II. Efficacy
- Significantly reduces allergic symptoms
- Reduces nasal obstruction
- Reduces Rhinorrhea, sneezing, and nasal itching
- More effective than Antihistamines
- Small effect on impaired smell
- References
III. Safety
- Pregnancy Category: C (except Budesonide which is pregnancy category B)
- Appears safe in children as young as age 2 years
- No hypothalamic-pituitary-adrenal axis suppression
- Galant (2003) Pediatrics 112:96-100 [PubMed]
IV. Pharmacokinetics
- Onset of action within hours, but maximal effect requires 2-4 weeks of continuous use
V. Adverse Effects
-
Epistaxis
- Reduced by spraying away from septum
- Use left hand when spraying right nostril
- Use right hand when spraying left nostril
- (2004) Prescribers Letter 11(1):2 [PubMed]
VI. General
- Aqueous Preparations: Better for dry nose, winter
- Moisturizing: Nasarel (Flunisolide)
- Moisture neutral: Nasocort AQ and Rhinocort AQ
- Drying agents (Alcohol): most AQ agents
- Non-Aqueous: Better for "wet", watery nose
VII. Preparations: By Age Restriction
- All agents are pregnancy category C (except Budesonide which is pregnancy category B)
- Age 2 years and older
- Fluticasone furoate (Veramyst)
- Mometasone (Nosonex)
- Age 6 years and older
- Beclomethasone (Beconase)
- Budesonide (Rhinocort, Pregnancy category B)
- Ciclesonide (Omnaris)
- Flunisolide
- Age 12 years and older
- Fluticasone propionate (Flonase)
- Triamcinolone (Nasocort)
VIII. Preparations: Low potency agents (especially in children)
-
Triamcinolone Acetonide (Nasacort)
- As of 2014, available as OTC ($20 per 120 spray bottle)
- Relative potency: 1
- Dose (age 6 and older)
- Child: 1 sprays per nostril daily
- Adult: 2 sprays per nostril daily (then taper to 1 spray per nostril daily as able)
- Mometasone (Nasonex)
- Dose (2 years and older): 1 spray each nostril daily (adults should use 2 sprays each nostril)
- Relative potency: 1
- OTC in 2022
IX. Preparations: Medium potency agents
- Flunisolide (Nasalide)
- Dose: 2 sprays per nostril twice daily
- Relative potency: 3
- Age 6 years and older
- Beclomethasone (Beclovent)
- Dose (age 6 and older): 1-2 sprays per nostril twice daily
- Relative potency: 5
- Pregnancy Category C
X. Preparations: Higher potency agents
- Budesonide (Rhinocort)
- As of 2016, over-ther-counter without a prescription
- Dose (age 6 to older): 1-2 sprays each nostril daily
- Adults may bolus start with 4 sprays/nostril daily for 1 week then use standard dose (1-2 sprays)
- Relative potency: 10
- Pregnancy Category B
- Fluticasone propionate (Flonase)
- As of 2015, over-ther-counter without a prescription
- Dose (age 12 years and older): 1-2 sprays per nostril daily
- Relative potency: 10
- Qvar 80 mg (use oral Inhaler with baby bottle nipple as nasal adapter)
- Dose: 1-2 sprays each nostril daily
- Ciclesonide (Omnaris, Zetonna)
- May be less irritating then other Intranasal Corticosteroids
- Omnaris (aqueous nasal spray)
- Zetonna (dry aerosol version)
XI. Preparations: Miscellaneous
- Combination Agents
- Fluticasone with Azelastine (Dymista)
- Expensive (up to $200/month) and add little to benefit of generic nasal Corticosteroids alone
- Alternatively, use OTC Azelastine (Astepro) and a generic generic nasal Corticosteroid
- (2022) Presc Lett 29(5): 25-6
- Fluticasone with Azelastine (Dymista)
- Xhance (fluticasone nose and mouth device, for Nasal Polyps)
- Patient blows into mouth piece while activating device 93 mcg bid
- Theoretically penetrates more deeply into nose (hence reaching Nasal Polyps)
- Unproven benefit and expensive ($425/month in 2018)
- Similar effect likely with Nasal Saline pre-treatment and 2 standard fluticasone sprays bid
- (2018) Presc Lett 25(7): 41
XII. References
Images: Related links to external sites (from Bing)
Related Studies
beconase (on 1/1/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
BECONASE AQ 0.042% SPRAY | $10.80 per gram | |
flonase (on 9/21/2016 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
FLONASE ALLERGY RLF 50 MCG SPR | Generic OTC | $0.96 per ml |
omnaris (on 1/18/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
OMNARIS 50 MCG NASAL SPRAY | $18.11 per gram | |
zetonna (on 2/22/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
ZETONNA 37 MCG NASAL SPRAY | $36.36 per gram | |
dymista (on 5/16/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
DYMISTA NASAL SPRAY | $7.47 per gram |
Ontology: Flonase (C0286677)
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | C065382 |
English | Flonase, flonase |
Ontology: Beconase (C0591154)
Concepts | Pharmacologic Substance (T121) , Steroid (T110) |
MSH | D001507 |
English | Becotide, Beconase Hayfever, Becodisk, becotide, beconase, Beconase, Becloforte, Becodisks, Propaderm, Allen & Hanburys Brand of Beclomethasone Dipropionate, Glaxo Wellcome Brand of Beclomethasone Dipropionate, GlaxoSmithKline Brand 1 of Beclomethasone Dipropionate, Sanasthmyl, Shire Brand of Beclomethasone Dipropionate, A & H Brand of Beclomethasone Dipropionate |
Ontology: Nasacort (C0594040)
Concepts | Pharmacologic Substance (T121) , Steroid (T110) |
English | Nasacort, nasacort |
Ontology: Rhinocort (C0678163)
Concepts | Pharmacologic Substance (T121) , Steroid (T110) |
MSH | D019819 |
English | rhinocort, Rhinocort |
Ontology: Vancenase (C0699072)
Concepts | Pharmacologic Substance (T121) , Steroid (T110) |
MSH | D001507 |
English | vancenase, Vancenase, Schering Brand 1 of Beclomethasone Dipropionate |
Ontology: Nasarel (C0721979)
Concepts | Pharmacologic Substance (T121) , Steroid (T110) |
MSH | C007734 |
English | nasarel, Elan Brand 2 of Flunisolide, Nasarel |
Ontology: Nasal form ciclesonide (C1827940)
Concepts | Steroid (T110) , Biologically Active Substance (T123) , Pharmacologic Substance (T121) |
SnomedCT | 424048001 |
English | Nasal form ciclesonide, Nasal form ciclesonide (product) |
Spanish | ciclesonida, forma nasal, ciclesonida, forma nasal (producto) |
Ontology: Corticosteroid nasal preparations for topical use (C3539185)
Concepts | Pharmacologic Substance (T121) , Steroid (T110) |
English | Corticosteroids, Corticosteroid nasal preparations for topical use |