Flunisolide is a corticosteroid medication used to treat asthma, allergic rhinitis (hay fever), and nasal polyps. It works by reducing inflammation in the nasal passages and airways, thereby relieving symptoms such as congestion, sneezing, itching, and runny nose. Flunisolide is typically administered as a nasal spray, which delivers the medication directly to the nasal tissues.

Like other corticosteroids, flunisolide can have side effects, although they are generally mild when used properly. Common side effects may include nasal irritation, dryness, or bleeding, as well as throat irritation or coughing. In some cases, long-term use of corticosteroid nasal sprays like flunisolide can lead to more serious side effects such as nasal septum perforation, glaucoma, or cataracts, though these are rare.

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 utilized to treat the nasal symptoms brought on by either seasonal or persistent 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):

• Start with two sprays, which equals 50 micrograms, in each nostril two times a day. This means you use the spray in the morning and again in the evening, totaling 200 micrograms per day.
• If needed, your doctor may suggest increasing the dose to two sprays in each nostril three times a day. This would be a total of 300 micrograms per day.
• The maximum recommended dose is eight sprays in each nostril per day, totaling 400 micrograms per day.

Flunisolide Nasal Spray Dose in Children

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

For children aged 6 to 14 years with seasonal or perennial rhinitis, the typical initial dose of flunisolide nasal spray is:

• Either 1 spray (25 micrograms) in each nostril three times a day, or
• 2 sprays (50 micrograms) in each nostril twice a day.

This amounts to a total daily dose of 150 to 200 micrograms. The maximum daily dose for this age group is 4 sprays per nostril per day, totaling 200 micrograms per day. Once symptoms are under control, the dosage should be reduced to the lowest effective dose, which could be as low as 1 spray (25 micrograms) in each nostril once daily, totaling 50 micrograms per day.

For adolescents aged 15 years and older:

• The usual starting dose is 2 sprays (50 micrograms) in each nostril twice a day, totaling 200 micrograms per day.
• If necessary, this can be increased to 2 sprays in each nostril three times a day, totaling 300 micrograms per day.
• The maximum daily dose is 8 sprays per nostril per day, totaling 400 micrograms per day.
• Once symptoms are controlled, the dosage should be reduced to the lowest effective dose, which could be 1 spray (25 micrograms) in each nostril once daily, totaling 50 micrograms per day.

Pregnancy Risk Factor C

• During pregnancy, flunisolide falls into category C, which means there's a possibility of adverse effects seen in animal studies.
• However, intranasal corticosteroids like flunisolide are still considered safe for treating rhinitis during pregnancy, according to guidelines from the National Asthma Education and Prevention Program (NAEPP) and other sources.
• It's important for pregnant individuals to use the lowest effective dose of flunisolide to minimize any potential risks.

Flunisolide use during breastfeeding:

• While some corticosteroids have been detected in breast milk, it's unclear if flunisolide, when inhaled, leads to detectable amounts in breast milk.
• However, according to the National Asthma Education and Prevention Program (NAEPP), using inhaled corticosteroids like flunisolide is generally considered safe during breastfeeding.
• Nonetheless, the manufacturer advises caution when administering flunisolide to nursing mothers.

Dose in Kidney Disease:

• The manufacturer's labeling for flunisolide does not include specific dosage adjustments for individuals with renal impairment.
• This suggests that no dosage adjustments are necessary for people with kidney problems when using flunisolide.

Dose in Liver disease:

• The manufacturer's labeling for flunisolide does not specify any dosage adjustments for individuals with hepatic impairment.
• This implies that no specific dosage adjustments are recommended for people with liver problems when using flunisolide.

Common Side Effects of Flunisolide Nasal Spray:

• Respiratory:
  • Nasal congestion
  • The stinging sensation of the nose
• Dermatologic:
  • Burning sensation in the nose

Less Common Side Effects of Flunisolide Nasal Spray:

• Respiratory:
  • Rhinitis
  • Sneezing
  • Dry nose
  • Nasal mucosa irritation
• Central nervous system:
  • Anosmia

Contraindications to Flunisolide Nasal Spray:

• Flunisolide should not be used if you have a known hypersensitivity to flunisolide or any of the ingredients in the formulation.
• It's essential to check the ingredients list for any potential allergens before using the medication.
• Additionally, while documentation of allergenic cross-reactivity for intranasal steroids is limited, there's a possibility of cross-sensitivity due to similarities in chemical structure and pharmacologic actions.
• In Canada, there are additional contraindications not listed in the US labeling, including active or quiescent tuberculosis, untreated fungal, bacterial, or viral infections, and the use of flunisolide is not recommended for children under 6 years old.

