II. Indications

  1. High potency Intranasal Steroid for Allergic Rhinitis (age >=4 years)

III. Dosing

  1. Approved for age >=4 years
  2. As of 2015, over-ther-counter without a prescription
  3. Adult (and age >=12 years): 2 sprays per nostril daily
  4. Child (ages 4 to 11 years): 1 spray per nostril daily

IV. Medications

  1. Fluticasone Propionate Nasal Inhaler (Flonase)
  2. Combination Agents
    1. Fluticasone with Azelastine (Dymista)
      1. Expensive (up to $200/month) and add little to benefit of generic nasal Corticosteroids alone
      2. Alternatively, use OTC Azelastine (Astepro) and a generic generic nasal Corticosteroid
      3. (2022) Presc Lett 29(5): 25-6
  3. Xhance (fluticasone nose and mouth device, for Nasal Polyps)
    1. Patient blows into mouth piece while activating device 93 mcg bid
    2. Theoretically penetrates more deeply into nose (hence reaching Nasal Polyps)
    3. Unproven benefit and expensive ($425/month in 2018)
    4. Similar effect likely with Nasal Saline pre-treatment and 2 standard fluticasone sprays bid
    5. (2018) Presc Lett 25(7): 41

V. Safety

  1. Pregnancy Category C
  2. Unknown safety in Lactation

VI. Adverse Effects

VII. Drug Interactions

  1. CYP3A4 Inhibitors (Ritonavir, Cobicistat, Ketoconazole, Erythromycin)
    1. Raise levels of CYP3A4 metabolized steroid Inhalers (risk of adrenal suppression)

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Cost: Medications

xhance (on 1/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing)