Fluticasone Nasal Spray (patient information)

# Why this medication is prescribed
Fluticasone nasal spray is used to treat the symptoms of seasonal (occurs only at certain times of year), and perennial (occurs all year round) allergic rhinitis and perennial nonallergic rhinitis. These symptoms include sneezing and stuffy, runny, or itchy nose. Fluticasone is in a class of medications called corticosteroids. It works by preventing and decreasing inflammation (swelling that can cause other symptoms) in the nose.

# How this medication should be used
Fluticasone comes as a liquid to spray in the nose. It is usually sprayed in each nostril once daily or twice daily in the morning and evening. It is sometimes used only as needed to treat symptoms. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use fluticasone exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.
Fluticasone nasal spray is only for use in the nose. Do not swallow the nasal spray and be careful not to spray it in your eyes.
Your doctor will probably start you on a high dose of fluticasone nasal spray and may decrease your dose after your symptoms are controlled.
Fluticasone nasal spray controls the symptoms of rhinitis but does not cure the condition. Your symptoms will probably not begin to improve for at least 12 hours after you first use fluticasone, and it may take several days or longer before you feel the full benefit of fluticasone. Fluticasone works best when used regularly. Use fluticasone on a regular schedule unless your doctor has told you to use it as needed. Continue to use fluticasone even if you feel well. Do not stop using fluticasone without talking to your doctor.
Each bottle of fluticasone nasal spray is designed to provide 120 sprays. The bottle might not be empty after 120 sprays have been used, but each spray might not contain the correct amount of medication. You should keep track of the number of sprays you have used and throw away the bottle after you have used 120 sprays even if it still contains some liquid.
To use the nasal spray, follow these steps:
- Shake the bottle gently.
- Remove the dust cover.
- If you are using the pump for the first time or have not used it for a week or more, you must prime it by following steps 4-5 below. If you have used the pump in the past week, skip to step 6.
- Hold the pump with the applicator between your forefinger and middle finger and the bottom of the bottle resting on your thumb. Point the applicator away from your body.
- If you are using the pump for the first time, press down and release the pump six times. If you have used the pump before, but not within the past week, press down and release the pump until you see a fine spray.
- Blow your nose until your nostrils are clear.
- Hold one nostril closed with your finger.
- Tilt your head slightly forward and carefully put the nasal applicator into your other nostril. Be sure to keep the bottle upright.
- Hold the pump with the applicator between your forefinger and middle finger and the bottom resting on your thumb.
- Begin to breathe in through your nose.
- While you are breathing in, use your forefinger and middle finger to press firmly down on the applicator and release a spray.
- Breathe gently in through the nostril and breathe out through your mouth.
- If your doctor told you to use two sprays in that nostril, repeat steps 6-12.
- Repeat steps 6-13 in the other nostril.
- Wipe the applicator with a clean tissue and cover it with the dust cover.

