Usage
- Fluticasone Furoate + Oxymetazoline nasal spray is prescribed for the treatment of perennial allergic rhinitis, particularly when nasal congestion is a prominent symptom. Perennial allergic rhinitis is a persistent inflammatory condition affecting the nasal passages, causing symptoms like sneezing, runny nose, congestion, and watery eyes, lasting for extended periods throughout the year.
- Pharmacological Classification: This drug is a combination product containing a corticosteroid (Fluticasone Furoate) and a decongestant (Oxymetazoline).
- Mechanism of Action: Fluticasone Furoate, a synthetic corticosteroid, exerts anti-inflammatory action by inhibiting the release of inflammatory mediators. Oxymetazoline, an α-adrenergic agonist, acts as a decongestant by constricting blood vessels in the nasal mucosa, reducing swelling and congestion.
Alternate Names
- While there isn’t a widely recognized international nonproprietary name (INN) for this combination specifically, it’s commonly referred to as Fluticasone Furoate + Oxymetazoline.
- Brand Names: The combination is marketed under various brand names depending on the region. (Brand names were not provided in the sources)
How It Works
- Pharmacodynamics: Fluticasone Furoate suppresses inflammation by inhibiting multiple inflammatory pathways, including the release of inflammatory cytokines and the activity of inflammatory cells. Oxymetazoline stimulates α-adrenergic receptors in the nasal vasculature, causing vasoconstriction and reducing nasal blood flow. The combined action leads to relief from nasal congestion and other allergic rhinitis symptoms.
- Pharmacokinetics: Fluticasone Furoate, when administered intranasally, is minimally absorbed into the systemic circulation. Oxymetazoline, also minimally absorbed systemically after nasal application, undergoes some hepatic metabolism. Both drugs are primarily eliminated through fecal excretion, though some renal elimination also takes place for oxymetazoline.
- Mode of Action: Fluticasone Furoate binds to glucocorticoid receptors in the cytoplasm, modulating gene transcription and ultimately decreasing the production of inflammatory mediators. Oxymetazoline acts directly on α-adrenergic receptors on vascular smooth muscle, leading to vasoconstriction.
Dosage
Standard Dosage
Adults:
- The typical starting dose is two sprays in each nostril once daily, preferably in the evening.
- The dose may be reduced to one spray per nostril once daily for maintenance therapy.
- The maximum daily dose should not exceed two sprays per nostril twice daily.
Children (6 to 11 years):
- The starting dose is one spray in each nostril once daily.
- If the response is inadequate, the dose can be increased to two sprays in each nostril once daily.
- Once symptoms are controlled, the dose should be reduced back to one spray per nostril daily.
- Use in children younger than six years is not recommended.
Special Cases:
- Elderly Patients: Dosage adjustments are usually not necessary. However, close monitoring is advised.
- Patients with Renal Impairment: No specific dose adjustments are typically required.
- Patients with Hepatic Dysfunction: While significant systemic absorption is minimal, cautious use and monitoring are warranted.
- Patients with Comorbid Conditions: For patients with conditions like diabetes, hypertension, hyperthyroidism, or heart disease, careful monitoring is essential.
Dosage Adjustments Dosage adjustments might be necessary based on individual patient responses and tolerability.
Side Effects
Common Side Effects
- Nasal irritation or dryness
- Headache
- Nosebleeds
- Altered taste
Rare but Serious Side Effects
- Severe or persistent sore throat
- Facial pain or pressure
- White patches in the nose or throat
- Vision changes (blurred vision, cataracts, glaucoma)
- Worsening nasal symptoms
Long-Term Effects Potential long-term effects may include adrenal suppression, growth retardation in children, glaucoma, and cataracts with prolonged use at high doses. These effects are less likely with intranasal use than with systemic corticosteroids.
Adverse Drug Reactions (ADR) Clinically significant ADRs include severe allergic reactions, nasal septum perforation, and systemic corticosteroid effects.
