Adult Dosing
Seasonal or perennial rhinitis
- Start 2 sprays in each nostril bid; may increase to 2 sprays per nostril tid, if necessary
- Max: 8 sprays in each nostril/day
Notes:- Use smallest effective dose for maintenance therapy after the desired clinical effect is obtained
- Pump must be primed before initial use; also, prime the pump if not used for more than 5 days or if it has been disassembled for cleaning
Pediatric Dosing
Seasonal or perennial rhinitis
Below 6 yrs
- Safety and effectiveness in pediatric patients <6 yrs of age have not been established
6-14 yrs
- Initiate 1 spray in each nostril tid or 2 sprays in each nostril bid
- Max: 4 sprays in each nostril/day
Children >14 yrs
- 2 sprays in each nostril bid; may increase to 2 sprays per nostril tid, if necessary
- Max: 8 sprays in each nostril/day
Notes:- Use smallest effective dose for maintenance therapy after the desired clinical effect is obtained
- Pump must be primed before initial use; also, prime the pump if not used for more than 5 days or if it has been disassembled for cleaning
[Outline]
See Supplemental Patient Information
- Patients may experience signs of adrenal insufficiency and occasionally withdrawal symptoms, such as joint pain, muscular pain, lassitude, and depression, when a systemic corticosteroid was replaced with a topical corticoid
- Monitor patients transferred from long-term systemic corticosteroids to flunisolide in order to avoid acute adrenal insufficiency in response to stress. This is of great significance in asthmatics who may encounter severe exacerbation of their symptoms
- Concomitant use of flunisolide with alternate-day systemic prednisone therapy may cause HPA suppression; caution should be exercised in such patients
- Flunisolide may increase the susceptibility to infections in individuals receiving immunosuppressive medications. Non-immune adults or pediatric patients should avoid exposure to chickenpox and measles
- Non-immune patients exposed to chickenpox and measles should receive prophylaxis with varicella zoster immune globulin (VZIG) and pooled intramuscular immunoglobulin (IG) respectively. If chickenpox develops, initiate therapy with antiviral agents
- Flunisolide may cause growth suppression in pediatric patients; hence, not recommended in children <6 yrs of age
- Some patients may not experience symptomatic relief until two weeks of therapy. Use of flunisolide is not recommended beyond 3 weeks in the absence of significant improvement of symptoms
- Rare instances of localized fungal infections (candidiasis) of the nose and pharynx have been reported with flunisolide use. If such infections develop, discontinue the drug and initiate appropriate antifungal therapy
- Use with caution in patients with active or dormant tuberculosis infection or the respiratory tract, ocular herpes simplex, and in untreated fungal, bacterial or viral infections
- Flunisolide may cause inhibition of wound healing. Caution should be exercised when using this drug in patients with recent nasal septal ulcers, recurrent epistaxis, nasal surgery or trauma until complete healing occurs
- Rare instances of nasal septal perforations, loss of taste and smell (temporary or permanent) have been reported in certain patients during therapy
- Systemic effects of flunisolide are minimal at recommended doses; however, this risk increases with excessive dosage. Avoid doses larger than recommended
Cautions: Use cautiously in
- Glaucoma
- Hypercorticism
- Elderly patients
Supplemental Patient Information
- Advise patients to clear their nasal passages of secretio ns prior to using the spray
- Instruct patients to contact their physicians if symptoms do not improve, or if the condition worsens, or if sneezing or nasal irritation occurs
- Inform patients that it may take 1-2 wks before full relief is obtained
Pregnancy Category:C
Breastfeeding: Safety unknown. The amount of drug excreted into breast milk may be too small to affect the breastfed infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/ht mlgen?LACT last accessed 25 May 2011). Manufacturer advises caution.
Pricing data from www.DrugStore.com in U.S.A.
- Flunisolide 29 MCG/ACT SOLN [Bottle] (APOTEX)
25 act = $45.99
75 act = $129.97 - Flunisolide 0.03 % SOLN [Bottle] (BAUSCH & LOMB)
25 % = $67.99
75 % = $189.98
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
