Fluticasone nasal spray and drops

Fluticasone nasal (nose) spray is a steroid medicine used to prevent and treat symptoms of allergic rhinitis and hay fever, including sneezing, itchy and runny nose, itchy and watery eyes, and a blocked nose. These are conditions caused by irritants in the air such as pollen, house dust mites and animal dander (tiny flecks of skin shed by animals).

It works by reducing the swelling and irritation inside the nose.

Flixonase, Avamys and Nasofan are prescription-only for adults and children. You can get some brands of fluticasone nasal spray, such as Pirinase, from pharmacies and shops but you must be 18 years old or over.

Fluticasone also comes as nasal drops that are used to shrink nasal polyps (painless soft growths inside the nose) to relieve the blocked nose. These are only available on prescription. Brand names include Flixonase.

Fluticasone is a type of medicine called a steroid (or corticosteroid). It's not the same as anabolic steroids.

Some nasal sprays, such as Dymista, contain fluticasone mixed with other medicines, such as antihistamines. These are used to treat allergic rhinitis.

Fluticasone also comes as an inhaler to treat asthma and chronic obstructive pulmonary disease (COPD), and as a cream or ointment for skin conditions such as eczema and dermatitis.

Most adults aged 18 and over can use fluticasone nasal spray.

Most adults and children aged 16 years and over can use fluticasone nasal drops.

Some fluticasone nasal sprays can be used by children but always check the leaflet that comes with the medicine, or speak to a pharmacist.

Fluticasone is not suitable for some people.

To make sure the nasal spray or drops are safe for you, tell your doctor or pharmacist if you:

• have ever had an allergic reaction to fluticasone or any other medicine
• are taking or have recently taken other steroid medicines
• have had nose surgery
• have an infection in your nose
• are pregnant or trying to get pregnant

Fluticasone comes as a 0.05% nasal spray, a 27.5 microgram nasal spray, or 400 microgram (1mg in 1ml) nasal drops.

You'll usually use the nasal spray once or twice a day.

The usual dose of fluticasone drops is 6 drops in each nostril, once or twice a day. Follow the instructions that come with your medicine.

Once your symptoms are under control, you'll be able to use your nasal spray less often. For example, you might go from using 2 sprays twice a day, to 1 spray once a day.

If you bought a fluticasone nasal spray from a pharmacy, stop using it when you think you no longer need it. Ask a pharmacist for advice if you're not sure when to stop. Do not use it continuously for more than 1 month without speaking to a doctor.

If your symptoms get worse after reducing your dose, you may want to increase it again.

If you get fluticasone nasal spray or nasal drops on prescription, your doctor will tell you how often to use it and when to change your dose.

Fluticasone nasal spray needs to be used regularly for it to work.

You'll usually use the spray once or twice a day (once in the morning and once at night). The usual dose is 1 or 2 sprays into each nostril.

Follow the instructions that come with your nasal spray. Do not use more than the maximum number of sprays in 24 hours.

If you're using a new bottle, it may not work the first time. Pump the spray a few times until a fine mist comes out. You'll also need to do this if you have not used the bottle for a few days.

Remove the cap and gently shake the bottle.

1. Blow your nose gently, then close 1 nostril with your finger.
2. Bend your head forward slightly and carefully put the nozzle into your other nostril, keeping the bottle upright.
3. Slowly breathe in through your nose and with your fingers press down on the widest part of the nozzle to squirt the spray once into your nostril.
4. Breathe out through your mouth.
5. Follow steps 3 and 4 again to squirt a second spray (if you need it) into the same nostril.

Repeat the process with the other nostril if you need it.

After using the spray, wipe the nozzle with a clean tissue and replace the cap.

Fluticasone drops come in small plastic containers called nasules. Each nasule contains enough for one dose. You can use 1 or 2 doses a day (once in the morning and once at night). The usual dose is 6 drops into each nostril.

Follow the instructions that come with your nasal drops.

Pull off 1 plastic container from the strip of nasules. Flick the container with your finger and then shake it several times to mix the medicine well.

Hold the bottom of the container firmly. Twist and remove the top to open it. Do not open the container until you're ready to use it.

1. Blow your nose gently.
2. Follow the instructions and pictures in the manufacturer's leaflet to get your head into the right position.
3. Carefully put the container into 1 nostril and gently squeeze.
4. Keep squeezing until the sides of the container touch each other, then release. This will mean that you've had about half of the dose (about 6 drops).
5. Follow steps 3 and 4 again to use the rest of the drops in your other nostril.
6. Stay with your head down for at least 1 minute after putting the drops in.

If these positions are difficult you can lie on a bed with your head tilted over the edge. After you have put the drops in, rest your head sideways on the bed for at least 1 minute.

