Corticosteroids Intranasal Preparations
Indications for use
- GSL products: Treatment of seasonal allergic rhinitis only (e.g. hayfever). Maximum 1 month
- P products: Some are licensed for prevention and treatment of allergic rhinitis, including perennial causes (e.g. house dust mite, animal dander) as well as seasonal. Longer treatment duration permitted (up to 3 months for some products). Always check the individual product SmPC/PIL
Age
- Generally 18 years + for both P and GSL products. Pirinase Hayfever 0.05% nasal spray (P) is licensed from 12 years; other fluticasone P products (e.g. Dymista Control) are licensed only from 18. Always check the individual product PIL/SmPC as age ranges vary
Dose/Directions
- This will depend on the individual corticosteroid. At the time of writing, five intranasal corticosteroids have been deregulated from prescription-only status i.e. beclometasone dipropionate, budesonide, fluticasone propionate, mometasone furoate and triamcinolone acetonide (OTC triamcinolone, Nasacort Allergy, has since been discontinued)
- The patient should be advised to use the minimum dose that effectively controls their symptoms and that the full effect takes several days to manifest
Duration
- Again, this will depend on the individual product so should be checked prior to providing any advice
- Example: patients should not use the product continuously for more than 3 months without consulting a doctor
- Example: if no symptom relief is obtained within 2 weeks of continuous treatment (or the symptoms are not adequately controlled), the patient should seek medical advice
Contra-indications/referral criteria
- Hypersensitivity to the active substance or to any of the excipients
- have been transferred from oral corticosteroids (to nasal corticosteroid) but are at risk of hypothalmic-pituitary-adrenal axis disturbances
- fungal and viral infections of the airways
- active or quiescent pulmonary tuberculosis
- infection of the nasal passages, ulceration in the nose, recent nasal surgery
- are pregnant (and consider they need a corrticosteroid nasal spray)
Examples of drug interactions
- Co-treatment with CYP3A inhibitors is expected to increase the risk of systemic corticosteroid side-effects
Side-effects
- Common side-effects include haemorrhagic secretion and epistaxis, nasal irritation (sneezing, stinging and dryness)
Other pertinent information
- Not intended to provide immediate relief i.e. the full effect is not achieved until after a few days treatment
- Usually has a different shelf life once opened (see the individual packaging)
- Reclassified POM→P at various dates: beclometasone (1994), budesonide (1995), fluticasone propionate (2002), triamcinolone (2004), mometasone (2017). Some presentations P→GSL: beclometasone (2003), fluticasone propionate (2015), triamcinolone (2021), mometasone (2023). P products remain available for larger packs, longer treatment and wider indications (see above)