Intranasal Steroid

Aka: Intranasal Steroid, Corticosteroid Intranasal, Nasacort, Rhinocort, Nasarel, Beconase, Vancenase, Flonase

1. Efficacy of Intranasal Steroids
   1. Significantly reduced symptoms
      1. Reduced nasal obstruction
      2. Reduced Rhinorrhea, sneezing, and nasal itching
      3. By comparison, Seldane was same as Placebo
   2. Reference
      1. Bronsky (1996) J Allergy Clin Immunol 97:915-21
2. Safety
   1. Appears safe in children as young as age 2 years
      1. No hypothalamic-pituitary-adrenal axis suppression
      2. Galant (2003) Pediatrics 112:96-100
   2. Pregnancy Category: C (unless otherwise noted)
3. Adverse Effects
   1. Epistaxis
      1. Reduced by spraying away from septum
      2. Use left hand when spraying right nostril
      3. Use right hand when spraying left nostril
      4. (2004) Prescribers Letter 11(1):2
4. General
   1. Aqueous Preparations: Better for dry nose, winter
      1. Moisturizing: Nasarel (Flunisolide)
      2. Moisture neutral: Nasocort AQ and Rhinocort AQ
      3. Drying agents (Alcohol): most AQ agents
   2. Non-Aqueous: Better for "wet", watery nose
5. Preparations: Low potency agents (especially in children)
   1. Triamcinolone acetonide (Nasacort)
      1. Dose (age 6 and older): 1-2 sprays per nostril daily
      2. Relative potency: 1
   2. Mometasone (Nasonex)
      1. Dose (2 years and older): 1 spray each nostril daily (adults should use 2 sprays each nostril)
      2. Relative potency: 1
6. Preparations: Medium potency agents
   1. Flunisolide (Nasalide)
      1. Dose: 2 sprays per nostril twice daily
      2. Relative potency: 3
      3. Age 6 years and older
   2. Beclomethasone (Beclovent)
      1. Dose (age 6 and older): 1-2 sprays per nostril twice daily
      2. Relative potency: 5
      3. Pregnancy Category B
7. Preparations: Higher potency agents
   1. Budesonide (Rhinocort)
      1. Dose (age 6 to older): 1-2 sprays each nostril daily
      2. Adults may bolus start with 4 sprays/nostril daily for 1 week then use standard dose (1-2 sprays)
      3. Relative potency: 10
   2. Fluticasone propionate (Flonase)
      1. Dose (age 12 years and older): 1-2 sprays per nostril daily
      2. Relative potency: 10
   3. Qvar 80 mg (use oral inhaler with baby bottle nipple as nasal adapter)
      1. Dose: 1-2 sprays each nostril daily
8. References
   1. Wallace (2008) J Allergy Clin Immunol 122(2 suppl):S21