Generic Name: Fluticasone Propionate eent
VA Class: NT200
Molecular Formula: C25H31F3O5S
CAS Number: 80474-14-2
Uses for Flonase
Seasonal and Perennial Rhinitis
Symptomatic treatment of seasonal or perennial rhinitis when conventional therapy with antihistamines or decongestants is ineffective or is not tolerated.1 2 7 16 19 27 33 34 46 51 54 55 57 71 73 74 76 78 110 113 122 123
Generally provides symptomatic relief of watery rhinorrhea, nasal congestion, sneezing, postnasal drip, and nasal itching;1 2 7 16 19 27 33 34 46 51 55 59 122 123 124 generally does not relieve signs and symptoms of conjunctivitis, although improvement in ophthalmic manifestations may occur.19 62 110 113
Relieves symptoms in both allergic1 2 7 16 19 27 33 34 46 51 54 55 71 73 74 76 78 110 113 122 123 and nonallergic1 57 113 rhinitis, although experience is more extensive with allergic rhinitis.1 2 7 16 19 27 33 34 46 51 54 55 57 71 73 74 76 78 110 113 122 123
Flonase Dosage and Administration
Avoid contact with the eyes.1
Although regular dosing generally provides optimal benefit, as needed (prn) dosing may be adequate in some patients with seasonal allergic rhinitis.1
Nasal inhaler delivers about 50 mcg of fluticasone propionate per metered spray and about 120 metered sprays per 16-g container.1
Therapeutic effects of intranasal corticosteroids, unlike those of decongestants, are not immediate.1 6 13 16 27 46 48 51 52 115 This should be explained to the patient in advance to ensure compliance and continuation of the prescribed treatment regimen.1
Generally assess response to the initial dosage 4–7 days after starting therapy; a reduction in maintenance dosage may be possible at that time.1
Adolescents and children ≥4 years of age: 1 spray (50 mcg) in each nostril once daily (total dose: 100 mcg/day).1 Increase dosage to 2 sprays (100 mcg) in each nostril daily (total dose: 200 mcg/day) if response is inadequate.1
Reduce dosage to 1 spray in each nostril (total dose: 100 mcg/day) once adequate symptom control is achieved.
Some patients ≥12 years of age with seasonal allergic rhinitis may find as needed (prn) use of 200 mcg (100 mcg in each nostril) doses (no more frequently than once daily) to be effective in controlling symptoms.1 Greater symptom control may be achieved with regular dosing.1
Adolescents and children ≥4 years of age: 1 spray (50 mcg) in each nostril daily (total dose: 100 mcg/day).1 Increase dosage to 2 sprays (100 mcg) in each nostril daily (total dose: 200 mcg/day) if response is inadequate.1
Maintenance dose is 1 spray in each nostril (total dose: 100 mcg/day) once adequate symptom control is achieved.
Some patients with seasonal allergic rhinitis may find as needed (prn) use of 200-mcg (100 mcg in each nostril) doses (no more frequently than once daily) to be effective in controlling symptoms.1 Greater symptom control may be achieved with regular dosing.1
Maintenance dose is 2 sprays (100 mcg) in each nostril daily (200 mcg total).121
Perennial RhinitisIntranasal Inhalation
Usual initial dose is 2 sprays (100 mcg) in each nostril once daily (total dose: 200 mcg/day).1 Alternatively, 1 spray (50 mcg) in each nostril twice daily (total 200 mcg/day).1 16 17 18 19 27 46 51 55
Exceeding the maximum recommended daily dosage may only increase the risk of adverse systemic effects (e.g., HPA-axis suppression, Cushing’s syndrome).1
Adolescents and children ≥4 years of age: Maximum 100 mcg (2 sprays) in each nostril (200 mcg total) daily.1
Adolescents and children ≥4 years of age: Maximum 100 mcg (2 sprays) in each nostril (200 mcg total) daily.1
Maximum 100 mcg (2 sprays) in each nostril (200 mcg total) daily.1
Maximum 100 mcg (2 sprays) in each nostril (200 mcg total) daily.1
No specific dosage recommendations for hepatic impairment.1
No specific dosage recommendations for renal impairment.1
No specific geriatric dosage recommendations.1
Cautions for Flonase
Withdrawal of Systemic Corticosteroid Therapy
Patients being switched from prolonged systemic corticosteroids to intranasal therapy should be monitored carefully since corticosteroid withdrawal symptoms (e.g., joint pain, muscular pain, lassitude, depression), acute adrenal insufficiency, and/or severe symptomatic exacerbation of asthma or other clinical conditions may occur.1 115
Infection, Trauma, or Surgery
Use cautiously, if at all, in patients with clinical tuberculosis or asymptomatic Mycobacterium tuberculosis infections; untreated local or systemic fungal or bacterial infections; systemic viral or parasitic infections; ocular herpes simplex infections; or septal ulcers, trauma, or surgery in the nasal region.1
Hypothalamic-Pituitary-Adrenal (HPA) Axis Suppression
