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Action/Kinetics:
Minimal systemic effects with intranasal use. Significant first-pass after inhalation; rapidly metabolized by the liver. Several days may be required for full beneficial effects.
t
1/2: 1.8 hr. Excreted by the feces (40%) and urine (50%).
Uses:
Inhalation: Prophylaxis of bronchial asthma in combination with other therapy. For asthma clients requiring systemic steroids where adding an inhaled steroid may decrease or eliminate the need for sysltemic steroids.
Intranasal: Seasonal or perennial rhinitis, especially if other treatment has proven unsatisfactory.
Contraindications:
Active or quiescent TB, especially of the respiratory tract. Untreated fungal, bacterial, systemic viral infections. Ocular herpes simplex. Use until healing occurs following recent ulceration of nasal septum, nasal surgery, or trauma. Lactation.
Special Concerns:
Safety and effectiveness in children less than 6 years of age have not been determined.
Additional Side Effects:
Respiratory: Hoarseness, coughing, throat irritation;
Candida infections of nose, larynx, and pharynx.
After intranasal use: Nasopharyngeal irritation, stinging, burning, dryness, headache.
GI: Dry mouth. Systemic corticosteroid effects, especially if recommended dose is exceeded.
How Supplied:
Metered Dose Inhaler: 250 mcg/inh;
Nasal Spray: 25 mcg/inh
Dosage
?Inhalation
Bronchial asthma.
Adults: 2 inhalations (total of 500 mcg flunisolide) in a.m. and p.m., not to exceed 4 inhalations b.i.d. (i.e., total daily dose of 2,000 mcg).
Pediatric, 6-15 years: 2 inhalations in the morning and evening, with total daily dose not to exceed 1,000 mcg.
?Intranasal
Rhinitis.
Adults, initial: 50 mcg (2 sprays) in each nostril b.i.d.; may be increased to 2 sprays t.i.d., up to maximum daily dose of 400 mcg (i.e., 8 sprays in each nostril).
Pediatric, 6-14 years, initial: 25 mcg (1 spray) in each nostril t.i.d. or 50 mcg (2 sprays) in each nostril b.i.d., up to maximum daily dose of 200 mcg (i.e., 4 sprays in each nostril).
Maintenance, adults, children: Smallest dose necessary to control symptoms. Some clients (approximately 15%) are controlled on 1 spray in each nostril daily.
