Drug Facts

Type of Drug:

Nasal corticosteroids; anti-inflammatory agents.

How the Drug Works:

Intranasal steroids for inhalation shrink swollen and irritated nasal tissue primarily by reducing inflammation, but also by constricting blood vessels of the nasal mucosa.

Uses:

To relieve nasal symptoms of seasonal or perennial allergic rhinitis (eg, hay fever), which involves inflammation of the mucous membranes of the nasal passages. Symptoms of allergic rhinitis include itching of the nose and eyes, runny nose, postnasal drip, nasal congestion, and sneezing.

Budesonide and beclomethasone (spray): Used to treat non allergic perennial rhinitis in adults.

Precautions:

Changing from other dosage forms: Patients on long-term oral corticosteroids may lose their body’s natural ability to produce corticosteroid hormones. Switching or lessening current doses may cause symptoms of withdrawal (eg, joint or muscle pain, tiredness, depression). Therefore, taper dosage of oral steroid gradually and only with the instruction of a doctor.

Intranasal steroids: Intranasal steroids are absorbed into the blood stream.

Using higher than recommended doses may interfere with normal adrenal functions.

Nasal decongestants: In the presence of excessive nasal congestion, the drug may fail to reach the site of intended action. In such cases, use a nasal decongestant spray just before use during the first 2 to 3 days of therapy. Do not use a nasal decongestant spray for more than 3 consecutive days.

Pregnancy: Adequate studies have not been done in pregnant women. Use only if clearly needed and potential benefits outweigh the possible hazards to the fetus.

Breastfeeding: It is not known whether these drugs are excreted in breast milk. Other corticosteroids do appear in breast milk. Consult your doctor before you begin breastfeeding.

Children: Safety and effectiveness in children under 3 years of age (mometasone), under 4 years of age (fluticasone), or under 6 years of age (beclomethasone, budesonide, flunisolide, triamcinolone) have not been established. Use is not recommended. May Suppress growth in children and teenagers with extended use.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or planning to take any over­ the-counter or prescription medications or dietary supplements while taking these drugs. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs or drug classes interacts with these drugs:

• Cytochrome P-450 3A4 inhibitors (eg, erythromycin, ketoconazole, ritonavir)
• Glucocorticoids (eg, prednisone)
• Immunosuppressants (eg, methotrexate)

Side Effects:

Every drug is capable of producing side effects. Many patients experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:

Nervous System: Headache; light-headedness; dizziness; nervousness.

Digestive Tract: Nausea; vomiting; dry mouth; indigestion; diarrhea; stomach pain.

Eyes or Ocular: Watery eyes; eye disorders; eye infection; cataracts; dry or irritated eyes; glaucoma; blurred vision.

Respiratory System: Nasal or throat irritation; stinging; burning; dryness; nosebleed; runny nose; sneezing (especially in children); blood in nasal mucus; congestion; asthma; increased cough; sore throat; thrush or sores in nose or throat; nasal pain; difficulty breathing; wheezing.

Other: Joint or muscle pain; weakness; depression; sense of smell or taste changes; earache; ringing in ears; painful menstruation; fever; flu-like symptoms; aches and pains; herpes simplex; hoarseness; infection; voice changes; facial swelling; hives; rash; itching.

Guidelines for Use:

• Dosage is individualized. Take exactly as prescribed.
• Do not stop taking or change the dose, unless instructed by your doctor. Do not exceed the recommended dosage.
• Read and follow patient instructions provided with these products.
• If a dose is missed, take it as soon as possible. If several hours have passed or it is nearing time for the next dose, do not double the dose to catch up, unless instructed by your doctor. If more than one dose is missed, or it is necessary to establish a new dosage schedule, contact your doctor or pharmacist.
• Effects are not immediate. Product requires daily use, and improvement usually occurs in a few days. Improvement time varies with each patient. Consult your doctor if condition does not improve or worsens after 3 weeks of daily use.
• May cause irritation and drying of nasal mucosa. Contact your doctor if symptoms do not improve, if the condition worsens, if sneezing or nasal irritation occurs, or if symptoms do not improve within 3 weeks.
• Report any unusual fever, muscle or joint pain, weakness, sneezing, dizziness, nasal irritation, depression, or fluid retention to your doctor.
• Clear nasal passages prior to use by blowing the nose. If nasal pas­sages are congested or blocked, use a decongestant nasal spray just before use to ensure adequate penetration of the spray. Do not use the decongestant nasal spray for more than 3 consecutive days.

• Clean outer portion of the nose with a damp tissue and wash hands with soap and water after drug administration.
• Infection of the nose and throat by a fungus (Candida albicans) has been associated with chronic use. Such infection (thrush) may require stop­ping the intranasal steroid to treat the infection.
• Avoid exposure to chickenpox, measles, or other infections. Consult your doctor immediately if exposed.
• Nasal polyps - Treatment may have to be continued for several weeks or more before results can be fully assessed. Recurrence of symptoms due to polyps can occur after stopping treatment, depending on the severity of the disease.
• Inform your doctor if you are pregnant, become pregnant, planning to become pregnant, or are breastfeeding.
• Lab tests may be required if you are using this medicine for several months. Be sure to keep appointments.
• Beclomethasone - Beneficial effects may decrease when the aerosol canister is cold. This medicine comes in different strengths and dos­age forms. Products and use may not be interchangeable.
• Budesonide - Store with valve upward. After opening aluminum pouch, use within 6 months. Avoid storage in areas of high humidity.
• Fluticasone - Do not exceed more than 2 sprays per nostril per day. Adolescents and children should start at one spray per nostril per day.
• Mometasone -In patients with known seasonal allergies, preventive use is recommended 2 to 4 weeks prior to the start of pollen season. Store at room temperature (59° to 86°F) in a dry place. Store mometasone at 36° to 77° F. Protect from light and moisture.

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