CORTICOSTEROIDS (Nasal)

Some commonly used brand names are:

In the U.S.?

• Beconase ¹
• Beconase AQ ¹
• Dexacort Turbinaire ³
• Flonase ⁵
• Nasacort ⁷
• Nasacort AQ ⁷
• Nasalide ⁴
• Nasarel ⁴
• Nasonex ⁶
• Rhinocort ²
• Vancenase ¹
• Vancenase AQ 84 mcg ¹
• Vancenase pockethaler ¹

In Canada?

• Beconase ¹
• Flonase ⁵
• Nasacort ⁷
• Nasacort AQ ⁷
• Nasonex ⁶
• Rhinalar ⁴
• Rhinocort Aqua ²
• Rhinocort Turbuhaler ²
• Vancenase ¹

Another commonly used name for beclomethasone is beclometasone.

Category

• Anti-inflammatory, steroidal, nasal?Beclomethasone; Budesonide; Dexamethasone; Flunisolide; Fluticasone; Mometasone; Triamcinolone
• Corticosteroid, nasal?Beclomethasone; Budesonide; Dexamethasone; Flunisolide; Fluticasone; Mometasone; Triamcinolone

Description

Nasal corticosteroids (kor-ti-ko-STER-oids) are cortisone-likemedicines. They belong to the family of medicines called steroids. These medicinesare sprayed or inhaled into the nose to help relieve the stuffy nose, irritation,and discomfort of hay fever, other allergies, and other nasal problems. Thesemedicines are also used to prevent nasal polyps from growing back after theyhave been removed by surgery.

These medicines are available only with your doctor's prescription, inthe following dosage forms:

Nasal
• Beclomethasone
  • Aerosol (U.S. and Canada)
  • Suspension (U.S.)
• Budesonide
  • Aerosol (U.S.)
  • Powder (Canada)
  • Suspension (Canada)
• Dexamethasone
  • Aerosol (U.S.)
• Flunisolide
  • Solution (U.S. and Canada)
• Fluticasone
  • Suspension (U.S. and Canada)
• Mometasone
  • Suspension (U.S. and Canada)
• Triamcinolone
  • Aerosol (U.S. and Canada)
  • Suspension (U.S. and Canada)

Before Using This Medicine

In deciding to use a medicine,the risks of taking the medicine must be weighed against the good it willdo. This is a decision you and your doctor will make. For corticosteroids,the following should be considered:

Allergies?Tell your doctor if you have ever had any unusual orallergic reaction to corticosteroids. Also tell your health care professionalif you are allergic to any other substances, such as foods, preservatives,or dyes.

Pregnancy?In one human study, use of beclomethasone oral inhalationby pregnant women did not cause birth defects or other problems. Other studieson birth defects with beclomethasone, budesonide, dexamethasone, flunisolide,fluticasone, mometasone or triamcinolone have not been done in humans.

In animal studies, corticosteroids taken by mouth or injection during pregnancywere shown to cause birth defects. Also, too much use of corticosteroids duringpregnancy, especially during the first trimester, may cause other unwantedeffects in the infant, such as slower growth and reduced adrenal gland function.

If corticosteroids are medically necessary during pregnancy to controlnasal problems, nasal corticosteroids are generally considered safer thancorticosteroids taken by mouth or injection. Also, use of nasal corticosteroidsmay allow some patients to stop using or decrease the amount of corticosteroidstaken by mouth or injection.

Breast-feeding?Use of dexamethasone is not recommended in nursingmothers, since dexamethasone passes into breast milk and may affect the infant'sgrowth.

It is not known whether beclomethasone, budesonide, flunisolide, fluticasoneor triamcinolone passes into breast milk. Although most medicines pass intobreast milk in small amounts, many of them may be used safely while breast-feeding.Levels of mometasone are not measurable in breast milk, thus exposure is expectedto be low. Mothers who are taking these medicines and wish to breast-feedshould discuss them with their doctor.

Children?Corticosteroids taken by mouth or injection havebeen shown to slow or stop growth in children and cause reduced adrenal glandfunction. If corticosteroids are medically necessary to control nasal problemsin a child, nasal corticosteroids are generally considered to be safer thancorticosteroids taken by mouth or injection. Prolonged or high-dose use ofnasal corticosteroids may potentially affect growth; although, most nasalcorticosteroids have not been shown to affect growth. Also, use of most nasalcorticosteroids may allow some children to stop using or decrease the amountof corticosteroids taken by mouth or injection.

Before this medicine is given to a child, you and your child's doctor shouldtalk about the good this medicine will do as well as the risks of using it.Follow the doctor's directions very carefully to lessen the chance of unwantedeffects.

Older adults?Although there is no specific information comparinguse of nasal corticosteroids in the elderly with use in other age groups,they are not expected to cause different side effects or problems in olderpeople than they do in younger adults.

Other medicines?Although certain medicines should not be usedtogether at all, in other cases two different medicines may be used togethereven if an interaction might occur. In these cases, your doctor may want tochange the dose, or other precautions may be necessary. Tell your health careprofessional if you are taking any prescription or nonprescription (over-the-counter[OTC]) medicines, such as:

• Ephedrine or
• Phenobarbital or
• Rifampin (e.g., Rifadin)?Ephedrine, phenobarbital, and rifampinmay decrease the blood levels of nasal corticosteroids, such as dexamethasone,warranting an increase in corticosteroid dose

Other medical problems?The presence ofother medical problems may affect the use of corticosteroids. Make sure youtell your doctor if you have any other medical problems, especially:

• Amebiasis?Nasal corticosteroids may make this condition worse

• Asthma?Nasal corticosteroids may make this condition worse

• Type 2 diabetes mellitus?Use of dexamethasone maydecrease carbohydrate tolerance, worsening blood glucose control and warrantingan increase in insulin dosage

• Glaucoma?Long-term use of nasal corticosteroids may worsenglaucoma by increasing the pressure within the eye

• Herpes simplex (virus) infection of the eye or
• Infections (virus, bacteria, or fungus)?Nasal corticosteroidsmay cover up the signs of these conditions

• Injury to the nose (recent) or
• Nose surgery (recent) or
• Sores in the nose?Nasal corticosteroids may prevent properhealing of these conditions

• Liver disease

• Tuberculosis (active or history of)

• Underactive thyroid

• Weak heart or
• Recent heart attack?Use of dexamethasone may worsen these conditions

Proper Use of This Medicine

This medicineusually comes with patient directions. Read them carefullybefore using the medicine. Beclomethasone, budesonide, dexamethasone,and triamcinolone are used with a special inhaler. If you do not understandthe directions, or if you are not sure how to use the inhaler, check withyour health care professional.

Before using this medicine, clear the nasal passages by blowing your nose.Then, with the nosepiece inserted into the nostril, aim the spray towardsthe inner corner of the eye.

In order for this medicine to help you, it must beused regularly as ordered by your doctor. This medicine usually beginsto work in about 1 week (for dexamethasone), but up to 3 weeks may pass beforeyou feel its full effects.

Use this medicine only as directed. Do not usemore of it and do not use it more often than your doctor ordered. To do somay increase the chance of absorption through the lining of the nose and thechance of unwanted effects.

Check with your doctor before using this medicine fornasal problems other than the one for which it was prescribed, sinceit should not be used on many bacterial, virus, or fungus nasal infections.

Save the inhaler that comes with beclomethasone or dexamethasone, sincerefill units may be available at lower cost.

Dosing?The dose of nasal corticosteroids will be different fordifferent patients. Follow your doctor's orders or thedirections on the label. The following information includes only theaverage doses of nasal corticosteroids. If your doseis different, do not change it unless your doctor tells you to do so.

For beclomethasone
• For allergies or other nasal conditions:
  • For nasal aerosol dosage form:
    • Adults and children 6 years of age and older?One spray in eachnostril two to four times a day.
    • Children up to 6 years of age?Use and dose must be determinedby your doctor.
  • For nasal suspension dosage form:
    • Adults and children 6 years of age and older?One or two spraysin each nostril two times a day.
    • Children up to 6 years of age?Use and dose must be determinedby your doctor.

For budesonide
• For allergies or other nasal conditions:
  • For nasal powder dosage form:
    • Adults and children 6 years of age and older?Two inhalationsin each nostril once a day in the morning.
    • Children up to 6 years of age?Use and dose must be determinedby your doctor.
  • For nasal suspension dosage form:
    • Adults and children 6 years of age and older?One or two spraysin each nostril one or two times a day.
    • Children up to 6 years of age?Use and dose must be determinedby your doctor.

For dexamethasone
• For allergies or other nasal conditions:
  • For nasal aerosol dosage form:
    • Adults and children 12 years of age and older?Two sprays ineach nostril two or three times a day for up to two weeks.
    • Children 6 to 12 years of age?One to two sprays in each nostriltwo times a day for up to two weeks.
    • Children up to 6 years of age?Use and dose must be determinedby your doctor.

For flunisolide
• For allergies or other nasal conditions:
  • For nasal solution dosage form:
    • Adults and children 6 years of age and older?One or two spraysin each nostril one to three times a day.
    • Children up to 6 years of age?Use and dose must be determinedby your doctor.