Contraindications
- Hypersensitivity to fluticasone furoate or oxymetazoline
- Recent nasal surgery or trauma
- Untreated nasal infections
- Narrow-angle glaucoma
Drug Interactions
- Tricyclic antidepressants (e.g., amitriptyline)
- MAO inhibitors (e.g., phenelzine)
- Some antifungal medications (e.g., ketoconazole)
- Ritonavir (HIV medication)
- Caffeine and grapefruit juice (potential interaction with oxymetazoline)
Pregnancy and Breastfeeding
- Pregnancy: Use only if the potential benefit to the mother outweighs the potential risk to the fetus. While fluticasone furoate’s systemic absorption is minimal, some corticosteroids have shown teratogenic effects in animal studies.
- Breastfeeding: Limited information is available regarding drug excretion in breast milk. The decision to breastfeed while using this medication should consider the balance of potential benefits and risks.
Drug Profile Summary
- Mechanism of Action: Fluticasone furoate: Corticosteroid with anti-inflammatory effects. Oxymetazoline: α-adrenergic agonist causing vasoconstriction and decongestion.
- Side Effects: Common: Nasal irritation, headache, nosebleeds. Serious: Vision changes, adrenal suppression, nasal septum perforation.
- Contraindications: Hypersensitivity, recent nasal surgery, untreated nasal infection, narrow-angle glaucoma.
- Drug Interactions: TCAs, MAOIs, some antifungals, ritonavir.
- Pregnancy & Breastfeeding: Use with caution; potential fetal risk. Minimal data on breastfeeding; weigh benefits and risks.
- Dosage: Adults: Initially, two sprays per nostril once daily, may reduce to one spray. Children (6-11): One spray per nostril daily, may increase to two.
- Monitoring Parameters: Monitor for local nasal effects, systemic corticosteroid effects (with long-term use), and potential drug interactions.
Popular Combinations The provided sources do not mention any specific combinations.
Precautions
- Avoid prolonged or excessive use of oxymetazoline to prevent rebound congestion.
- Monitor for potential drug interactions.
- Evaluate patients with existing medical conditions like diabetes, hypertension, or thyroid disorders carefully.
- Advise pregnant or breastfeeding women about the potential risks and benefits.
FAQs (Frequently Asked Questions)
A: Adults: Start with two sprays in each nostril once daily, preferably in the evening. Children (6-11 years): One spray in each nostril once daily, which can be increased to two sprays if needed.
A: It’s generally recommended to limit the use of oxymetazoline to a maximum of 3-5 days to minimize the risk of rebound congestion.
Q3: Can children under 6 use this medication?
A: No, this medication is not recommended for children under 6 years of age.
A: Pregnant women should consult their healthcare provider to weigh the potential benefits against the possible risks to the fetus before using this medication.
Q5: What are the common side effects of this nasal spray?
A: Common side effects include nasal irritation, dryness, headache, nosebleeds, and changes in taste perception.
Q6: Can I use this nasal spray if I have glaucoma?
A: Patients with narrow-angle glaucoma should not use this medication.
Q7: Are there any drug interactions I should be aware of?
A: Yes, this medication can interact with certain medications, including tricyclic antidepressants, MAO inhibitors, and some antifungal medications. Inform your doctor about all the medications you are currently taking.
Q8: What should I do if I experience severe nosebleeds while using this spray?
A: Discontinue use and consult your doctor immediately if you experience severe or persistent nosebleeds.
Q9. What is the difference between seasonal and perennial allergic rhinitis?
A: Seasonal allergic rhinitis (hay fever) is triggered by specific allergens like pollen and occurs during particular seasons. Perennial allergic rhinitis, however, persists throughout the year and is often caused by indoor allergens like dust mites, pet dander, or mold.
A: The combination offers the convenience of treating both inflammation and congestion with a single product. It may be more effective in relieving congestion than using fluticasone furoate alone. However, using oxymetazoline separately for short periods may be sufficient for mild, intermittent congestion. Your doctor can help determine the best approach.