Avoid higher than recommended dosages since suppression of HPA function may occur.1
Although risk with intranasal use is unknown, consider the possibility that corticosteroid-induced immunosuppression could occur.1 Avoid exposure to varicella and measles in previously unexposed patients.1
Possible immediate hypersensitivity reactions (e.g., wheezing, contact dermatitis, rash, dyspnea, anaphylaxis/anaphylactoid reactions, pruritus, urticaria, angioedema, edema of the face and tongue, and bronchospasm).1 112
Systemic Corticosteroid Effects
Excessive intranasal dosages or use in patients who are particularly sensitive to corticosteroid effects may cause systemic corticosteroid effects (e.g., Cushing’s syndrome, adrenal suppression).1
Temporary or permanent loss of smell may occur.1
Avoid use until healing occurs in patients with recurrent epistaxis, recent nasal septal ulcers, nasal surgery, or nasal trauma.1
Possible increased IOP.1
Temporary or permanent loss of taste may occur.1
May cause adverse effects (e.g., growth suppression) in nursing infants if distributed into milk.1
May be a useful therapeutic alternative to oral corticosteroids in children ≥4 years of age with seasonal or perennial allergic rhinitis since intranasal administration is associated with a decreased risk of adverse systemic effects.
Intranasal corticosteroids may reduce growth velocity in pediatric patients.1 Children 3–9 years of age receiving 200 mcg of fluticasone propionate daily for 1 year did not show evidence of reduction in normal growth velocity.1 No clinically relevant changes in HPA axis or bone mineral density (as assessed by dual X-ray absorptiometry) observed.1
Adverse effect profile similar to profile in younger adults.1
Common Adverse Effects
Mild, transient nasal burning and stinging,1 3 16 17 21 27 46 51 54 55 aftertaste1 , epistaxis,13 16 17 19 21 22 46 51 54 55 112 124 headache,1 112 124 nausea and vomiting,1 21 abdominal bloating,1 pharyngitis,1 16 17 27 112 cough1 124 and asthma symptoms1 124 are most common.
Interactions for Flonase
Metabolized by CYP3A4.
Drugs Affecting Hepatic Microsomal Enzymes
Potential pharmacodynamic interaction (increased the risk of hypercorticism, suppression of the HPA axis, decreased growth rate in children) with concomitant use of other inhaled and/or systemically absorbed corticosteroids1 38 79 84
Concomitant use not recommended
Does not affect the pharmacokinetics of fluticasone1
Possible increase in mean plasma fluticasone concentrations and toxicity1
Increases plasma fluticasone concentrations, resulting in decreased plasma cortisol AUC1
Cushing’s syndrome and adrenal suppression reported1
Concomitant use not recommended unless potential benefit outweighs the risk of adverse effects1
Placental distribution in humans is unknown, but fluticasone crosses the placenta in animals.1
Distribution into milk unknown, but other corticosteroids are distributed.1
Plasma Protein Binding
Discard the nasal pump spray after 120 sprays.1
Reduces the number of mediator cells (basophils,2 5 7 13 17 27 35 46 51 55 57 58 eosinophils,2 4 5 7 9 13 17 27 35 46 50 51 55 57 58 60 61 63 116 helper-inducer [CD4+, T4+] T-cells,4 60 116 mast cells,7 50 60 61 116 and neutrophils)2 7 13 35 in the nasal mucosa. Also reduces nasal reactivity to allergens and release of inflammatory mediators63 and proteolytic enzymes.63
Advice to Patients
Proper techniques for assembly and priming of nasal spray pump and for administration and storage of the nasal solution.1
Importance of not administering the entire dose (i.e., 2–4 sprays) into a single nostril.1
Give patients a copy of the manufacturer’s patient instructions.1
Importance of shaking containers of nasal spray gently prior to each use.b
Importance of taking as directed and not exceeding prescribed dosage.1
Importance of informing clinician if symptoms fail to improve or if symptoms worsen.1
Importance of not increasing dosage unless directed by a clinician.1
Importance of advising clinician if sneezing or nasal irritation occurs.1
Advise that concomitant nasal decongestants and/or oral antihistamines may be needed until effects of fluticasone are optimal.
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.1
Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1
Importance of informing patients of other important precautionary information.1 (See Cautions.)
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Suspension, for intranasal use only
50 mcg/metered spray
Flonase Nasal Spray (with benzalkonium chloride and phenylethyl alcohol)
This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 02/2014. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.
Flonase 50MCG/ACT Suspension (GLAXO SMITH KLINE): 16/$89.99 or 48/$260.98
Fluticasone Propionate 50MCG/ACT Suspension (ROXANE): 16/$60.99 or 48/$170.96
Veramyst 27.5MCG/SPRAY Suspension (GLAXO SMITH KLINE): 10/$112.99 or 30/$320.96
AHFS DI Essentials. © Copyright, 2004-2016, Selected Revisions August 1, 2005. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.
1. GlaxoSmithKline. Flonase (fluticasone propionate) nasal spray 50 mcg prescribing information. Research Triangle Park, NC; 2004 Mar.
2. Bryson HM, Faulds D. Intranasal fluticasone propionate: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in allergic rhinitis. Drugs. 1992; 43:760-75. [IDIS 359172] [PubMed 1379151]
3. Phillipps GH. Structure-activity relationships of topically active steroids: the selection of fluticasone propionate. Respir Med. 1990; 84(Suppl A):19-23. [PubMed 2287791]
4. Masuyama K, Jacobson MR, Rak S et al. Topical glucocorticosteroid (fluticasone propionate) inhibits cells expressing cytokine mRNA for interleukin-4 in the nasal mucosa in allergen-induced rhinitis. Immunology. 1994; 82:192-9. [PubMed 7927488]
5. Konno A, Yamakoshi T, Terada N et al. Mode of action of a topical steroid on immediate phase reaction after antigen challenge and nonspecific nasal hyperreactivity in nasal allergy. Int Arch Allergy Immunol. 1994; 103:79-87. [PubMed 8260854]
6. Allen and Hanburys. Flonase (fluticasone propionate) nasal spray 0.05% patient information. Research Triangle Park, NC. 1994 Sep.
7. Allen and Hanburys, Research Triangle Park, NC: Personal communication.
8. Harding SM. The human pharmacology of fluticasone propionate. Respir Med. 1990; 84(Suppl A):25-9. [PubMed 2287792]
9. Thomas KE, Greenwood L, Murrant N et al. The effects of topical fluticasone propionate on allergen-induced immediate nasal airways response and eosinophil activation: preliminary results. Respir Med. 1990; 84(Suppl A):33-5. [PubMed 2287795]
10. Juliusson S, Holmberg K, K et al. Mast cells and mediators in the nasal mucosa after allergen challenge. Effects of four weeks’ treatment with topical glucocorticoid. Clin Exp Allergy. 1993; 23:591-9. [PubMed 7693314]
11. Bye A. The oral systemic availability of fluticasone propionate in man—preliminary data. Br J Clin Pharmacol. 1993; 36:12-3.
12. Andersson P, Brattsand R, Dahlstrom K et al. Oral availability of fluticasone propionate. Br J Clin Pharmacol. 1993; 36:135-6. [IDIS 318868] [PubMed 8398584]
13. Meltzer EO, Orgel HA, Bronsky EA et al. A dose-ranging study of fluticasone propionate aqueous nasal spray for seasonal allergic rhinitis assessed by symptoms, rhinomanometry, and nasal cytology. J Allergy Clin Immunol. 1990; 86:221-30. [IDIS 287713] [PubMed 2200821]
14. Lozewicz S, Wang J, Duddle J et al. Topical glucocorticoids inhibit activation by allergen in the upper respiratory tract. J Allergy Clin Immunol. 1992; 89:951-7. [IDIS 295962] [PubMed 1583252]
15. van As A, Bronsky E, Grossman J et al. Dose tolerance study of fluticasone propionate aqueous nasal spray in patients with seasonal allergic rhinitis. Ann Allergy. 1991; 67:156-62. [IDIS 287303] [PubMed 1867454]
16. Ratner PH, Paull BR, Findlay SR et al. Fluticasone propionate given once daily is as effective for seasonal allergic rhinitis as beclomethasone dipropionate given twice daily. J Allergy Clin Immunol. 1992; 90:285-91. [IDIS 302398] [PubMed 1527313]
17. van As A, Bronsky EA, Dockhorn RJ et al. Once daily fluticasone propionate is as effective for perennial allergic rhinitis as twice daily beclomethasone diproprionate. J Allergy Clin Immunol. 1993; 91:1146-54. [IDIS 315940] [PubMed 8509578]
18. Dolovich J, O’Connor M, Stepner N et al. Double-blind comparison of intranasal fluticasone propionate, 200mcg, once daily with 200mcg twice daily in the treatment of patients with severe seasonal allergic rhinitis to ragweed. Ann Allergy. 1994; 72:435-40. [IDIS 329397] [PubMed 8179230]
19. Dolovich J, Wong AG, Chodirker WB et al. Multicenter trial of fluticasone propionate aqueous nasal spray in ragweed allergic rhinitis. Ann Allergy. 1994; 73:147-53. [IDIS 334215] [PubMed 8067598]
20. Vargas R, McMahon FG, Dockhorn R et al. An assessment of HPA axis effects of fluticasone propionate aqueous nasal spray using 6-hr ACTH infusion. Clin Pharmacol Ther. 1994; 55:184.
21. Bousquet J, Chanal I, Alquié MC et al. Prevention of pollen rhinitis symptoms: comparison of fluticasone propionate aqueous nasal spray and disodium cromoglycate aqueous nasal spray: a multicenter, double-blind, double-dummy, parallel-group study. Allergy. 1993; 48:327-33. [PubMed 8368459]
22. Haye R, Gomez EG. A multicentre study to assess long-term use of fluticasone propionate aqueous nasal spray in comparison with beclomethasone dipropionate aqueous nasal spray in the treatment of perennial rhinitis. Rhinology. 1993; 31:169-74. [PubMed 8140383]
23. O’shaughnessy KM, Wellings R, Gillies B et al. Differential effects of fluticasone propionate on allergen-evoked bronchoconstriction and increased urinary leukotriene E4 excretion. Am Rev Respir Dis. 1993; 147:1472-6. [IDIS 315801] [PubMed 8389108]
24. Gustafsson P, Tsanakas J, Gold M et al. Comparison of the efficacy and safety of inhaled fluticasone propionate 200 mcg/day with inhaled beclomethasone dipropionate 400 mcg/day in mild and moderate asthma. Arch Dis Child. 1993; 69:206-11. [IDIS 319533] [PubMed 8215522]
25. Leblanc P, Mink S, Keistinen T et al. A comparison of fluticasone propionate 200 mcg/day with beclomethasone dipropionate 400 mcg/day in adult asthma. Allergy. 1994; 49:380-5. [PubMed 8092438]
26. Fabbri L, Burge PS, Croonenborgh L et al. Comparison of fluticasone propionate with beclomethasone dipropionate in moderate to severe asthma treated for one year. Thorax. 1993; 48:817-23. [PubMed 8211872]
27. van Bavel J, Findlay SR, Hampel FC et al. Intranasal fluticasone propionate is more effective than terfenadine tablets for seasonal allergic rhinitis. Arch Intern Med. 1994; 154:2699-704. [IDIS 339502] [PubMed 7993153]
28. Hawthorne AB, Record CO, Holdsworth CD et al. Double blind trial of oral fluticasone propionate v prednisolone in the treatment of active ulcerative colitis. Gut. 1993; 34:125-8. [IDIS 308470] [PubMed 8432442]
29. Zaitoun A, Record CO. Morphometric studies in duodenal biopsies from patients with coeliac disease: the effect of the steroid fluticasone propionate. Aliment Pharmacol Ther. 1991; 5:151-60. [PubMed 1716168]
30. Angus P, Snook JA, Reid M et al. Oral fluticasone propionate in active distal ulcerative colitis. Gut. 1992; 33:711-4. [IDIS 297298] [PubMed 1612492]
31. Carpani de Kaski M, Peters AM, Lavender JP et al. Fluticasone propionate in Crohn’s disease. Gut. 1991; 32:657-61. [IDIS 284152] [PubMed 2060874]
32. Haynes RC Jr. Adrenocorticotropic hormone; adrenocortical steroids and their synthetic analogs; inhibitors of the synthesis and actions of adrenocortical hormones. In: Gilman AG, Rall TW, Nies AS et al, eds. Goodman and Gilman’s the pharmacological basis of therapeutics. 8th ed. New York: Pergamon Press; 1990:1431-1462.
33. Darnell R, Pecoud A, Richards DH. A double-blind comparison of fluticasone propionate aqueous nasal spray, terfenadine tablets, and placebo in the treatment of patients with seasonal allergic rhinitis to grass pollen. Clin Exp Allergy. 1994; 24:1144-50. [PubMed 7889428]
34. Belling U. Once daily treatment with fluticasone propionate aqueous nasal spray or astemizole tablets for seasonal rhinitis. Clin Exp Allergy. 1990; 20(Suppl 1):98.
