Flonase


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fluticasone (nasal)

(floo-ti-ka-sone) ,

Avamys

(trade name),

Flonase

(trade name),

Veramyst

(trade name)

Classification

Therapeutic: anti inflammatories steroidal
Pharmacologic: corticosteroids
Pregnancy Category: C

Indications

Seasonal or perennial allergic rhinitis.Seasonal or perennial nonallergic rhinitis (Flonase only).

Action

Potent, locally acting anti-inflammatory and immune modifier.

Therapeutic effects

Decrease in symptoms of allergic and nonallergic rhinitis.

Pharmacokinetics

Absorption: <2%; action is primarily local following nasal use.
Distribution: Crosses the placenta and enters breast milk in small amounts.
Metabolism and Excretion: Rapidly and extensively metabolized by the liver; primarily excreted in feces; <5% excreted in urine.
Half-life: 7.8 hr.

Time/action profile (improvement in symptoms)

ROUTEONSETPEAKDURATION
Intranasalfew daysup to 3 wkunknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity (Flonase contains alcohol).
Use Cautiously in: Active untreated infections; Diabetes or glaucoma; Underlying immunosuppression (due to disease or concurrent therapy); Systemic corticosteroid therapy (should not be abruptly discontinued when intranasal therapy is started); Concurrent use of ritonavir; Recent nasal trauma, septal ulcers, or surgery (wound healing may be impaired by nasal corticosteroids); Obstetric / Lactation / Pediatric: Pregnancy, lactation, or children <4 yr (for Flonase) or <2 yr (for Veramyst) (safety not established; prolonged or high-dose therapy may lead to complications).

Adverse Reactions/Side Effects

Central nervous system

  • headache

Ear, Eye, Nose, Throat

  • epistaxis
  • nasal burning
  • nasal irritation
  • nasopharyngeal fungal infection
  • pharyngitis

Gastrointestinal

  • nausea
  • vomiting

Endocrinologic

  • adrenal suppression (↑ dose, long-term therapy only)
  • ↓ growth (children)

Dermatologic

  • rash
  • urticaria

Respiratory

  • cough

Miscellaneous

  • anaphylaxis
  • angioedema

Interactions

Drug-Drug interaction

Ritonavir and ketoconazole ↓ metabolism and ↑ levels of fluticasone. Concomitant use of ritonavir and fluticasone not recommended.

Route/Dosage

Intranasal (Adults) Flonase–2 sprays in each nostril once daily or 1 spray in each nostril twice daily (not to exceed 2 sprays in each nostril/day); after several days, attempt to ↓ dose to 1 spray in each nostril once daily. Patients ≥ 12 yr with seasonal allergic rhinitis may also use 2 sprays in each nostril once daily on an as-needed basis; Veramyst–2 sprays in each nostril once daily or 1 spray in each nostril twice daily; once symptoms controlled, attempt to ↓ dose to 1 spray in each nostril once daily.
Intranasal (Children ≥4 yr) Flonase–1 spray in each nostril once daily (not to exceed 2 sprays in each nostril/day).
Intranasal (Children 2–11 yrs) Veramyst–1 spray in each nostril daily; may ↑ to 2 sprays if no response; once symptoms controlled, attempt to ↓ dose to 1 spray/day.

Availability (generic available)

Nasal spray (Flonase): 50 mcg/metered spray in 16-g bottle (delivers 120 metered sprays)
Nasal spray (Veramyst): 27.5 mcg/spray in a 10-g bottle (delivers 120 sprays)
In combination with: azelastine (Dymista); see combination drugs).

Nursing implications

Nursing assessment

  • Monitor degree of nasal stuffiness, amount and color of nasal discharge, and frequency of sneezing.
    • Patients on long-term therapy should have periodic otolaryngologic examinations to monitor nasal mucosa and passages for infection or ulceration.
    • Monitor growth rate in children receiving chronic therapy; use lowest possible dose.
  • Monitor for signs and symptoms of hypersensitivity reactions (rash, pruritis, swelling of face and neck, dyspnea) periodically during therapy.
  • Lab Test Considerations: Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal (HPA) axis suppression in chronic therapy. Children and patients using higher than recommended doses are at highest risk for HPA suppression.

