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Pharmacologic class: Intranasal steroid
Therapeutic class: Respiratory inhalant
Pregnancy risk category C
Unknown. Thought to diminish capillary permeability and suppress migration of polymorphonuclear leukocytes, decreasing inflammation.
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.
• Hypersensitivity to drug or its components
• Untreated local infections of nasal mucosa
Use cautiously in:
• localized Candida albicans infection; tuberculosis; untreated fungal, bacterial, or systemic viral infections; ocular herpes simplex
• patients receiving immunosuppressive therapy.
• Don't increase dosage or discontinue drug abruptly.
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
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
Drug-diagnostic tests. Aspartate aminotransferase: increased level
☞ Monitor patient closely for serious adverse reactions, including anaphylaxis, angioedema, hyperadrenocorticism, and serious infections.
☞ 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.
flunisolide (nasal)(floo-niss-oh-lide) ,
ClassificationTherapeutic: anti inflammatories steroidal
Time/action profile (improvement in symptoms)
|Intranasal||few days||up to 3 wk||unknown|
Adverse Reactions/Side Effects
Ear, Eye, Nose, Throat
- nasal burning (most frequent)
- nasal dryness
- nasal irritation
- nasopharyngeal fungal infection
- aftertaste (most frequent)
- adrenal suppression (increased dose, long-term therapy only)
- ↓ growth (children)
Drug-Drug interactionNone known.
Availability (generic available)
- 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.
- 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 DiagnosesIneffective airway clearance (Indications)
Risk for infection (Side Effects)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)
- 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.
- Advise patient to take medication exactly as directed. If a dose is missed, take 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 5–6 times or until fine mist appears. If not used for at least 5 days or if unit has been disassembled, reprime unit. Warn patient that temporary nasal stinging may occur.
- Instruct patient to notify health care professional if symptoms do not improve within 3 wk, if symptoms worsen, or if sneezing or nasal irritation occurs.
- Resolution of nasal stuffiness, discharge, and sneezing in seasonal or perennial allergic rhinitis.