Flunisolide Nasal Spray is a topical corticosteroid that is used in the management of patients with allergic rhinitis to relieve the symptoms of rhinorrhea, sneezing, and itching.

Flunisolide Uses:

• Rhinitis:

  • It is used in the management of the nasal symptoms associated with seasonal or perennial rhinitis

• Off Label Use of Flunisolide in Adults:

  • Empiric treatment of acute bacterial rhinosinusitis as an adjunct to antibiotics.
  • Chronic rhinosinusitis
  • Nonallergic rhinitis
  • Symptomatic relief of viral rhinosinusitis

Flunisolide Nasal Spray Dose in Adults

Flunisolide Nasal Spray Dose in the treatment of Rhinitis (seasonal and perennial):

• Intranasal:
  • Two sprays of 50 mcg in each nostril two times a day (total daily dose: 200 mcg/day);
  • The dose may be increased to 2 sprays in each nostril thrice daily (total daily dose: 300 mcg/day);
  • The maximum dose: 8 sprays/day in each nostril (total daily dose: 400 mcg/day)

Flunisolide Nasal Spray Dose in Childrens

Flunisolide Nasal Spray Dose in the treatment of Seasonal and perennial rhinitis: Intranasal (25 mcg/spray):

• Children ≥6 years and Adolescents ≤14 years:

  • Initial:
    • One spray (25 mcg) per nostril three times a day or 2 sprays (50 mcg) per nostril two times a day (total daily dose: 150 to 200 mcg/day);
    • The maximum daily dose is 4 sprays per nostril/day (200 mcg/day);
    • The dose should be reduced to the lowest effective dose once the patient achieves symptomatic control of the condition.
    • Most patients may require just a single spray (25 mcg) per nostril once daily (the total daily dose: 50 mcg/day)

• Adolescents ≥15 years:

  • Initial:
    • 2 sprays (50 mcg) per nostril two times a day (total daily dose: 200 mcg/day);
    • The dose may be increased to 2 sprays (50 mcg) per nostril thrice daily (total daily dose: 300 mcg/day);
    • The maximum daily dose is 8 sprays per nostril/day (400 mcg/day);
    • The dose may be reduced to one spray (25 mcg) per nostril once a day once the symptoms are controlled (total daily dose: 50 mcg/day)

Pregnancy Risk Factor C

• In animal reproduction studies, adverse pregnancy outcomes have been observed.
• Intranasal corticosteroids may be used to treat rhinitis during pregnancy, however, the lowest effective dose should be used for the minimum required time.

Flunisolide use during breastfeeding:

• Corticosteroids can be found in breastmilk, however, it is not known if topical intranasal use results in a sufficient systemic absorption that could influence the drug concentration in breastmilk or not.
• Inhalational or intranasal corticosteroids can be used during pregnancy. The manufacturer recommends using it with caution in lactating women.

Dose in Kidney Disease:

There are no dosage adjustments provided in the manufacturer's labeling.

Dose in Liver disease:

There is no dosage adjustment provided in the manufacturer's labeling.

Common Side Effects of Flunisolide Nasal Spray:

• Dermatologic:

  • Burning sensation of the nose

• Respiratory:

  • Nasal congestion
  • The stinging sensation of the nose

Less Common Side Effects of Flunisolide Nasal Spray:

• Central nervous system:

  • Anosmia

• Respiratory:

  • Dry nose
  • Nasal mucosa irritation
  • Rhinitis
  • Sneezing

Contraindications to Flunisolide Nasal Spray:

Allergic reactions to the drug or any component of the formulation. Patients allergic to other drugs may develop hypersensitivity reactions to flunisolide as well. Additional contraindications as per Canadian labeling include:

• Active or latent tuberculosis
• Untreated fungal and bacterial infections
• Children who are younger than 6 years of age.

Warnings and Precautions

• Delayed wound healing:

  • Topical corticosteroids may delay wound healing. It should be avoided in patients who have undergone recent nasal surgery, had nasal trauma, or have a recent nasal septal ulcer.
  • The treatment should be withheld until healing has occurred.

Flunisolide (nasal): Drug Interaction

Monitoring Parameters:

None mentioned.

How to administer Flunisolide Nasal Spray?

• Before using the spray, prime it by pressing the pump 5 to 6 times or until a fine spray is released.
• Priming should be repeated if the spray has not been dissembled for cleaning or the spray has not been used for 5 days or more.
• The spray should be administered at regular intervals as advised.
• Before inserting the applicator, the patient should blow the nose to clear the nasal passages.
• Insert the applicator into the nostril while keeping the bottle upright.
• The other nostril should be blocked.
• The patient should be asked to breathe in through the nose, press the pump and inhale via the same nostril.

Mechanism of action of Flunisolide:

• It is a topical corticosteroid that inhibits local inflammation such as reversing capillary permeability and the suppression/ migration of inflammatory cells to the site of inflammation.
• It does not cause the depression of hypothalamic function.

Absorption:

• About 50% of the drug is absorbed.

International Brand Names of Flunisolide:

• APO-Flunisolide
• Rhinalar

Flunisolide Brand Names in Pakistan: