flunisolide (nasal)

General

Pronunciation:
floo-niss-oh-lide


Trade Name(s)

  • Nasarel
  • Rhinalar Canadian Tradename

Ther. Class.
anti-inflammatories (steroidal)

Pharm. Class.
corticosteroids

Indications

Seasonal or perennial allergic rhinitis.

Action

Potent, locally acting anti-inflammatory and immune modifier.

Therapeutic Effect(s):

Decrease in symptoms of allergic rhinitis.

Pharmacokinetics

Absorption: 50%; action is primarily local following nasal use.

Distribution: Crosses the placenta and enters breast milk in small amounts.

Metabolism and Excretion: Rapidly and extensively metabolized by the liver; 50% excreted in urine; 50% in feces.

Half-life: 1–2 hr.

TIME/ACTION PROFILE (improvement in symptoms)

ROUTEONSETPEAKDURATION
Intranasalfew daysup to 3 wkunknown

Contraindication/Precautions

Contraindicated in:

  • Hypersensitivity (product contains propylene glycol and polyethylene glycol).

Use Cautiously in:

  • Active untreated infections
  • Diabetes or glaucoma
  • Underlying immunosuppression (due to disease or concurrent therapy)
  • Systemic corticosteroid therapy (should not be abruptly discontinued when intranasal therapy is started)
  • Recent nasal trauma, septal ulcers, or surgery (wound healing may be impaired by nasal corticosteroids)
  • OB:  Lactation: Pedi:  Pregnancy, lactation, or children <6 yr (safety not established; prolonged or high-dose therapy may lead to complications).

Adverse Reactions/Side Effects

EENT: nasal burning, epistaxis, nasal dryness, nasal irritation, nasopharyngeal fungal infection, pharyngitis

GI: aftertaste, nausea

Endo: adrenal suppression (increased dose, long-term therapy only), ↓ growth (children)

Resp: cough

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

None known.

Route/Dosage

Intranasal (Adults and Children  >14 yr): 2 sprays in each nostril twice daily; may be ↑ to 2 sprays in each nostril 3 times daily if greater effect needed after 4–7 days (not to exceed 8 sprays in each nostril/day).

Intranasal (Children  6–14 yr): 1 spray in each nostril 3 times daily or 2 sprays in each nostril twice daily (not to exceed 4 sprays in each nostril/day).

Availability (generic available)

Nasal spray: 25 mcg/metered spray in 25-mL bottle (200 metered sprays)

Assessment

  • 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 Diagnoses

Implementation

  • 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.

Patient/Family Teaching

  • 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 medication administration techniques). 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.

Evaluation/Desired Outcomes

Resolution of nasal stuffiness, discharge, and sneezing in seasonal or perennial allergic rhinitis.

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