# Other uses for this medicine
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

# Special precautions
Before using fluticasone nasal spray:
- tell your doctor and pharmacist if you are allergic to fluticasone, or any other medications.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or have recently taken. Be sure to mention any of the following: amiodarone (Cordarone); antifungals such as fluconazole (Diflucan), itraconazole (Sporanox), and ketoconazole (Nizoral); cimetidine (Tagamet); clarithromycin (Biaxin); cyclosporine (Neoral, Sandimmune); danazol (Danocrine); delavirdine (Rescriptor); diltiazem (Cardizem, Dilacor, Tiazac); fluoxetine (Prozac, Sarafem); fluvoxamine (Luvox); HIV protease inhibitors such as indinavir (Crixivan) nelfinavir (Viracept), ritonavir (Norvir) and saquinavir (Fortovase, Invirase); isoniazid (INH, Nydrazid); metronidazole (Flagyl); nefazodone (Serzone); oral contraceptives (birth control pills); oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), and prednisone (Deltasone); paroxetine (Paxil); steroids that are inhaled by mouth such as beclomethasone (QVAR), budesonide (Pulmicort), flunisolide (Aerobid), fluticasone (Flovent), and triamcinolone (Azmacort); troleandomycin (TAO); verapamil (Calan, Covera, Isoptin, Verelan); and zafirlukast (Accolate). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you have or have ever had tuberculosis (a type of infection) in your lungs, cataracts (clouding of the lens of the eye), or glaucoma (an eye disease), and if you now have sores in your nose, any type of untreated infection, or a herpes infection (a type of infection that causes a sore on the eyelid or eye surface) in your eye. Also tell your doctor if you have recently had surgery on your nose or injured your nose in any way.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking fluticasone, call your doctor.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking fluticasone.
- if you have been taking oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), prednisolone (Pediapred, Prelone) or prednisone (Deltasone), your doctor may want to gradually decrease your steroid dose after you begin using fluticasone. *Special caution is needed for several months as your body adjusts to the change in medication. *If you have any other medical conditions, such as arthritis, or eczema (a skin disease), they may worsen when your oral steroid dose is decreased. Tell your doctor if this happens or if you experience any of the following symptoms during this time: extreme tiredness, muscle weakness or pain; sudden pain in stomach, lower body or legs; loss of appetite; weight loss; upset stomach; vomiting; diarrhea; dizziness; fainting; depression; irritability; and darkening of skin. Your body may be less able to cope with stress such as surgery, illness, severe asthma attack, or injury during this time. Call your doctor right away if you get sick and be sure that all health care providers who treat you know that you recently replaced your oral steroid with fluticasone inhalation. Carry a card or wear a medical identification bracelet to let emergency personnel know that you may need to be treated with steroids in an emergency.
- you should know that fluticasone may decrease your ability to fight infection. Stay away from people who are sick and wash your hands often. Be especially careful to stay away from people who have chicken pox or measles. Tell your doctor right away if you find out that you have been around someone who hads one of these viruses.

# Special dietary instructions
Talk to your doctor about drinking grapefruit juice while taking this medication.

# What to do if you forget a dose
Use the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not use a double dose to make up for a missed one.

# Side effects

## Minor side effects
Fluticasone may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- headache
- nosebleed
- burning or irritation in the nose
- runny nose
- bloody mucus in nose
- cough
- upset stomach
- vomiting
- stomach pain
- diarrhea
- dizziness

## Severe side effects
Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:
- painful white patches in nose or throat
- flu-like symptoms
- sore throat
- vision problems
- injury to nose
- new or increased acne (pimples)
- easy bruising
- enlarged face and neck
- extreme tiredness
- muscle weakness
- irregular menstruation (periods)
- hives
- rash
- itching
- swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
- hoarseness
- difficulty breathing or swallowing
- wheezing
Fluticasone may cause children to grow more slowly. It is not known whether using fluticasone decreases the final adult height that children will reach.Talk to your child's doctor about the risks of giving this medication to your child.
Fluticasone may cause other side effects. Call your doctor if you have any unusual problems while using this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online  or by phone .

# Storage conditions needed for this medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

# In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
Using too much fluticasone on a regular basis over a long period of time may cause the following symptoms:
- enlarged face and neck
- new or worsening acne
- easy bruising
- extreme tiredness
- muscle weakness
- irregular menstrual periods
- loss of appetite
- weight loss
- irritability
- depression
- fainting or dizziness when standing up from a sitting or lying position
- darkening of skin

# Other information
Keep all appointments with your doctor.
You should clean your nasal spray applicator once a week. You will need to remove the dust cap and then pull on the applicator to remove it from the bottle. Wash the dust cap and applicator in warm water, let them dry at room temperature, and then put them back on the bottle. If the applicator is clogged, soak it in warm water and then rinse it in cold water and dry it. Do not use pins or other sharp objects to remove the blockage.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

# Brand names
- Flonase Nasal Spray