35. Meltzer EO, Orgel HA, Rogenes PR et al. Nasal cytology in patients with allergic rhinitis: effects of intranasal fluticasone propionate. J Allergy Clin Immunol. 1994; 94:708-15. [IDIS 336956] [PubMed 7930304]
36. Dahl R, Lundback B, Malo JL et al. A dose-ranging study of fluticasone propionate in adult patients with moderate asthma. Chest. 1993; 104:1352-8. [IDIS 322126] [PubMed 8222787]
37. Chervinsky P, van As A, Bronsky EA et al. Fluticasone propionate aerosol for the treatment of adults with mild to moderate asthma. J Allergy Clin Immunol. 1994; 94:676-83. [IDIS 336954] [PubMed 7930300]
38. Wolthers OD, Pedersen S. Short term growth during treatment with inhaled fluticasone propionate and beclomethasone diproprionate. Arch Dis Child. 1993; 68:673-6. [IDIS 315278] [PubMed 8323338]
39. Barnes NC, Marone G, Di Maria GU et al. A comparison of fluticasone propionate, 1 mg daily, with beclomethasone dipropionate, 2 mg daily, in the treatment of severe asthma. Eur Respir J. 1993; 6:877-85. [PubMed 8339809]
40. Ward C, Booth H, Gardiner PV et al. The effect of high dose inhaled fluticasone propionate (FP) on broncho alveolar lavage (BAL) lymphocyte subsets from asthmatic subjects. Eur Respir J. 1993; 6(Suppl 17):585S.
41. Noonan MJ, Chervinsky P, Weisberg SC et al. Fluticasone propionate (FP) aerosol in the treatment of oral corticosteroid dependent asthmatics. Eur Respir J. 1993; 6(Suppl 17):585S.
42. Harding SM, Felstead S. A comparison of the tolerance and systemic effects of fluticasone propionate (FP) and beclomethasone dipropionate (BDP) in healthy volunteers. Eur Respir J. 1988; 1(Suppl 2):196S.
43. Price JF. Comparative data in childhood asthma. Eur Respir J. 1992; 5(Suppl 15):326S.
44. Pauli G, Dietemann A, Desfougères JL et al. Fluticasone propionate is more effective and as safe as nedocromil in the treatment of moderate asthma. Eur Respir J. 1993; 6(Suppl 17):586S.
45. MacKenzie CA, Wales JKH. Clinical experience with inhaled fluticasone propionate-childhood growth. Eur Respir J. 1993; 6(Suppl 17):262S.
46. Nathan RA, Bronsky EA, Fireman P et al. Once daily fluticasone propionate aqueous nasal spray is an effective treatment for seasonal allergic rhinitis. Ann Allergy. 1991; 67:332-8. [IDIS 289494] [PubMed 1897811]
47. Mitchison HC, Al Mardini H, Gillespie S et al. A pilot study of fluticasone propionate in untreated coeliac disease. Gut. 1991; 32:260-5. [IDIS 279109] [PubMed 1901562]
48. Glaxo. Product information form for American hospital formulary service: Flonase (fluticasone propionate nasal spray). Research Triangle Park, NC; 1994 Nov.
49. Scadding GK, Darby YC, Austin CE. Effect of short-term treatment with fluticasone propionate nasal spray on the response to nasal allergen challenge. Br J Clin Pharmacol. 1994; 38:447-51. [IDIS 338763] [PubMed 7893587]
50. Feather I, Wilson S, Smith S et al. The accumulation of mast cells and eosinophils in the nasal mucosa in seasonal allergic rhinitics during natural pollen exposure, is inhibited by prophylactic fluticasone propionate aqueous nasal spray. Am Rev Respir Dis. 1992; 145:A853. [PubMed 1554222]
51. Banov CH, Woehler TR, LaForce CF et al. Once daily intranasal fluticasone propionate is effective for perennial allergic rhinitis. Ann Allergy. 1994; 73:240-6. [IDIS 336185] [PubMed 8092559]
52. Grossman J, Banov C, Bronsky EA. Fluticasone propionate aqueous nasal spray is safe and effective for children with seasonal allergic rhinitis. Pediatrics. 1993; 92:594-9. [IDIS 320553] [PubMed 8414833]
53. Fluticasone Propionate Collaborative Pediatric Working Group. Treatment of seasonal allergic rhinitis with once-daily intranasal fluticasone propionate therapy in children. J Pediatr. 1994; 125:628-34. [IDIS 336611] [PubMed 7931889]
54. LaForce C, Dockhorn R, Findlay S et al. Fluticasone propionate treatment for seasonal allergic rhinitis is safe and effective in adults and adolescents. J Allergy Clin Immunol. 1991; 87:153.
55. Dockhorn RJ, Paull BR, Meltzer EO et al. Once-versus twice-daily fluticasone propionate aqueous nasal spray for seasonal allergic rhinitis. Am J Rhinology. 1993; 7:77-83.
56. Hampel F, Howland W, Martin B et al. The efficacy of fluticasone propionate aqueous nasal spray for treatment of rhinitis is dependent on topical application. J Allergy Clin Immunol. 1994; 93:165.
