Pronunciation: Ex-hans
Generic name: fluticasone nasal
Brand name: Xhance
Dosage form: nasal spray with an exhalation delivery system
Drug class: Nasal steroids

Medically reviewed by Carmen Pope, BPharm. Last updated on Mar 26, 2024.

What is Xhance?

Xhance (fluticasone propionate) is a corticosteroid nasal spray with a unique exhalation delivery system that may be used to treat adults who have chronic rhinosinusitis:

• with nasal polyps (CRSwNP)
• without nasal polyps (CRSsNP).

Xhance (fluticasone propionate) has an anti-inflammatory effect, although the exact way it works is unknown. Corticosteroids, such as fluticasone, affect a wide range of immune system cells and mediators involved in inflammation such as mast cells, eosinophils, neutrophils, macrophages, lymphocytes, histamine, eicosanoids, leukotrienes, and cytokines. Fluticasone has a binding affinity to human glucocorticoid receptors that is stronger than dexamethasone, beclomethasone, and budesonide.

Xhance uses the Exhalation Delivery System (EDS) which is designed to deliver a topical steroid to the high and deep regions of the nasal cavity where sinuses ventilate and drain. 

Xhance was first FDA-approved on September 18, 2017.

Warnings

Hypersensitivity reactions including anaphylaxis and hives have been reported after the administration of fluticasone propionate products, such as Xhance. Do not use Xhance if you are allergic to fluticasone propionate or any of the inactive ingredients in the spray.

Xhance can cause side effects within your nose, such as nose bleeding, nasal erosion or ulceration, perforation of the septum (the part that separates your right and left nostrils), infection, and impaired wound healing. Your healthcare provider will monitor you for these side effects. Do not use Xhance in people with recent nasal ulcerations, nasal surgery, or nasal trauma.

Glaucoma and cataracts may occur with long-term use. Your healthcare provider will monitor you for symptoms and refer you to an ophthalmologist if necessary.

May increase the risk of infection or worsen existing infections (such as tuberculosis, fungal, bacterial, viral, or parasitic infections). Some of these infections may become life-threatening (eg, chickenpox and measles).

High dosages of Xhance or regular dosages in susceptible individuals may cause high levels of cortisol and adrenal suppression. Xhance should be discontinued slowly if these occur.

May decrease bone mineral density and this should be assessed before starting Xhance and periodically thereafter.

Do not use Xhance Nasal Spray for a child or adolescent younger than 18 years old.

Before using

You should not use Xhance if you are allergic to fluticasone.

Fluticasone can weaken your immune system, making it easier for you to get an infection or worsen an infection you already have or recently had. Tell your doctor about any illness or infection you have had within the past several weeks.

Before using Xhance, tell your healthcare provider about all of your medical conditions, including if you:

• have or have had nasal sores, nasal surgery, or nasal injury
• have eye problems, such as cataracts or glaucoma
• have an immune system problem
• have any type of viral, bacterial, or fungal infection
• are exposed to chickenpox or measles
• have weak bones (osteoporosis)
• have liver problems
• have diabetes
• are pregnant or plan to become pregnant
• are breastfeeding or plan to breastfeed.

Pregnancy

It is not known if Xhance may harm your unborn baby. Talk to your healthcare provider about using it if you are pregnant.

Breastfeeding

It is not known if Xhance passes into your breast milk and if it can harm your baby. Talk to your healthcare provider about using it if you are breastfeeding.

How should I use Xhance?

Use Xhance exactly as your healthcare provider tells you and do not use it more often than prescribed. Ask your healthcare provider if you have any questions.

• Only use Xhance in your nose. Do not spray it in your eyes or mouth.
• It may take several days of regular use for your symptoms to get better, and several months for the medicine to have its greatest effect. If your symptoms do not improve or get worse, call your healthcare provider.
• You will get the best results if you keep using Xhance regularly twice each day without missing a dose.

Do not stop using it unless your healthcare provider tells you to do so.

Do not share this medicine with another person, even if they have the same symptoms you have.

Dosage information

Shake the nasal spray just before each use.

• If you are unclear about how to use Xhance, ask your healthcare provider or pharmacist to show you. Read the instructions for use.
• If you switched to fluticasone from another steroid medicine, you should not stop using it suddenly. Follow your doctor's instructions about tapering your dose.

Xhance has a unique delivery system and looks different from other nasal inhalers.

• Note how it has a cone-shaped non-flexible nosepiece and a longer flexible mouthpiece.
• Gently insert the tapered tip of the cone-shaped nosepiece deep into your nose to expand the nasal passage and create a tight seal between the nosepiece and the nostril.
• A seal must be maintained as the patient blows into the mouthpiece and actuates the spray pump.
• Put your mouth around the mouthpiece.
• To actuate the device, push the bottle up while continuing to blow forcefully into the mouthpiece. Within the device is a valve that prevents the release of breath until the bottle is pushed.
• Pushing the bottle also actuates the spray pump, releasing a metered dose of aerosolized medication while simultaneously allowing a “burst” of exhaled breath to pass through the device. This helps deliver the medication deep into your nose.

Do not try to inhale or “sniff” when blowing (exhaling) into the mouthpiece.

Do not block the other nostril because the exhaled breath must pass around the back of the nasal septum and out the other side of the nose.

