Flunisolide

A to Z Drug Facts

 Action Has local anti-inflammatory activity on lung or nasal mucosa with minimal systemic effect. May decrease number and activity of cells involved in inflammatory response and enhance effect of other drugs or endogenous substances that aid in bronchodilation.

 Indications

Inhalation: Control of bronchial asthma and related bronchospastic states for patients requiring chronic treatment with corticosteroids.

Intranasal: Symptoms of perennial or seasonal rhinitis. Unlabeled use(s): Treatment of serous otitis media in children and treatment of polyps.

 Contraindications Primary treatment of status asthmaticus or acute asthma when intensive measures are required; systemic fungal infections; persistently positive Candida albicans sputum culture; untreated local infection of the nasal mucosa (intranasal use).

 Route/Dosage

ADULTS AND CHILDREN 6 TO 15 YR: Inhalation 2 inhalations (500 mcg) bid. ADULTS: Do not exceed 4 inhalations bid (2 mg/day). CHILDREN: Do not exceed 2 inhalations bid. ADULTS: Intranasal Initial dose: 2 sprays (50 mcg) in each nostril bid. Max: 8 sprays in each nostril daily. CHILDREN 6 TO 14 YR: Initial dose: 1 spray (25 mcg) in each nostril tid or 2 sprays in each nostril bid. Max: 4 sprays in each nostril daily.

 Interactions None well documented.

 Lab Test Interferences

Fluticasone: Use caution when coadministering ketoconazole and other known cytochrome P450 inhibitors.

 Adverse Reactions

CNS: Headache, lightheadedness (inhalation, intranasal). DERM: Rash, facial edema (inhalation). GI: Dry mouth. META: Suppression of hypothalamic-pituitary-adrenal (HPA) function (inhalation). RESP: Throat irritation, hoarseness, dysphonia, coughing, wheezing, pharyngeal fungal infections, pulmonary infiltrates (inhalation); nasopharyngeal irritation, burning, stinging, rebound congestion, bronchial asthma, sneezing, rhinorrhea (intranasal). OTHER: Hypersensitivity reaction (eg, urticaria, angioedema, rash, bronchospasm, edema of face and tongue, pruritus, wheezing, dyspnea).

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Because other corticosteroids are excreted in human milk, use caution. Children: Safety and efficacy in children less than 6 yr not established. Oral corticosteroids may suppress growth in children and adolescents, particularly with higher doses over extended periods. Acute asthma: Not indicated for rapid relief of bronchospasm. Fungal infections: Antifungal therapy and discontinuance of steroid may be necessary. Hypersensitivity: Immediate and delayed reactions have occurred. Immunology: Patients receiving immunosuppressant agents are more susceptible to infections than healthy adults. If a patient is exposed to measles or chickenpox, appropiate prophylaxis and treatment may be indicated. Route change: Particular caution is needed when transferring patient from systemically active corticosteroids to flunisolide inhaler because deaths caused by adrenal insufficiency have occurred in asthmatic patients during and after transfer from systemic to aerosol corticosteroids. Systemic effects: Use cautiously in patients taking alternate-day prednisone; may increase likelihood of HPA suppression. Exceeding recommended dose may cause systemic effects.

 Administration/Storage

• Before nasal inhalation, have patient blow nose gently to clear nasal passages. A decongestant may be used 5 to 10 min before administration to ensure adequate penetration of spray if nasal passages are congested. Clean outer portion of nose with a damp tissue. Wash hands with soap and water and dry them.
• Use bronchodilator before inhalation if bronchospasm is evident.
• Use spacer for metered-dose inhaler to enhance intrapulmonary deposition.
• Shake inhaler well before administration.
• Cleanse inhaler daily with warm water and wash hands.
• Store at room temperature.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note any untreated infections especially those involving nasal mucosa, unhealed ulcers in nasal septum, or active or quiescent tubercular infections of respiratory tract.
• If change is made from systemic (oral) to inhaled or intranasal corticosteroids, observe patient carefully for signs of steroid withdrawal (eg, depression, joint pain), acute adrenal insufficiency, or exacerbation of asthma. Notify health care provider if these occur.
• If signs of localized fungal infection or any alteration in nasal mucosa, recurrent epistaxis, significant increase in weight or BP, persistent dizziness, or severe headache occur, notify health care provider.

 Patient/Family Education

• Instruct patient to shake spray container before using.
• Caution patient not to exceed prescribed dose.
• Review manufacturer's instructions with patient for correct use of nasal spray.
• Explain that effects of drug are not immediate. Benefit requires regular use and usually occurs after several days. Full relief may take 1 to 2 wk. Caution patient not to continue intranasal therapy and to contact health care provider if there is no improvement within 3 wk.
• Advise patient that dosage will be slowly tapered before stopping.
• Instruct patient to notify health care provider if more than 1 dose is missed or if a dosage cannot be taken because of persistent severe nasopharyngeal irritation.
• Inform patient that mild nasopharyngeal irritation, burning, stinging, and dryness are common side effects.
• If patient is using inhalation bronchodilator, instruct patient to use device 5 min before taking flunisolide.
• Advise patient to rinse mouth and brush teeth after using inhaler to prevent Candida infection.
• Advise patient to use spacer with metered-dose inhaler to maximize intrapulmonary deposition.
• Instruct patient to report the following symptoms to health care provider: rebound congestion, loss of taste, persistent epistaxis or sneezing, infection, increased or irregular heart beat, high BP, fluid retention, joint pain, muscle weakness, headache, dizziness, weight gain, fungal infection of nose or throat.
• Advise patient to use with caution if sores or injuries occur in nasal passages. Drug may prevent or slow proper healing.
• Advise patient to avoid exposure to chickenpox or measles and to seek medical advice if exposed.

Books@Ovid
Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts