Intranasal Corticosteroid Pregnancy: There is inadequate evidence of safety in human pregnancy; use requires that the possible benefits be weighed against the possible hazards. Corticosteroids given to pregnant animals can cause abnormalities of foetal development (including cleft palate and intra-uterine growth retardation) after relatively high systemic exposure, whereas direct intranasal application ensures minimal systemic exposure. Secretion in human breast milk has not been investigated; when used in breast-feeding mothers the therapeutic benefits must be weighed against the potential hazards to mother and baby.

Fluticasone Propionate Nasal Spray

Brand names: Flixonase, Pirinase (OTC)

Used in: Asthma

Fluticasone propionate nasal spray is an intranasal corticosteroid used to control the symptoms of allergic and non-allergic rhinitis.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Adults and children over 12 years: two sprays into each nostril once a day. In some cases two sprays into each nostril twice daily may be required. Once symptoms are under control, a maintenance dose of one spray per nostril once a day may be used.

Route: Intranasal (administration by the intranasal route only; contact with the eyes should be avoided)

Frequency: Once daily, preferably in the morning (twice daily if required)

Max: Adults and children over 12 years: the maximum daily dose should not exceed four sprays into each nostril. Children under 12 years (4-11 years): the maximum daily dose should not exceed two sprays into each nostril.

Source: Flixonase Aqueous Nasal Spray SPC — for the prophylaxis and treatment of seasonal allergic rhinitis and perennial rhinitis. The fetched section 4.2 does not state the microgram content per spray, so the strength of the product used must be confirmed separately. If symptoms recur the dosage may be increased accordingly; the minimum dose at which effective control of symptoms is maintained should be used. Elderly patients: the normal adult dosage is applicable. Children aged 4-11 years: one spray into each nostril once daily, preferably in the morning; in some cases one spray into each nostril twice daily may be required (maximum two sprays into each nostril daily). For full therapeutic benefit regular usage is essential; the absence of an immediate effect should be explained to the patient, as maximum relief may not be obtained until after 3 to 4 days of treatment. Section 4.4 was truncated at the source-fetch limit and section 4.5 (interactions) was not retrieved.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients

Side effects

Epistaxis (very common)
Headache, unpleasant taste, unpleasant smell (common)
Nasal dryness, nasal irritation, throat dryness, throat irritation (common)
Glaucoma, raised intraocular pressure, cataract (very rare, identified from spontaneous reports following prolonged treatment); blurred vision (frequency not known)
Nasal septal perforation (very rare); nasal ulcers (frequency not known)
Hypersensitivity reactions including cutaneous reactions, angioedema (mainly facial and oropharyngeal oedema), bronchospasm and anaphylactic reactions (very rare). Systemic effects of nasal corticosteroids may occur, particularly at high doses for prolonged periods.

Clinical monograph

How it works

Applied topically to the nasal mucosa, it exerts potent local anti-inflammatory glucocorticoid activity, reducing inflammatory mediators and mucosal oedema with minimal systemic absorption.

Prescribing in practice

Local effects such as epistaxis, nasal dryness and, rarely, nasal septal perforation can occur, so correct away-from-the-septum spray technique should be advised.
It works prophylactically and needs regular daily use, with full benefit taking several days to develop rather than giving immediate relief.
Prolonged high-dose intranasal corticosteroid use warrants awareness of potential systemic effects, particularly with concurrent inhaled or oral steroids.

Monitoring

Monitor symptom control and inspect for local nasal adverse effects such as bleeding or crusting at review.

Counselling the patient

Use it every day as prescribed even when you feel well, as it prevents rather than instantly relieves symptoms.
Aim the nozzle slightly away from the middle wall of the nose and avoid sniffing hard.
Report persistent nosebleeds or nasal discomfort.

Evidence & guidelines

Intranasal corticosteroids are the most effective treatment for moderate-to-severe allergic rhinitis and are recommended first-line in NICE and ARIA guidance.

Reference: NICE NG174 Allergic Rhinitis; BAO-HNS Rhinitis Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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