57. Selner J, Banov C, Boltansky H et al. Fluticasone propionate aqueous nasal spray effectively treats perennial non-allergic rhinitis. J Allergy Clin Immunol. 1994; 93:165.
58. Lemanske R, Dunn K, Galant S et al. Fluticasone propionate aqueous nasal spray is more effective than astemizole in the treatment of seasonal allergic rhinitis. J Allergy Clin Immunol. 1994; 93:165.
59. Boner A, Sette L, Martinati L et al. The efficacy and tolerability of fluticasone propionate aqueous nasal spray in children with seasonal allergic rhinitis. Allergy. 1995; 50:498-505. [PubMed 7573843]
60. Peroni D, Feather I, Wilson S et al. Fluticasone propionate aqueous nasal spray alleviates the symptoms of perennial allergic rhinitis without changing the mucosal inflammatory cell profile. J Allergy Clin Immunol. 1993; 91:260.
61. Feather I, Peroni D, Wilson S et al. Prophylactic fluticasone propionate aqueous nasal spray (FP) suppresses eosinophil and mast cell accumulation in seasonal allergic rhinitis without altering local T lymphocyte populations. J Allergy Clin Immunol. 1993; 91:260.
62. Scadding GK, Lund VJ, Holmstrom M et al. Clinical and physiological effects of fluticasone propionate aqueous nasal spray in the treatment of perennial rhinitis. Rhinology. 1991; (Suppl 11):37-43.
63. Meltzer EO, Jalowayski AA, Field EA et al. Intranasal fluticasone propionate reduces histamine and tryptase in the mucosa of allergic rhinitis patients. J Allergy Clin Immunol. 1993; 91:298.
64. Pedersen B, Dahl R, Lindqvist N et al. Nasal inhalation of the glucocorticoid budesonide from a spacer for the treatment of patients with pollen rhinitis and asthma. Allergy. 1990; 45:451-6. [PubMed 2244675]
65. Glaxo Dermatology. Cutivate (fluticasone propionate) ointment, 0.005% prescribing information. Research Triangle Park, NC; 1992 Jan.
66. Glaxo Dermatology. Cutivate (fluticasone propionate) cream, 0.05% prescribing information. Research Triangle Park, NC; 1992 Feb.
67. Siegel SC. Topical intranasal corticosteroid therapy in rhinitis. J Allergy Clin Immunol. 1988; 81:984-91. [IDIS 316618] [PubMed 2897390]
68. Davies B. A comparison of beclomethasone dipropionate and budesonide in the treatment of asthma. Br J Clin Pract. 1993; 47:87-93. [IDIS 315197] [PubMed 8334070]
69. Anon. Fluticasone propionate nasal spray for allergic rhinitis. Med Lett Drugs Ther. 1995; 37:5-6. [PubMed 7815981]
70. Hill D, Connolly D, Vorath J. Beclomethasone dipropionate aerosol in the treatment of children with severe perennial rhinitis. Med J Aust. 1978; 2:603-4. [PubMed 366350]
71. Austen KF. Diseases of immediate type hypersensitivity. In: Isselbacher KJ, Braunwald E, Wilson JD et al, eds. Harrision’s principles of internal medicine. 13th ed. New York: McGraw Hill, Inc.; 1994:1630,1638.
72. Anon. Histamine H1-receptor antagonists. In: Reynolds JEF, ed. Martindale: the extra pharmacopoeia. 30th ed. London: The Pharmaceutical Press; 1993:926-30.
73. Payton KB, Hebert J, Clarke KD. Assessing and treating rhinits: a practical guide for Canadian physicians. CMAJ. 1994; 151(Suppl):5-27.
74. May JR, Guill MF. Allergic rhinitis. In: DiPiro JT, Talbert RL, Hayes PE et al, eds. Pharmacotherapy a pathophysiologic approach. 2nd ed. New York: Elsevier; 1992:1377-86.
75. Kaliner M, Eggleston PA, Mathews KP. Rhinitis and asthma. JAMA. 1987; 258:2851-73. [IDIS 235475] [PubMed 2889834]
76. Knight A. The role of levocabastine in the treatment of allergic rhinoconjunctivitis. Br J Clin Pract. 1994; 48:139-43. [IDIS 330721] [PubMed 7913336]
77. Welch MJ. Topical nasal steroids for allergic rhinitis. West J Med. 1993; 158:616-7. [IDIS 316169] [PubMed 8337862]
78. Wood S. Allergic rhinitis and hayfever. Practitioner. 1992; 236:440-7. [IDIS 295836] [PubMed 1360654]
79. Mabry RL. Topical pharmacotherapy for allergic rhinitis: new agents. South Med J. 1992; 85:149-54. [IDIS 291787] [PubMed 1738880]