For fluticasone
• For allergies or other nasal conditions:
  • For nasal suspension dosage form:
    • Adults and children 4 years of age and older?One or two spraysin each nostril one or two times a day.
    • Children up to 4 years of age?Use and dose must be determinedby your doctor.

For mometasone
• For allergies or other nasal conditions:
  • For nasal suspension dosage form:
    • Adults and children 12 years of age and older?One or two spraysin each nostril one time a day.
    • Children up to 12 years of age?Use and dose must be determinedby your doctor.

For triamcinolone
• For allergies or other nasal conditions:
  • For nasal aerosol dosage form:
    • Adults and children 6 years of age and older (In Canada, children12 years of age and older)?One or two sprays in each nostril once aday.
    • Children up to 6 years of age (In Canada, children up to 12 yearsof age)?Use and dose must be determined by your doctor.
  • For nasal suspension dosage form:
    • Adults and children 6 years of age and older?One or two spraysin each nostril one time a day.
    • Children up to 6 years of age?Use and dose must be determinedby your doctor.

Missed dose?If you miss a dose of this medicine and rememberwithin an hour or so, use it right away. However, if you do not remember untillater, skip the missed dose and go back to your regular dosing schedule. Donot double doses.

Storage?To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store budesonide powder in the bathroom, near the kitchensink, or in other damp places, especially if the cap has not been tightlyscrewed back on. Moisture may cause the medicine to break down.
• Keep the medicine from getting too cold or freezing. This medicinemay be less effective if it is too cold when you use it.
• Do not puncture, break, or burn the beclomethasone, dexamethasone,or triamcinolone aerosol container, even after it is empty.
• Do not keep outdated medicine or medicine no longer needed. Also,discard any unused beclomethasone or flunisolide solution 3 months after youopen the package. Be sure that any discarded medicine is out of the reachof children.

Precautions While Using This Medicine

If youwill be using this medicine for more than a few weeks, your doctor shouldcheck your progress at regular visits.

Check with your doctor:

• if signs of a nose, sinus, or throat infection occur.
• if your symptoms do not improve within 7 days (for dexamethasone)or within 3 weeks (for beclomethasone, budesonide, flunisolide, fluticasone,mometasone, or triamcinolone).
• if your condition gets worse.

When you are being treated with dexamethasone, and after you stop treatmentwith it, do not have any immunizations (vaccinations) without your doctor'sapproval. Dexamethasone may lower your body's resistance and there is a chanceyou may get the infection the immunization is meant to prevent. In addition,other persons living in your household should not take or have recently takenoral polio vaccine since there is a chance they could pass the polio viruson to you. Also, avoid other persons who have taken oral polio vaccine. Don'tget close to them, and do not stay in the same room with them for very long.If you cannot take these precautions, you should consider wearing a protectiveface mask that covers the nose and mouth.

Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects.Although not all of these side effects may occur, if they do occur they mayneed medical attention.

Check with your doctor as soon as possible if any of the following sideeffects occur:

Less common or rare

Bad smell; blindness; bloody mucus or unexplained nosebleeds; blurred orgradual loss of vision; burning or stinging afteruse of spray or irritation inside nose (continuing); crusting, white patches, or sores inside nose; dischargeor redness in eye, eyelid, or inner lining of the eyelid; eye pain; headache; hives; light-headedness or dizziness; loss of sense of taste or smell; muscle pain; nausea or vomiting; ringing in the ears; shortness of breath; skin rash; sore throat, cough, or hoarseness; stomach pains; stuffy, dry, or runnynose or watery eyes (continuing); swelling of eyelids,face, or lips; tightness in chest; troubled breathing; unusual tiredness or weakness; wheezing; white patchesin throat

Symptoms of overdose

Acne; blurred vision; bone fractures; excess hair growth in females; fullness or rounding of the face, neck, and trunk; high blood pressure; impotence in males; increased urination or thirst; lack of menstrual periods; menstrual changes; muscle wasting and weakness

Other side effects may occur that usually donot need medical attention. These side effects may go away during treatmentas your body adjusts to the medicine. However, check with your doctor if anyof the following side effects continue or are bothersome:

More common

Burning, dryness, or other irritation inside the nose (mild,lasting only a short time); increase in sneezing; irritation of throat

Less common

Sneezing; itching of throat

Not all of the side effects listedabove have been reported for each of these medicines, but they have been reportedfor at least one of them. All of the nasal corticosteroids are very similar,so any of the above side effects may occur with any of these medicines.

Other side effects not listed above may also occur in some patients. Ifyou notice any other effects, check with your doctor.