Usual Adult Dose for Nasal Polyps

1 spray (93 mcg of fluticasone propionate per spray) in each nostril twice daily (total daily dose, 372 mcg).

• A dose of 2 sprays (93mcg of fluticasone propionate per spray) in each nostril twice daily may also be effective in some patients (total daily dose, 744 mcg).
• Do not exceed the maximum total daily dosage of 2 sprays in each nostril twice daily (total daily dose, 744 mcg).

What happens if I miss a dose?

If you miss a dose of Xhance, take it as soon as you remember the same day. Do not take more than your prescribed dose each day.

Use the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not use two doses at one time.

What happens if I overdose?

Call your healthcare provider for instructions if you take too much Xhance.

An overdose of fluticasone is not expected to produce life-threatening symptoms. Long-term use of steroid medicine can lead to glaucoma, cataracts, thinning skin, easy bruising, changes in body fat (especially in your face, neck, back, and waist), increased acne or facial hair, menstrual problems, impotence, or loss of interest in sex.

What should I avoid while using Xhance nasal spray?

Avoid getting the spray in your eyes or mouth. If this does happen, rinse with water.

Do not try to inhale or “sniff” when blowing (exhaling) into the mouthpiece.

Do not block the other nostril because the exhaled breath must pass around the back of the nasal septum and out the other side of the nose.

Avoid being near people who are sick or have infections. Call your doctor for preventive treatment if you are exposed to chickenpox or measles. These conditions can be serious or even fatal in people who are using Xhance.

What are the side effects of Xhance?

Get emergency medical help if you have signs of an allergic reaction to Xhance, such as hives, rash; feeling light-headed; difficulty breathing; or swelling of your face, lips, tongue, or throat.

Xhance may cause serious side effects, including:

• Nasal problems. Talk to your doctor if you have symptoms of nasal problems such as:
• nose bleeds
• crusting in the nose
• sores (ulcers) in the nose
• hole in the cartilage of the nose (nasal septal perforation). A whistling sound when you breathe may be a symptom of nasal septum perforation
• thrush (candida), a fungal infection in your nose and throat. Tell your healthcare provider if you have any redness or white-colored patches in your nose or mouth
• slow wound healing. You should not use Xhance until your nose has healed if you have a sore in your nose, have had surgery on your nose, or if your nose has been injured.
• Eye problems including glaucoma and cataracts. You should have regular eye exams while you use Xhance. Call your healthcare provider if you have vision changes while using it.
• Weakened immune system and increased chance of getting infections (immunosuppression). Taking medicines that weaken your immune system makes you more likely to get infections and can make certain infections worse. These infections may include tuberculosis (TB), herpes simplex infections of the eyes (ocular herpes simplex infections), and infections caused by fungi, bacteria, viruses, and parasites. Avoid contact with people with a contagious disease such as chickenpox or measles while using Xhance. If you come in contact with someone who has chickenpox or measles, call your healthcare provider right away. Symptoms of an infection may include:
• Fever
• pain
• aches
• chills
• feeling tired
• nausea
• vomiting.
• Reduced adrenal function (adrenal insufficiency). This happens when your adrenal glands do not make enough steroid hormones. This can happen when you stop taking oral corticosteroid medicines (such as prednisone) and start taking a medicine containing a steroid inhaled into the lungs or for use in the nose. It can also happen when nasal corticosteroids, such as Xhance, are used at a dose higher than the usual dose or in people who are likely to have adrenal insufficiency at the usual dose. This may be more likely to happen after surgery or during periods of stress. Symptoms of reduced adrenal function may include:
• tiredness
• weakness
• nausea and vomiting
• low blood pressure
• Weak bones (osteoporosis).
• Slowed growth in children. Xhance is not recommended in children.

The most common side effects of Xhance affecting 3% or more adults with chronic rhinosinusitis depending on whether they have or do not have nasal polyps include:

• minor nosebleed, burning, or itching in your nose
• sores or white patches inside or around your nose
• cough, trouble breathing
• headache, back pain
• sinus pain, sore throat, fever or
• nausea, vomiting.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

What other drugs will affect Xhance?

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Xhance and certain other medicines may interact with each other. This may cause serious side effects. Tell your doctor about all your other medicines, especially:

• antifungal medicine or
• antiviral medicine to treat hepatitis C or HIV/AIDS
• other corticosteroids.

This list is not complete. Other drugs may interact with fluticasone, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Storage

Store Xhance in an upright position at room temperature, away from moisture and heat. Throw the spray bottle away after you have used 120 sprays, even if there is still medicine left in the bottle.

After initial priming, throw away Xhance once the counter reaches 120 sprays. Even though the bottle may not be completely empty, you may not get the correct dose of medicine if you continue to use it.

The Xhance bottle is made of glass. Do not remove the base from the bottle.

Keep out of the reach of children.

Ingredients

Active ingredient: fluticasone propionate

Inactive ingredients: microcrystalline cellulose, carboxymethylcellulose sodium, dextrose, benzalkonium chloride, polysorbate 80, edetate disodium dihydrate, sodium hydroxide, and hydrochloric acid (to adjust pH), and purified water.

Each spray contains 93 mcg of fluticasone propionate.

Manufacturer

OptiNose US, Inc.

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