flunisolide
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flunisolide
[floo-nis´o-līd]flunisolide
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.
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.