Rhinitis (seasonal/perennial): Intranasal: Two sprays (50 mcg) in each nostril twice daily (total daily dose: 200 mcg/day); may increase to 2 sprays in each nostril 3 times daily (total daily dose: 300 mcg/day); maximum dose: 8 sprays/day in each nostril (total daily dose: 400 mcg/day)
There are no dosage adjustment provided in manufacturer's labeling.
There are no dosage adjustment provided in manufacturer's labeling.
(For additional information see "Flunisolide (nasal): Pediatric drug information")
Seasonal and perennial rhinitis: Intranasal (25 mcg/spray):
Children ≥6 years and Adolescents ≤14 years: Initial: 1 spray (25 mcg) per nostril 3 times daily or 2 sprays (50 mcg) per nostril twice daily (total daily dose: 150 to 200 mcg/day); maximum daily dose: 4 sprays per nostril/day (200 mcg/day); once symptoms are controlled, the dose should be reduced to the lowest effective dose; 1 spray (25 mcg) per nostril once daily may be effective in some patients (total daily dose: 50 mcg/day)
Adolescents ≥15 years: Initial: 2 sprays (50 mcg) per nostril twice daily (total daily dose: 200 mcg/day); if needed, may increase to 2 sprays (50 mcg) per nostril 3 times daily (total daily dose: 300 mcg/day); maximum daily dose: 8 sprays per nostril/day (400 mcg/day); once symptoms are controlled, the dose should be reduced to the lowest effective dose; 1 spray (25 mcg) per nostril once daily may be effective in some patients (total daily dose: 50 mcg/day)
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Nasal:
Generic: 25 mcg/actuation (0.025%) (25 mL)
Yes
Before first use, prime by pressing pump 5-6 times or until a fine spray appears. Repeat priming if ≥5 days between use, or if dissembled for cleaning. Administer at regular intervals. Blow nose to clear nostrils. Insert applicator into nostril, keeping bottle upright, and close off the other nostril. Breathe in through nose. While inhaling, press pump to release spray.
For intranasal use only. Shake well prior to each use. Before first use, prime by pressing pump 5 to 6 times or until a fine spray appears. Repeat priming if ≥5 days between use or if dissembled for cleaning. Administer at regular intervals. Blow nose to clear nostrils. Insert applicator into nostril, keeping bottle upright, and close off the other nostril. Breathe in through nose. While inhaling, press pump to release spray. Do not spray into eyes. Discard after labeled number of doses has been used, even if bottle is not completely empty.
Rhinitis: Management of the nasal symptoms associated with seasonal or perennial rhinitis
Acute bacterial rhinosinusitis, adjunct to antibiotics (empiric treatment); Chronic rhinosinusitis; Non-allergic rhinitis; Symptomatic relief of viral rhinosinusitis
Flunisolide may be confused with Flumadine®, fluocinonide
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
Frequency not always defined.
>10%:
Dermatologic: Burning sensation of the nose (≤13%)
Respiratory: Nasal congestion (15%), stinging sensation of the nose (≤13%)
1% to 10%:
Central nervous system: Anosmia
Respiratory: Dry nose, nasal mucosa irritation, rhinitis, sneezing
<1%, postmarketing, and/or case reports: Nasal mucosa ulcer
Hypersensitivity to flunisolide or any component of the formulation
Documentation of allergenic cross-reactivity for intranasal steroids is limited; however, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty.
Canadian labeling: Additional contraindications (not in US labeling): Active or quiescent tuberculosis; untreated fungal, bacterial, or viral infections; children <6 years
Concerns related to adverse effects:
• Delayed wound healing: Avoid nasal corticosteroid use in patients with recent nasal septal ulcers, nasal surgery or nasal trauma until healing has occurred.
Special populations:
• Pediatric: Avoid using higher than recommended dosages; suppression of linear growth (ie, reduction of growth velocity), reduced bone mineral density, or hypercortisolism (Cushing's syndrome) may occur; titrate to lowest effective dose. Reduction in growth velocity may occur when corticosteroids are administered to pediatric patients, even at recommended doses via intranasal route (monitor growth).
Substrate of CYP3A4 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential
Esketamine: Corticosteroids (Nasal) may diminish the therapeutic effect of Esketamine. Management: Patients who require a nasal corticosteroid on an esketamine dosing day should administer the nasal corticosteroid at least 1 hour before esketamine. Risk D: Consider therapy modification
An agent with less systemic absorption is preferred for the treatment of allergic rhinitis during pregnancy (BSACI [Scadding 2017]).
It is not known if sufficient quantities of flunisolide are absorbed following inhalation to produce detectable amounts in breast milk.
Other corticosteroids have been found in breast milk; therefore, the manufacturer recommends caution be used if administered to a breastfeeding woman.
Decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability; does not depress hypothalamus
Absorption: ~50%
Solution (Flunisolide Nasal)
25 MCG/ACT (0.025%) (per mL): $2.88
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