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Generic Name: Fluticasone
Brand Name(s):
Information updated: April 1, 2000
Overview
Flonase nasal spray has become a very popular allergy treatment.
Corticosteroids (cortisone-like drugs such as prednisone) are very
effective at easing irritation and inflammation in the upper respiratory tract
(nose and lungs).
The problem with oral steroids, however, is that they
come with a long list of side effects if they are used on a regular basis
(cataracts, glaucoma, fluid retention, high blood pressure, muscle weakness,
weakened bones, peptic ulcer, mood swings, etc.)
Ingredients in nasal
sprays, however, are less likely to be absorbed into the body and cause such
serious adverse reactions.
Flonase is prescribed for allergic symptoms
such as runny nose, stuffiness, sneezing, nasal itching, and congestion.
Side Effects and Interactions
Nasal irritation and burning may sometimes
accompany the use of Flonase.
Other side effects may include sneezing,
sore throat, nosebleeds, runny nose, nasal congestion, sinusitis, nasal dryness,
or unpleasant taste. Headache, dizziness, itching, wheezing, skin rash, and
nausea have also been reported.
In rare cases patients using
corticosteroid nasal sprays have noted ulceration of the nasal tissues and
perforation of the septum (the cartilage between the nostrils).
Cataracts
and glaucoma are quite uncommon but may represent signs of systemic absorption.
Prolonged use at higher than recommended doses can increase the risk of
such side effects. Report any symptoms to your physician promptly.
Special Precautions
Corticosteroid sprays are not supposed to be readily absorbed into the body.
Nevertheless, a study in the New England Journal of Medicine (July 3, 1997) revealed that when asthma patients inhaled beclomethasone (found in Vanceril and Beclovent) for long periods of time, they experienced a substantial increase in cataract formation.
An article in JAMA (March 5, 1997) noted that high doses of inhaled steroids (taken for more than three months) increased the risk for glaucoma. This suggests that at least for corticosteroid asthma inhalers there is absorption of the drug into the body.
Although Flonase is very effective for relieving nasal allergy symptoms, care must be taken not to overuse this spray.
Exceeding the recommended dose could lead to systemic absorption and side effects such as cataracts, glaucoma, reduced growth in children, fluid retention, acne, menstrual changes, enlarged face, and suppression of the body's natural cortisol production.
People exposed to chicken pox or measles should contact a physician immediately. If the immune system is impaired (through excess corticosteroid exposure) these infections could become very serious.
Anyone with TB, herpes infection of the eye, or an untreated bacterial, fungal, or viral infection should probably not use any corticosteroid nasal spray unless specifically told to do so by a physician.
If someone uses corticosteroid nasal sprays for prolonged periods of time (more than several months) he should be seen by a physician so an examination of the nasal mucosa can be carried out.
There have been rare cases of nasal septum perforation (a hole between the two nostrils) when such products are used for a long time.
Cases of yeast infections (Candida albicans) can occur with repeated use of any corticosteroid spray. If such an infection arises in the nose it will likely require suspension of Flonase and appropriate antifungal therapy.
If symptoms persist or someone experiences nasal irritation or breathing problems such as wheezing, a physician should be notified promptly. In rare cases pressure within the eye has increased after exposure to nasal steroid sprays.
People with a risk of glaucoma should be periodically checked by an ophthalmologist.
A woman who may become pregnant should talk with a physician before using any corticosteroid nasal spray.
Taking the Medicine
The initial dose of Flonase is two sprays in each nostril once daily.
An alternate dosing schedule may be one spray in each nostril twice daily (e.g., once in the morning and once in the evening).
After symptom relief has been achieved (usually within a week or less) it may be possible to maintain adequate benefit from Flonase with just one spray in each nostril once daily.
Never exceed two sprays in each nostril per day.
Steroid nasal sprays do not relive symptoms immediately. It may take several days of regular use to experience benefit.
If symptom relief is not noted within a week a physician should be consulted.
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Joe Graedon is a pharmacologist. Teresa Graedon holds a doctorate in medical anthropology and is a nutrition expert. Their syndicated radio show can be heard on public radio.
© 2000
Reader Comments
I am terrified. I went to the optometrist last month, and he said I may have low-pressure glaucoma. His tests weren't conclusive. A few weeks later, I heard an ad for fluticasone on TV that mentioned glaucoma as a side effect. This is the first time I had heard of this. I've been taking inhaled fluticasone since the early 1990s. Do you know if the damage is already done, or can I reverse it by stopping the medicine?
Posted by: Cathy | October 25, 2007 4:41 PM
I used Flonase for 1 year, 2 sprays per night. I am 37 and was just told I have cataracts in both eyes. The optometrist was as surprised as I was that I would have this at this age, particularly because I am in really good health. I saw a commercial for Veramyst (has fluticasone) and it says cataracts are a possible side effect. I'm angry because I was never warned that the Flonase might cause this. I hope someone sues them.
Posted by: tmw | December 26, 2007 10:08 PM