Warnings and Precautions

Delayed wound healing:

• If you have recently had nasal septal ulcers, nasal surgery, or nasal trauma, it's important to avoid using nasal corticosteroids like flunisolide until the affected area has fully healed.
• This is because corticosteroids may delay wound healing and could potentially worsen the condition.
• It's crucial to allow the nasal tissues to heal properly before resuming the use of nasal corticosteroids.

Flunisolide (nasal): Drug Interaction

Monitoring Parameters:

None mentioned.

How to administer Flunisolide Nasal Spray?

Before First Use:

• Prime the nasal spray pump by pressing it 5-6 times until you see a fine mist.
• Repeat priming if you haven't used the spray for more than 5 days or if you've disassembled it for cleaning.

Administration:

• Use the nasal spray at regular intervals as prescribed by your healthcare provider.
• Before using the spray, blow your nose gently to clear your nostrils.

Application:

• Hold the bottle upright and insert the applicator tip into one nostril, keeping the other nostril closed.
• Breathe in gently through your nose.
• While breathing in, press down on the pump to release the spray.
• Repeat the process for the other nostril if directed by your doctor.

Mechanism of action of Flunisolide:

• Flunisolide works by reducing inflammation in the body.
• It does this by stopping certain white blood cells (called polymorphonuclear leukocytes) from moving to the site of inflammation and by reversing increased leakage from tiny blood vessels (capillaries).
• Importantly, flunisolide does not affect the hypothalamus, a part of the brain responsible for regulating various bodily functions.

Absorption:

• About 50% of flunisolide is absorbed into the body after administration.
• This means that roughly half of the medication enters the bloodstream and is available to produce its effects.

International Brand Names of Flunisolide:

• APO-Flunisolide
• Rhinalar

Flunisolide Brand Names in Pakistan:

Flunisolide is a corticosteroid medication used to treat asthma, allergic rhinitis (hay fever), and nasal polyps. It works by reducing inflammation in the nasal passages and airways, thereby relieving symptoms such as congestion, sneezing, itching, and runny nose. Flunisolide is typically administered as a nasal spray, which delivers the medication directly to the nasal tissues.

Like other corticosteroids, flunisolide can have side effects, although they are generally mild when used properly. Common side effects may include nasal irritation, dryness, or bleeding, as well as throat irritation or coughing. In some cases, long-term use of corticosteroid nasal sprays like flunisolide can lead to more serious side effects such as nasal septum perforation, glaucoma, or cataracts, though these are rare.

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 utilized to treat the nasal symptoms brought on by either seasonal or persistent 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):

• Start with two sprays, which equals 50 micrograms, in each nostril two times a day. This means you use the spray in the morning and again in the evening, totaling 200 micrograms per day.
• If needed, your doctor may suggest increasing the dose to two sprays in each nostril three times a day. This would be a total of 300 micrograms per day.
• The maximum recommended dose is eight sprays in each nostril per day, totaling 400 micrograms per day.

Flunisolide Nasal Spray Dose in Children

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

For children aged 6 to 14 years with seasonal or perennial rhinitis, the typical initial dose of flunisolide nasal spray is:

• Either 1 spray (25 micrograms) in each nostril three times a day, or
• 2 sprays (50 micrograms) in each nostril twice a day.

This amounts to a total daily dose of 150 to 200 micrograms. The maximum daily dose for this age group is 4 sprays per nostril per day, totaling 200 micrograms per day. Once symptoms are under control, the dosage should be reduced to the lowest effective dose, which could be as low as 1 spray (25 micrograms) in each nostril once daily, totaling 50 micrograms per day.

For adolescents aged 15 years and older:

• The usual starting dose is 2 sprays (50 micrograms) in each nostril twice a day, totaling 200 micrograms per day.
• If necessary, this can be increased to 2 sprays in each nostril three times a day, totaling 300 micrograms per day.
• The maximum daily dose is 8 sprays per nostril per day, totaling 400 micrograms per day.
• Once symptoms are controlled, the dosage should be reduced to the lowest effective dose, which could be 1 spray (25 micrograms) in each nostril once daily, totaling 50 micrograms per day.

Pregnancy Risk Factor C

• During pregnancy, flunisolide falls into category C, which means there's a possibility of adverse effects seen in animal studies.
• However, intranasal corticosteroids like flunisolide are still considered safe for treating rhinitis during pregnancy, according to guidelines from the National Asthma Education and Prevention Program (NAEPP) and other sources.
• It's important for pregnant individuals to use the lowest effective dose of flunisolide to minimize any potential risks.

Flunisolide use during breastfeeding:

• While some corticosteroids have been detected in breast milk, it's unclear if flunisolide, when inhaled, leads to detectable amounts in breast milk.
• However, according to the National Asthma Education and Prevention Program (NAEPP), using inhaled corticosteroids like flunisolide is generally considered safe during breastfeeding.
• Nonetheless, the manufacturer advises caution when administering flunisolide to nursing mothers.

Dose in Kidney Disease:

• The manufacturer's labeling for flunisolide does not include specific dosage adjustments for individuals with renal impairment.
• This suggests that no dosage adjustments are necessary for people with kidney problems when using flunisolide.

Dose in Liver disease:

• The manufacturer's labeling for flunisolide does not specify any dosage adjustments for individuals with hepatic impairment.
• This implies that no specific dosage adjustments are recommended for people with liver problems when using flunisolide.

Common Side Effects of Flunisolide Nasal Spray:

• Respiratory:
  • Nasal congestion
  • The stinging sensation of the nose
• Dermatologic:
  • Burning sensation in the nose

Less Common Side Effects of Flunisolide Nasal Spray:

• Respiratory:
  • Rhinitis
  • Sneezing
  • Dry nose
  • Nasal mucosa irritation
• Central nervous system:
  • Anosmia

Contraindications to Flunisolide Nasal Spray:

• Flunisolide should not be used if you have a known hypersensitivity to flunisolide or any of the ingredients in the formulation.
• It's essential to check the ingredients list for any potential allergens before using the medication.
• Additionally, while documentation of allergenic cross-reactivity for intranasal steroids is limited, there's a possibility of cross-sensitivity due to similarities in chemical structure and pharmacologic actions.
• In Canada, there are additional contraindications not listed in the US labeling, including active or quiescent tuberculosis, untreated fungal, bacterial, or viral infections, and the use of flunisolide is not recommended for children under 6 years old.

Warnings and Precautions

Delayed wound healing:

• If you have recently had nasal septal ulcers, nasal surgery, or nasal trauma, it's important to avoid using nasal corticosteroids like flunisolide until the affected area has fully healed.
• This is because corticosteroids may delay wound healing and could potentially worsen the condition.
• It's crucial to allow the nasal tissues to heal properly before resuming the use of nasal corticosteroids.

Flunisolide (nasal): Drug Interaction

Monitoring Parameters:

None mentioned.

How to administer Flunisolide Nasal Spray?

Before First Use:

• Prime the nasal spray pump by pressing it 5-6 times until you see a fine mist.
• Repeat priming if you haven't used the spray for more than 5 days or if you've disassembled it for cleaning.

Administration:

• Use the nasal spray at regular intervals as prescribed by your healthcare provider.
• Before using the spray, blow your nose gently to clear your nostrils.

Application:

• Hold the bottle upright and insert the applicator tip into one nostril, keeping the other nostril closed.
• Breathe in gently through your nose.
• While breathing in, press down on the pump to release the spray.
• Repeat the process for the other nostril if directed by your doctor.

Mechanism of action of Flunisolide:

• Flunisolide works by reducing inflammation in the body.
• It does this by stopping certain white blood cells (called polymorphonuclear leukocytes) from moving to the site of inflammation and by reversing increased leakage from tiny blood vessels (capillaries).
• Importantly, flunisolide does not affect the hypothalamus, a part of the brain responsible for regulating various bodily functions.

Absorption:

• About 50% of flunisolide is absorbed into the body after administration.
• This means that roughly half of the medication enters the bloodstream and is available to produce its effects.

International Brand Names of Flunisolide:

• APO-Flunisolide
• Rhinalar

Flunisolide Brand Names in Pakistan: