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Intranasal Corticosteroid Pregnancy: Compatible — minimal systemic absorption

Fluticasone Propionate Nasal Spray

Brand names: Flixonase, Pirinase (OTC)

Adult dose

Dose: 200 mcg (2 sprays/nostril) OD or 50 mcg (1 spray/nostril) BD. Maintenance: 100 mcg (1 spray/nostril) OD.
Route: Intranasal
Frequency: OD–BD
Max: 400 mcg/day
For allergic and non-allergic rhinitis, nasal polyps. Available OTC (Pirinase 50 mcg). Takes 3–7 days for symptom relief. Consistent daily use required.

Paediatric dose

Route: Intranasal
Frequency: OD
Max: 100 mcg OD (4–11 years); 200 mcg OD (≥12 years)
Concentration: 50 mcg/spray mcg/ml
Children ≥4 years: 50 mcg (1 spray) per nostril OD. Not for children <4 years. Review regularly — use lowest effective dose.

Dose adjustments

Renal

N/A

Hepatic

N/A

Clinical pearls

  • Ritonavir interaction: potent CYP3A4 inhibitor dramatically increases systemic fluticasone — use beclometasone or mometasone instead in patients on ritonavir-containing HIV regimens
  • Spray technique: aim away from nasal septum (towards outer nasal wall) to avoid septal perforation
  • Epistaxis: frequent — use Vaseline on anterior septum; if persistent, switch to aqueous spray
  • OTC availability as Pirinase — patients can self-manage seasonal allergic rhinitis

Contraindications

  • Untreated nasal infection

Side effects

  • Epistaxis (most common)
  • Nasal dryness and irritation
  • Headache
  • Nasal septal perforation (rare, incorrect technique — spray away from septum)

Interactions

  • Ritonavir — increases systemic fluticasone exposure (Cushing's syndrome risk — avoid combination)

Monitoring

  • Symptom control
  • Epistaxis
  • Nasal septal inspection (prolonged use)

Reference: BNFc; BNF; NICE NG174 Allergic Rhinitis; BAO-HNS Rhinitis Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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