Fluticasone nasal spray and drops (Flixonase): uses and cautions

Fluticasone nasal spray is used to prevent and treat symptoms of allergic rhinitis and hay fever, including sneezing, itchy or runny nose, itchy watery eyes and a blocked nose. Allergens in the air such as pollen, house dust mites and animal fur trigger these symptoms, and fluticasone reduces the swelling and irritation inside the nose.

Nasal drops, supplied in single-dose plastic nasules, are used to shrink nasal polyps, painless soft growths that block the nose, and are available only on prescription. Some nasal sprays such as Dymista mix fluticasone with an antihistamine for allergic rhinitis.

As a steroid it calms the inflammation that drives itching, sneezing, mucus and blockage. The NHS notes it takes a little longer to work than antihistamine nasal sprays but its effects last longer. Benefit builds over a few days, and some people need 2 weeks or more for the maximum effect.

Tell your doctor if you are no better after 7 days of the spray. For hay fever, start at least a couple of weeks before the season if it comes round at the same time every year. Polyp drops need daily use and may show no improvement for a few weeks; if there is none after 4 to 6 weeks, tell your doctor, who may change treatment.

The NHS lists a 0.05% spray, a 27.5 microgram spray and 400 microgram nasal drops, in 1 mg per ml nasules. The spray is usually used once or twice daily, as 1 or 2 sprays into each nostril, and you should never exceed the maximum number of sprays in 24 hours. Once symptoms are controlled, you can reduce, for example from 2 sprays twice daily to 1 spray once daily, and go back up if they return.

Prime a new bottle by pumping until a fine mist emerges, and again after a few days unused. Remove the cap, shake gently, blow your nose, close one nostril, lean slightly forward, put the nozzle in the other nostril with the bottle upright, breathe in slowly while pressing once, breathe out through the mouth, and repeat as needed. Wipe the nozzle clean afterwards.

If you bought the spray, stop when you no longer need it, and check with a pharmacist if unsure. Do not use it continuously for more than a month without speaking to a doctor. A prescriber will say how long yours should be used.

The usual dose is 6 drops in each nostril once or twice a day. Pull one nasule from the strip, flick and shake it to mix, twist off the top only when ready and blow your nose gently. Position your head as the manufacturer's leaflet shows, insert the container in one nostril, squeeze gently and repeat on the other side. Stay with your head down for at least a minute afterwards. If that position is awkward, lie on a bed with your head tilted over the edge and rest it sideways afterwards.

If you forget a dose, use it as soon as you remember unless the next is nearly due, and do not double up. Using too much is unlikely to harm; ask a pharmacist or doctor if you are concerned.

More than 1 in 100 people get an unpleasant taste or smell, a dry or sore nose or nosebleeds, a dry or sore throat or hoarse voice, or headache. Rinse your mouth with water, or brush your teeth, to help with taste and throat symptoms. If your nose is sore or bleeds, stop for a few days and then restart, and speak to a doctor or pharmacist if it persists.

The NHS says serious effects are rare, fewer than 1 in 10,000 people, and more likely with high doses for more than a few months. Call a doctor or 111 immediately for breathing problems, damage or sores inside the nose, or sight changes such as blurred vision or a cloudy lens, which can signal glaucoma or cataract. High doses, or other steroids or HIV or antifungal tablets used together, can cause underactive adrenal glands; ask whether you need a steroid emergency card. Swelling of the lips, mouth, throat or tongue needs 999. Suspected side effects can be reported through the Yellow Card scheme.

Tell your doctor or pharmacist if you have ever had an allergic reaction to fluticasone or another medicine, take or have recently taken other steroids, have had nose surgery or have a nose infection, or are pregnant or trying to get pregnant.

Check with a pharmacist if you take HIV medicines such as ritonavir or cobicistat, antifungals such as ketoconazole or itraconazole, or other steroid products including creams, inhalers, tablets, injections, other nose sprays and drops, or eye drops. Alcohol, food, contraception and driving are generally unaffected.

Not all brands are suitable for children, so a child should only use the spray prescribed for them. Children and teenagers on high doses for a long time may need their height and weight monitored, as growth can be affected.

The NHS says fluticasone nasal spray and drops can be used during pregnancy because very little reaches the blood, but advises speaking to a doctor or pharmacist before buying a spray if you are pregnant. It is usually fine while breastfeeding, and the combination sprays are usually acceptable too, after checking with a professional. There is no evidence of reduced fertility.