Only use it once. Throw the container away after using it.

If you buy fluticasone nasal spray from a pharmacy or shop, check the leaflet that comes with the medicine. This will tell you how long you can use it for.

Do not use it continuously for more than 1 month without speaking to a doctor.

If your doctor prescribes fluticasone nasal spray, they may advise you to use it for longer.

It may take a few weeks for the medicine to work. Keep using it even though you may not feel better immediately.

If you're using fluticasone drops to shrink nasal polyps, your doctor will tell you how long to use them for. It will usually be for 4 to 6 weeks.

If you forget to use your nasal spray or drops, use them as soon as you remember, unless it's almost time for your next dose. In this case skip the missed dose and use it the next time as usual.

Do not use 2 doses to make up for a forgotten one.

If you forget doses often, it may help to set an alarm to remind you. You could also ask a pharmacist for advice on other ways to help you remember to take your medicine.

Using too much fluticasone nasal spray or drops is unlikely to harm you.

Speak to a pharmacist or doctor if you're worried.

These common side effects of fluticasone nasal spray or drops can happen in more than 1 in 100 people. There are things you can do to help cope with them:

Rinse your mouth with water or have a drink of water.

Stop using your nasal spray for a few days, then start again. Speak to your doctor or a pharmacist if these side effects do not go away.

Rinse your mouth with water or brush your teeth after you use your nasal spray or drops to help prevent this.

Try to rest and drink plenty of fluids. Do not drink too much alcohol. Talk to your doctor if the headache does not go away or is severe.

Speak to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

Serious side effects are rare. Less than 1 in 10,000 people have a serious side effect when using fluticasone nasal spray or drops.

Very little medicine is absorbed into the rest of your body, so it's not likely to give you serious side effects.

However, serious side effects are more likely if you use high doses of fluticasone for more than a few months.

Call your doctor or call 111 immediately if you get:

• problems with your breathing
• damage to your nose or sores inside your nose
• changes in your eyesight, such as blurred vision or a cloudy lens in the eye – these can be signs of increased pressure in your eyes (glaucoma) or a cataract

If your doctor has prescribed high doses of fluticasone, or you're also taking other steroid medicines or tablets for fungal infections or HIV, you may get symptoms of underactive adrenal glands as a side effect. Ask your doctor if you need to carry a steroid emergency card.

Serious allergic reaction

It happens rarely, but it is possible to have a serious allergic reaction (anaphylaxis) to fluticasone nasal spray or drops.

Call 999 now if:

• your lips, mouth, throat or tongue suddenly become swollen
• you're breathing very fast or struggling to breathe (you may become very wheezy or feel like you're choking or gasping for air)
• your throat feels tight or you're struggling to swallow
• your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
• you suddenly become very confused, drowsy or dizzy
• someone faints and cannot be woken up
• a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)

You or the person who's unwell may also have a rash that's swollen, raised, itchy, blistered or peeling.

These can be signs of a serious allergic reaction and may need immediate treatment in hospital.

These are not all the side effects of fluticasone nasal spray or drops. For a full list see the leaflet inside your medicines packet.

Fluticasone nasal spray and drops can be used during pregnancy.

Very little of the medicine gets into your blood and almost none gets to your baby. Even if a small amount does get to your baby, it will not harm them.

It's usually OK to use your fluticasone nasal spray or drops as normal while you're breastfeeding.

It's not known how much fluticasone gets into breast milk, but it's likely to be a tiny amount. Your baby will not absorb a lot of fluticasone into their body from the breast milk. It's very unlikely to cause any side effects in your baby.

In some nasal sprays, fluticasone is mixed with medicines such as antihistamines. It's also usually OK to use these combination nasal sprays while breastfeeding, but always check with your doctor or pharmacist first.

If you notice that your baby is not feeding as well as usual, or if you have any other concerns about your baby, talk to your health visitor, midwife, pharmacist or doctor as soon as possible.

There is no evidence to suggest fluticasone nasal spray or drops reduce fertility in either men or women.

Tell your doctor if you're:

• trying to get pregnant
• pregnant
• breastfeeding

Some medicines and fluticasone can affect each other. This can increase your chance of side effects. It may mean you need to change your dose of fluticasone.

Check with a pharmacist or your doctor if you're taking:

• medicines used to treat HIV, such as ritonavir or cobicistat
• medicines used to treat fungal infections, such as ketoconazole or itraconazole
• other medicines that contain steroids, such as eczema creams, asthma inhalers, steroid tablets, injections, other nasal sprays and drops, or eye drops

There's not enough information to say that complementary medicines, herbal remedies and supplements are safe to take while using fluticasone nasal spray and drops. They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.