80. Hide W. Clinical allergy—state of the art. Br J Clin Pract. 1990; 44:85-7. [IDIS 265625] [PubMed 2188686]
81. Sutherland DC. Antihistamine agents: new options or just more drugs? Med J Aust. 1989; 151:158-62. (IDIS 261855)
82. Dahl MGC. Hazards of topical steroid therapy. Adv Drug React Bull. 1985; Dec:428-31.
83. Anon. Avoiding eye damage from topical corticosteroids. Drug Ther Bull. 1987; 25:29-30. [PubMed 3582180]
84. Fraunfelder FT, Meyer SM. Posterior subcapsular cataracts associated with nasal or inhalation corticosteroids. Am J Ophthalmol. 1990; 109:489-90. [IDIS 264793] [PubMed 2330959]
85. Sly RM, Kemp JP, and the American Academy of Allergy and Immunology Committee on Drugs. The use of antihistamines in patients with asthma. J Allergy Clin Immunol. 1988; 82:481-2. [IDIS 316872] [PubMed 2902113]
86. Astra. Rhinocort (budesonide) nasal inhaler prescribing information. Westborough, MA; 1994 Jun.
87. Anon. Corticosteroids. In: Reynolds JEF, ed. Martindale: the extra pharmacopoeia. 30th ed. London: The Pharmaceutical Press; 1993:712-40.
88. Abzug MJ, Cotton MF. Severe chickenpox after intranasal use of corticosteroids. J Pediatr. 1993; 123:577-9. [IDIS 320992] [PubMed 8410510]
89. Jones JF. FDA varicella warning: the issues. Pediatrics. 1992; 90:479-81.
90. Anon. Prednisone: fetal risk summary. In: Briggs GG, Freeman RK, Yaffe SJ, eds. Drugs in pregnancy and lactation. 2nd ed. Baltimore: Williams & Wilkins; 1986:366-7p.
91. Hilman BC. Bronchodilators and antiallergy drugs. In: Wilson JT, ed. Drugs in breast milk. Sydney: ADIS Health Science Press; 1981:53-60.
92. Ramsdale EH, Kline PA. Comparison of once daily treatment with an antihistamine (loratadine) and topical steroid (fluticasone propionate) during the ragweed pollen season. J Allergy Clin Immunol. 1991; 87:298.
93. Johannessen TA. A comparison of fluticasone propionate, flunisolide and placebo in patients with seasonal allergic rhinitis to birch pollen—a multicentre trial. Clin Exp Allergy. 1990; 20(Suppl 1):102.
94. Prahl P, Wilken-Jensen K, Mygind N. Beclomethasone dipropionate aerosol in treatment of hay fever in children. Arch Dis Child. 1975; 50:875-8. [PubMed 2110]
95. Vervloet D, Charpin D, Desfougeres JL. Fluticasone propionate aqueous nasal spray versus cetirizine (C) in seasonal rhinitis. Eur Resp J. 1991; 4(Suppl 14):436S.
96. Naclerio RM, Mygind N. Intranasal steroids. In: Mygind N, Naclerio RM, eds. Allergic and non-allergic rhinitis clinical aspects. 1st ed. Copenhagen: Munksgaard; 1993:114-22.
97. Middleton E Jr. Systemic steroids. In: Mygind N, Naclerio RM, eds. Allergic and non-allergic rhinitis clinical aspects. 1st ed. Copenhagen: Munksgaard; 1993:111-3.
98. Deltasone (prednisone) tablets prescribing information. In: Physicians’ desk reference. 47th ed. Montvale, NJ: Medical Economics Company Inc; 1993:2444-6.
99. Anon. Revised label warns of severe viral problems with corticosteroids. FDA Med Bull. 1991 Dec; 21:3.
100. Peterson F (US Food and Drug Administration). Corticosteroid drugs and chickenpox. Rockville, MD; 1991 Dec 2.
101. Corticosteroid interactions. In: Hansten PD, Horn Jr. Drug Interactions and Updates. Vancouver, WA: Applied Therapeutics, Inc; 1993:559-60.
102. Gregg I. The importance of patient education in the use of inhaled steroids. In: Mygind N, Clark TJH eds. Topical steroid treatment for asthma and rhinitis. London: Baillière Tindall; 1980:137-42.
103. Shaw RJ. Pharmacology of fluticasone propionate. Respir Med. 1994; 88(Suppl A):5-8. [PubMed 7972993]
104. Sahay JN, Ibrahim NBN, Chatterjee SS et al. Long-term study of flunisolide treatment in perennial rhinitis with special reference to nasal mucosal histology and morphology. Clin Allergy. 1980; 10:451-7. [PubMed 6778629]
105. Mygind N, Clark TJH. Safety and topical side-effects. In: Mygind N, Clark TJH eds. Topical steroid treatment for asthma and rhinitis. London: Baillière Tindall; 1980:171-9.
