flunisolide intranasal (Rx)

Brand and Other Names:
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

nasal spray

  • 25mcg/actuation
  • 29mcg/actuation
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Seasonal Allergic Rhinitis

2 sprays each nostril BID; may increase to TID/QID

Administration

Prime spray by actuating 5-6 times first before use, if it has not been used for >4 days, or if it has been disassembled for cleaning

Dosage Forms & Strengths

nasal spray

  • 25mcg/actuation
  • 29mcg/actuation
more...

Seasonal Allergic Rhinitis

<6 years: Safety and efficacy not established

6-14 years: 1 spray each nostril TID, or 2 sprays each nostril BID

Administration

Prime spray by actuating 5-6 times first before use, if it has not been used for >4 days, or if it has been disassembled for cleaning

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Adverse Effects

>10%

Nasal burning/stinging (13-44%)

Aftertaste (8-17%)

1-10%

Nausea

Epistaxis

Nasal dryness

Pharyngitis

Cough increased

<1%

Hoarseness

Nasal ulceration

Abnormal sense of smell

Sinusitis

Vertical growth suppression

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Warnings

Contraindications

Hypersensitivity

Do not use with untreated local infection involving the nasal mucosa

Recent nasal surgery/injury

Cautions

Replacement of systemic corticosteroids with topical administration can be accompanied by signs of adrenal insufficiency: some patients may experience withdrawal symptoms

Intranasal corticosteroids may cause a reduction in growth velocity when administered to pediatric patients Rare reports of nasal septal perforation

Temporary or permanent loss of sense of smell or taste reported

Because of the inhibitory effect of corticosteroids on wound healing, a nasal corticosteroid should be used with caution in patients who have experienced recent nasal septal ulcers, recurrent epistaxis, nasal surgery or trauma, until healing has occurred

Systemic corticoid effects typical of Cushing's syndrome are minimal with recommended doses of topical steroids, this potential increases with excessive doses

Corticosteroids are known to cause immunosuppression resulting in increased susceptibility to infection

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Pregnancy & Lactation

Pregnancy Category: C

Lactation: Corticosteroids are known to be secreted in breast milk

Pregnancy Categories

A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA:Information not available.

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Pharmacology

Mechanism of Action

Elicits potent glucocorticoid and weak mineralocorticoid effects; provides direct anti-inflammatory actions to nasal mucosa

Absorption

Bioavailability: 50% (intranasal); 20% (PO) due high first-pass liver metabolism

Metabolism

Converted by the liver to the much less active primary metabolite and to glucuronide and sulfate conjugates

Elimination

Half-life: 1-2 hr

Excretion: 50% feces; 50% urine

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Formulary

FormularyPatient Discounts

Adding plans allows you to compare formulary status to other drugs in the same class.

To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

Adding plans allows you to:

  • View the formulary and any restrictions for each plan.
  • Manage and view all your plans together – even plans in different states.
  • Compare formulary status to other drugs in the same class.
  • Access your plan list on any device – mobile or desktop.

The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

Tier Description
1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
NC NOT COVERED – Drugs that are not covered by the plan.
Code Definition
PA Prior Authorization
Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
QL Quantity Limits
Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
ST Step Therapy
Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
OR Other Restrictions
Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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