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 ?
Unlike most O-T-C allergy pills, Flonase Sensimist helps block six key inflammatory substances.
By collaborating with Weather, we are able to tap into their scale and get the Allergy Tracker as well as the Flonase Sensimist Allergy Relief campaign in front of nearly a quarter billion consumers across the Weather properties.
GSK Consumer Healthcare, a science-led global healthcare company, has introduced a new over-the-counter treatment for symptoms associated with seasonal and perennial allergies, branded as Flonase Sensimis Allergy Relief (fluticasone furoate, 27.
Making sure they get their share of products like Nexium and Flonase, which were billion-dollar businesses as prescriptions, are big opportunities they should not miss.
The company's motivation for Veramyst is probably the fact the fluticasone went off patent, and a generic substitute for Flonase became available.
She recommends over-the-counter Claritin or the prescription antihistamines Zyrtec and Allegra, as well as the nasal steroid sprays Nasonex and Flonase.
Glaxo is also expected to have taken a knock from an increase in US competition to its anti-nausea drug Zofran, anti- depressant Wellbutrin and allergy treatment Flonase.
Generic Drug Update: As we go to press, physicians may now opt to prescribe generic forms of Pravachol (pravastatin sodium), Zocor (simvastatin), Flonase (fluticasone propionate), and Proscar (finasteride).
Huynh observing the patient's oropharynx to be red and inflamed, diagnosed allergic rhinitis/sinusitis, and ordered a trial of Claritin with Flonase and, if no response, antibiotics.
TABLE Intranasal steroids for treating allergic rhinitis Cost per Drug Usual adult dosages month * Beclomethasone dipropionate Beconase AQ 2 sprays/nostril qd $44 Vancenase AQ 2 sprays/nostril qd $40 Budesonide Rhinocort AQ 2 sprays/nostril bid $48 Flunisolide Nasarel 2 sprays/nostril bid $44 Nasalide 2 sprays/nostril bid $46 Fluticasone propionate Flonase 2 sprays/nostril qd $53 Mometasone furoate Nasonex 2 sprays/nostril qd $56 Triamcinolone acetonide Nasacort AQ 2 sprays/nostril qd $56 bid, twice a day; qd, every day.
She reported on 99 patients aged 18 or older who participated in the Ceftin and Flonase for Sinusitis (CAFFS) trial, a double-blind, randomized, placebo-controlled study that was conducted at 12 primary care and 10 otolaryngology practice sites.
She reported on 99 patients aged 18 or older in the Ceftin and Flonase for Sinusitis (CAFFS) trial, a double-blind, randomized, placebo-controlled study conducted at 12 primary care and 10 otolaryngology practice sites.