106. Wales JKH, Milner RDG. Knemometry in assessment of linear growth. Arch Dis Child. 1987; 62:166-71. [PubMed 3827294]
107. Hermanussen M, Geiger-Benoit K, Burmeister J et al. Can the knemometer shorten the time for growth rate assessment? Acta Paediatr Scand. 1987; 337(Suppl):30-6.
108. Li J, Lyles K, Halstenson C et al. Long-term safety study of fluticasone propionate aqueous nasal spray. Ann Allergy Asthma Immunol. 1995; 74:58.
109. Glaxo Inc. Research Triangle Park, NC: Product information for fluticasone propionate. Undated.
110. Glaxo Inc. Research Triangle Park, NC: Personal communication.
111. Glaxo Inc. Research Triangle Park, NC: Toxicology studies summary information for fluticasone propionate. Undated.
112. Benincasa C, Lloyd RS. Evaluation of fluticasone propionate aqueous nasal spray taken alone and in combination with cetirizine in the prophylactic treatment of seasonal allergic rhinitis. Drug Invest. 1994; 8:225-33.
113. Reviewers’ comments (personal observations).
114. Nathan RA. The efficacy of fluticasone propionate aqueous nasal spray in the treatment of allergic rhinitis. Todays Ther Trends. 1995; 12:119-34.
115. Syntex Laboratories, Inc. Nasalide (flunisolide) nasal solution 0.025% prescribing information. In: Physicians’ desk reference. 49th ed. Montvale, NJ: Medical Economics Company Inc; 1995:2480-1.
116. Rak S, Jacobson MR, Sudderick RM et al. Influence of prolonged treatment with topical corticosteroid (fluticasone propionate) on early and late phase nasal responses and cellular infiltration in the nasal mucosa after allergen challenge. Clin Exp Allergy. 1994; 24:930-9. [PubMed 7842362]
117. Högger P, Rohdewald P. Binding kinetics of fluticasone propionate to the human glucocorticoid receptor. Steroids. 1994; 59:597-602. [PubMed 7878687]
118. Pichler WJ, Klint T, Blaser M et al. Clinical comparison of systemic methylprednisolone acetate versus topical budesonide in patients with seasonal allergic rhinitis. Allergy. 1988; 43:87-92. [PubMed 3364627]
119. Clissold SP, Heel RC. Budesonide: a preliminary review of its pharmacodynamic properties and therapeutic efficacy in asthma and rhinitis. Drugs. 1984; 28:485-518. [IDIS 194409] [PubMed 6394263]
120. Cockcroft DW, Hargreave FE, Dolovich J. Intranasal beclomethasone dipropionate in rhinitis. In: Mygind N, Clark TJH eds. Topical steroid treatment for asthma and rhinitis. London: Baillière Tindall; 1980:143-53.
121. Szefler SJ. Glucocorticoid therapy for asthma: clinical pharmacology. J Allergy Clin Immunol. 1991; 88:147-65. [IDIS 286942] [PubMed 1880315]
122. Jordana G, Dolovich J, Briscoe MP et al. Intranasal fluticasone propionate versus loratadine in the treatment of adolescent patients with seasonal allergic rhinitis. J Allergy Clin Immunol. 1996; 97:588-95. [IDIS 360730] [PubMed 8621843]
123. Ngamphaiboon J, Thepchatri A, Chatchtatee P et al. Fluticasone propionate aqueous nasal spray treatment for perennial allergic rhinitis in children. Ann Allergy Asthma Immunol. 1997; 78:479-84. [IDIS 386909] [PubMed 9164361]
124. Richards DH, Milton CM. Fluticasone propionate aqueous nasal spray: a well-tolerated and effective treatment for children with perennial rhinitis. Pediatr Allergy Immunol. 1996; 7:35-43. [PubMed 8792382]
125. GlaxoSmithKline. Flovent Rotadisk (fluticasone propionate) inhalation powder 50, 100, and 250 mcg prescribing information. Research Triangle Park, NC; 2001 Sep.
126. Pedersen S. Assessing the effect of intranasal steroids on growth. J Allergy Clin Immunol. 2001; 108:S40-4. [IDIS 467845] [PubMed 11449205]
127. Skoner D. Update of growth effects of inhaled and intranasal corticosteroids. Cur Opin Allergy Clin Immunol. 2002; 2:7-10.
b. GlaxoSmithKline. How to use flonase. Research Triangle Park, NC; undated. Available at: http://www.flonase.ibreathe.com/use/howto.html. Accessed 2003 Sep 2.