What is the use of Fluticasone (Fluticasone propionate)?

From the Guidelines

Fluticasone is the most effective medication for treating allergic rhinitis, and its use as an intranasal corticosteroid is recommended for initial treatment of moderate to severe seasonal allergic rhinitis in persons aged 12 years or older, with a typical adult dose of 1-2 sprays in each nostril once daily. The medication works by reducing inflammation by suppressing the activity of inflammatory cells and decreasing the production of inflammatory chemicals in the body 1. When using nasal sprays, patients should aim away from the septum and toward the ear to avoid septum damage. For inhalers, patients should rinse their mouth afterward to prevent oral thrush. Side effects may include nasal irritation, headache, nosebleeds with nasal sprays, or hoarseness and oral thrush with inhalers. Fluticasone typically takes several days of regular use to reach maximum effectiveness, so patients should use it consistently rather than as needed for best results. Some key points to consider when prescribing fluticasone include:

• The onset of therapeutic effect of intranasal corticosteroid occurs between 3 and 12 hours 1
• As-needed dosing of an intranasal corticosteroid (fluticasone propionate) has been shown to be effective in the treatment of seasonal allergic rhinitis, but may not be as efficacious as continuous use 1
• Intranasal corticosteroids are also effective in the treatment of nonallergic rhinitis, especially NARES and vasomotor rhinitis 1
• Local side effects of intranasal corticosteroids such as nasal irritation, bleeding, and nasal septal perforation are rare and can be avoided with proper administration technique 1. In terms of specific dosing, the combination of an intranasal corticosteroid and an intranasal antihistamine for initial treatment of moderate to severe seasonal allergic rhinitis in persons aged 12 years or older is recommended, with fluticasone propionate (200 mcg) plus azelastine (548 mcg) as a single combination spray being a viable option 1. Overall, fluticasone is a highly effective medication for treating allergic rhinitis, and its use as an intranasal corticosteroid is supported by strong evidence from recent studies 1.

From the FDA Drug Label

INDICATIONS AND USAGE Fluticasone Propionate Nasal Spray, USP, is indicated for the management of the nasal symptoms of seasonal and perennial allergic and nonallergic rhinitis in adults and pediatric patients 4 years of age and older. Safety and effectiveness of Fluticasone Propionate Nasal Spray, USP, in children below 4 years of age have not been adequately established.

The primary use of Fluticasone is for the management of nasal symptoms of:

• Seasonal allergic rhinitis
• Perennial allergic rhinitis
• Nonallergic rhinitis in adults and pediatric patients 4 years of age and older 2. Key points to consider:
• Age restriction: Safety and effectiveness in children below 4 years of age have not been established.
• Indications: Management of nasal symptoms of allergic and nonallergic rhinitis.

From the Research

Overview of Fluticasone

• Fluticasone propionate is a topical corticosteroid spray used for the treatment of allergic rhinitis and asthma, as shown in a study published in 1998 3.
• It has been found to be effective in both asthma and allergic rhinitis, with minimal systemic activity due to its low absorption from the gut.

Efficacy of Fluticasone

• A study published in 2005 compared the efficacy of fluticasone propionate nasal spray with montelukast in patients with seasonal allergic rhinitis and persistent asthma, and found that fluticasone propionate was superior in reducing nasal symptoms 4.
• Another study published in 2011 reviewed the use of fluticasone furoate, a newer glucocorticoid, and found it to have a high affinity and selectivity for glucocorticoid receptors, providing potent and prolonged anti-inflammatory activity 5.
• A dose-ranging study published in 2007 found that fluticasone furoate nasal spray was effective in reducing nasal and ocular symptoms in patients with seasonal allergic rhinitis, with the 110-microg dose chosen for phase III development due to its optimal risk-benefit ratio 6.

Comparison of Fluticasone Regimens

• A randomized controlled trial published in 2021 compared the efficacy of as-needed versus regular use of fluticasone furoate nasal spray in patients with moderate to severe perennial allergic rhinitis, and found that both regimens had similar improvements in total nasal symptom score and quality of life, but the as-needed group had half the cumulative dose of the regular group 7.
• The study suggests that as-needed use of fluticasone furoate may be a viable option for patients with perennial allergic rhinitis, reducing the overall exposure to the medication while maintaining similar efficacy.