Nasarel

Nasarel,

trademark for an intranasal steroid antiinflammatory agent (flunisolide).

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flunisolide

APO-Flunisolide (CA), Nasarel, Novo-Flunisolide (CA), PMS-Flunisolide (CA), Ratio-Flunisolide (CA), Rhinalar Nasal Mist (CA), Syntaris (UK)

Pharmacologic class: Intranasal steroid

Therapeutic class: Respiratory inhalant

Pregnancy risk category C

Action

Unknown. Thought to diminish capillary permeability and suppress migration of polymorphonuclear leukocytes, decreasing inflammation.

Availability

Spray solution: 25 ml (each actuation delivers approximately 25 mcg)

⊘Indications and dosages

➣ Relief of seasonal or perennial rhinitis

Adults: Two sprays in each nostril b.i.d.; may increase to two sprays in each nostril t.i.d. Maximum daily dose is eight sprays in each nostril. For maintenance, after desired clinical effect occurs, reduce dosage to smallest amount needed to control symptoms.

Children ages 6 to 14: One spray in each nostril t.i.d. or two sprays in each nostril b.i.d.; maximum daily dose is four sprays in each nostril. For maintenance, after desired clinical effect occurs, reduce dosage to smallest amount needed to control symptoms.

Contraindications

• Hypersensitivity to drug or its components
• Untreated local infections of nasal mucosa

Precautions

Use cautiously in:
• localized Candida albicans infection; tuberculosis; untreated fungal, bacterial, or systemic viral infections; ocular herpes simplex
• patients receiving immunosuppressive therapy.

Administration

• Don't increase dosage or discontinue drug abruptly.

Route	Onset	Peak	Duration
Inhalation (nasal)	Unknown	10-30 min	Unknown

Adverse reactions

CNS: headache, light-headedness, nervousness, dizziness

EENT: cataracts; glaucoma; blurred vision; conjunctivitis; increased intraocular pressure; lacrimation; dry, irritated eyes; tinnitus; otitis; otitis media; rhinorrhea; rhinitis; nasal irritation, burning, and dryness; nasal stuffiness and pain; sneezing; nasal ulcer; epistaxis; localized Candida albicans nasal infections; nasal mucosa ulcerations; nasal septum perforation; throat discomfort, soreness, and dryness; mild nasopharyngeal irritation; pharyngitis; dry mucous membranes; nasal and sinus congestion; sinusitis; hoarseness, voice changes

GI: nausea, vomiting, diarrhea, abdominal pain, dyspepsia, dry mouth

Metabolic: hyperadrenocorticism

Musculoskeletal: myalgia, arthralgia, aseptic necrosis of femoral head

Respiratory: wheezing, dyspnea, increased cough, bronchitis, bronchospasm, asthma symptoms

Skin: rash, pruritus, urticaria, contact dermatitis, alopecia, herpes simplex infection

Other: altered taste and smell, facial edema, fever, flulike symptoms, aches and pains, infections, angioedema, anaphylaxis

Interactions

Drug-diagnostic tests. Aspartate aminotransferase: increased level

Patient monitoring

☞ Monitor patient closely for serious adverse reactions, including anaphylaxis, angioedema, hyperadrenocorticism, and serious infections.

Patient teaching

☞ Teach patient to recognize and immediately report serious adverse reactions.
• Teach patient proper use of drug. Caution him not to use more than prescribed amount; doing so may cause serious side effects.
• Tell patient maximum drug effects may not occur for several weeks.
• Tell patient to avoid people with measles, chickenpox, and other transmissible infections.
• Caution patient to withhold dose and contact prescriber if infection occurs.
• Instruct female patient to tell prescriber if she becomes pregnant.
• Tell female patient not to breastfeed without consulting prescriber.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the tests mentioned above.