effective as the adult dose (200 mcg) in children and should be used preferentially 3, 4
- Limit duration: Children should use for the shortest time necessary to achieve symptom relief; if treatment exceeds 2 months per year, consult the child's physician as growth rate may be slower with prolonged use 1
Adolescents ≥12 Years (and Adults)
- Week 1: Use 2 sprays (50 mcg each) per nostril once daily for a total of 200 mcg/day 1
- Weeks 2 through 6 months: Use 1–2 sprays per nostril once daily as needed to control symptoms 1
- After 6 months of daily use, consult a physician before continuing 1
Children Under 4 Years
- Do not use fluticasone propionate nasal spray in this age group 1
Important Clinical Considerations
Timing and Expectations
- Onset of action is delayed (approximately 12 hours), with maximal efficacy reached over days to weeks 5
- Regular daily use is essential rather than as-needed administration to maintain optimal symptom control 5, 6
- Both seasonal and perennial allergic rhinitis respond to treatment 5
Administration Technique
Proper technique minimizes side effects and maximizes efficacy 5:
- Prime the bottle before first use
- Shake gently before each spray 1
- Have the child blow their nose before using
- Keep head upright during administration
- Breathe in gently while spraying
Safety Profile
- Common side effects include headache, pharyngitis, epistaxis, and nasal burning or irritation 2, 5
- At recommended doses (100 mcg in children 4–11 years, 200 mcg in adolescents), no significant effect on growth has been demonstrated compared to placebo 6, 3, 4
- No interference with HPA axis function at pediatric doses 3, 7
- Local side effects such as nasal irritation and bleeding are rare with proper technique 5, 6
Contraindications
Comparison with Other Intranasal Steroids
While several intranasal corticosteroids are available for children, fluticasone propionate stands out for specific reasons 2:
- Mometasone furoate and triamcinolone acetonide are approved for children as young as 2 years, but fluticasone propionate is approved from age 4 years 2
- Budesonide requires twice-daily dosing and is only approved for ages ≥6 years 2, 6
- Fluticasone propionate offers convenient once-daily dosing with demonstrated efficacy at lower doses in children 3, 4, 8