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Intranasal Steroid
Aka: Intranasal Steroid, Intranasal Corticosteroid, Corticosteroid Intranasal, Nasacort, Rhinocort, Nasarel, Beconase, Vancenase, Flonase, Omnaris, Ciclesonide, Zetonna, Dymista
- Efficacy
- Significantly reduces allergic symptoms
- Reduces nasal obstruction
- Reduces Rhinorrhea, sneezing, and nasal itching
- More effective than Antihistamines
- Small effect on impaired smell
- References
- Bronsky (1996) J Allergy Clin Immunol 97:915-21 [PubMed]
- Yanez (2002) Ann Allergy Asthma Immunol 89(5): 479-84 [PubMed]
- 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]
- Pharmacokinetics
- Onset of action within hours, but maximal effect requires 2-4 weeks of continuous use
- 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]
-
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
- 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)
- 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
- 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
- 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)
- Preparations: Miscellaneous
- Combination Agents
- 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
- References
- Wallace (2008) J Allergy Clin Immunol 122(2 suppl):S21 [PubMed]