Fluticasone Propionate Nasal Spray

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.