Skip to Content

Flunisolide (Nasal)

Medically reviewed by Drugs.com. Last updated on Aug 28, 2020.

Pronunciation

(floo NISS oh lide)

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Nasal:

Generic: 25 mcg/actuation (0.025%) (25 mL)

Pharmacologic Category

  • Corticosteroid, Nasal

Pharmacology

Decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability; does not depress hypothalamus

Absorption

~50%

Use: Labeled Indications

Rhinitis: Management of the nasal symptoms associated with seasonal or perennial rhinitis

Off Label Uses

Acute bacterial rhinosinusitis, adjunct to antibiotics (empiric treatment)

Based on the Infectious Diseases Society of America (IDSA) guidelines for acute bacterial rhinosinusitis (ABRS) in children and adults and the American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNS) guidelines for adult sinusitis, flunisolide (nasal), among other intranasal corticosteroids, is effective and recommended as an adjunctive treatment to antibiotic therapy for the management of ABRS, primarily when a history of allergic rhinitis exists (according to IDSA guidelines).

Chronic rhinosinusitis

Based on the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) guidelines for adult sinusitis, flunisolide (nasal), among other intranasal corticosteroids, is effective and recommended (with or without nasal saline irrigation) for the symptomatic relief of chronic rhinosinusitis. Data from a multicenter, double-blind, randomized study supports the use of intranasal flunisolide as adjunct therapy to oral anitbiotics in patients with chronic rhinosinusitis [Meltzer 1993].

Non-allergic rhinitis

Data from a single blinded, randomized and controlled study conducted over 8 weeks supports the use of flunisolide in the treatment of adults with non-allergic rhinitis. Additional trials may be necessary to further define the role of drug flunisolide in this condition [Varricchio 2011].

Symptomatic relief of viral rhinosinusitis

Based on the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) guidelines for adult sinusitis topical intranasal steroids (including flunisolide), analgesics and/or nasal saline irrigation may be recommended for symptomatic relief of viral rhinosinusitis [Rosenfeld 2015].

Contraindications

Hypersensitivity to flunisolide or any component of the formulation

Documentation of allergenic cross-reactivity for intranasal steroids is limited; however, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty.

Canadian labeling: Additional contraindications (not in US labeling): Active or quiescent tuberculosis; untreated fungal, bacterial, or viral infections; children <6 years

Dosing: Adult

Rhinitis (seasonal/perennial): Intranasal: Two sprays (50 mcg) in each nostril twice daily (total daily dose: 200 mcg/day); may increase to 2 sprays in each nostril 3 times daily (total daily dose: 300 mcg/day); maximum dose: 8 sprays/day in each nostril (total daily dose: 400 mcg/day)

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Seasonal and perennial rhinitis: Intranasal (25 mcg/spray):

Children ≥6 years and Adolescents ≤14 years: Initial: 1 spray (25 mcg) per nostril 3 times daily or 2 sprays (50 mcg) per nostril twice daily (total daily dose: 150 to 200 mcg/day); maximum daily dose: 4 sprays per nostril/day (200 mcg/day); once symptoms are controlled, the dose should be reduced to the lowest effective dose; 1 spray (25 mcg) per nostril once daily may be effective in some patients (total daily dose: 50 mcg/day)

Adolescents ≥15 years: Initial: 2 sprays (50 mcg) per nostril twice daily (total daily dose: 200 mcg/day); if needed, may increase to 2 sprays (50 mcg) per nostril 3 times daily (total daily dose: 300 mcg/day); maximum daily dose: 8 sprays per nostril/day (400 mcg/day); once symptoms are controlled, the dose should be reduced to the lowest effective dose; 1 spray (25 mcg) per nostril once daily may be effective in some patients (total daily dose: 50 mcg/day)

Administration

Before first use, prime by pressing pump 5-6 times or until a fine spray appears. Repeat priming if ≥5 days between use, or if dissembled for cleaning. Administer at regular intervals. Blow nose to clear nostrils. Insert applicator into nostril, keeping bottle upright, and close off the other nostril. Breathe in through nose. While inhaling, press pump to release spray.

Storage

Store at 15°C to 25°C (59°F to 77°F).

Drug Interactions

Desmopressin: Corticosteroids (Nasal) may enhance the hyponatremic effect of Desmopressin. Avoid combination

Esketamine: Corticosteroids (Nasal) may diminish the therapeutic effect of Esketamine. Management: Patients who require a nasal corticosteroid on an esketamine dosing day should administer the nasal corticosteroid at least 1 hour before esketamine. Consider therapy modification

Adverse Reactions

Frequency not always defined.

>10%:

Dermatologic: Burning sensation of the nose (≤13%)

Respiratory: Nasal congestion (15%), stinging sensation of the nose (≤13%)

1% to 10%:

Central nervous system: Anosmia

Respiratory: Dry nose, nasal mucosa irritation, rhinitis, sneezing

<1%, postmarketing, and/or case reports: Nasal mucosa ulcer

Warnings/Precautions

Concerns related to adverse effects:

• Delayed wound healing: Avoid nasal corticosteroid use in patients with recent nasal septal ulcers, nasal surgery or nasal trauma until healing has occurred.

Special populations:

• Pediatric: Avoid using higher than recommended dosages; suppression of linear growth (ie, reduction of growth velocity), reduced bone mineral density, or hypercortisolism (Cushing's syndrome) may occur; titrate to lowest effective dose. Reduction in growth velocity may occur when corticosteroids are administered to pediatric patients, even at recommended doses via intranasal route (monitor growth).

Pregnancy Considerations

An agent with less systemic absorption is preferred for the treatment of allergic rhinitis during pregnancy (BSACI [Scadding 2017]).

Patient Education

What is this drug used for?

• It is used to ease allergy signs.

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

• Burning

• Stinging

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Stuffy nose

• Severe nosebleeds

• Nasal sores

• Whistling sound when breathing

• Thrush

• Sneezing

• Chills

• Sore throat

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine's uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.