Potential Nursing Diagnoses

Ineffective airway clearance (Indications)
Risk for infection (Side Effects)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

  • Do not confuse Flovent (fluticasone oral inhalation) with Flonase (fluticasone nasal spray).
  • After the desired clinical effect has been obtained, attempts should be made to decrease dose to lowest amount. Gradually decrease dose every 2–4 wk as long as desired effect is maintained. If symptoms return, dose may briefly return to starting dose.
  • Intranasal: Patients also using a nasal decongestant should be given decongestant 5–15 min before corticosteroid nasal spray. If patient is unable to breathe freely through nasal passages, instruct patient to blow nose gently in advance of medication administration.

Patient/Family Teaching

  • Advise patient to take medication exactly as directed. Take missed doses as soon as remembered unless almost time for next dose.
  • Instruct patient in correct technique for administering nasal spray (see ). Shake well before use. Before first-time use, prime unit by spraying 6 times. If not used for at least 7 days or if cap left off for more than 5 days, reprime unit. Warn patient that temporary nasal stinging may occur.
  • Instruct patient to stop fluticasone and notify health care professional immediately if signs of anaphylaxis (rash, hives, difficulty breathing, swollen lips or throat) occur.
  • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking other Rx, OTC, or herbal products.
  • Advise female patients to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
  • Instruct patient to notify health care professional if symptoms do not improve within 1 mo or if symptoms worsen.

Evaluation/Desired Outcomes

  • Resolution of nasal stuffiness, discharge, and sneezing in seasonal or perennial rhinitis.

Flonase

(flō′nāz′)
A trademark for the drug fluticasone propionate.

Flonase

Fluticasone propionate, see there.
References in periodicals archive ?
This approval will bring Flonase Allergy Relief to consumers in a convenient way at the same dosage strength as found in prescription Flonase.
Although some persons may require desensitization (a series of shots) to control severe pollen allergy, many persons who previously suffered severely from pollen allergy have obtained complete or marked relief from the use of nasal inhalers containing various steroidal anti-inflammatory agents, such as Beconase, Flonase, Nasacort, Nasalide, etc.
Two additional intranasal steroid switches have been approved since, namely Flonase Allergy Relief (GlaxoSmithKline) in July 2014 and Rhinocort Allergy Spray (Johnson & Johnson) in March 2015.
Amityville NY) won approval for its generic version of GlaxoSmithKline Plc's nasal spray Flonase for the management of nasal allergy symptoms.
WASHINGTON - GlaxoSmithKline said Friday that it had obtained a temporary restraining order blocking the shipment and sales of a recently FDA-approved generic competitor to its Flonase nasal spray for allergies.
Firstly, the generic version of the company's Flonase drug is set for release.
Also, new precautions have been added to the Norvir and Kaletra labels regarding interactions with fluticasone (a component of Flonase nasal spray), the antidepressant Desyrel (trazodone), and alfuzosin (used to treat a prostate condition known as "benign prostatic hypertrophy").
She reported on a total of 99 patients aged 18 or older who participated in the Ceftin and Flonase for Sinusitis (GAFFS) trial, a double-blind, randomized, placebo-controlled study conducted at 12 primary care and 10 otolaryngology practice sites.
We own some of the world's best loved healthcare brands, including Sensodyne, Theraflu, Excedrin, Nicorette and NicoDermCQ, Flonase, and TUMS.
But prescription nasal sprays, or topical steroids such as Vancenase, Flonase, Rhinocort or Nasacort, work very well for allergy sufferers without fear of dependency.
These include Zyrtec, a nonsedating antihistamine, and steroid aerosol nasal sprays such as Flonase and Rhinocort, which prevent allergic reactions by coating nasal mucous membranes.
Other than the Avandia issue, Glaxo still has to deal with generic erosion of a number of drugs, including Coreg IR, Flonase, Wellbutrin XR, Lamictal, Requip, Valtrex and Imitrex.