Category:

• Anti-inflammatory corticosteroid (synthetic)

Description:

• Halogenated synthetic glucocorticoid

Indications:

• INH for chronic asthma

• NASAL for seasonal/perennial rhinitis; prevention of recurrence of nasal polyps; non-allergic (vasomotor) rhinitis

Contraindications:

• Primary treatment of status asthmaticus, nonasthmatic bronchial disease

• Bacterial, fungal, or viral infections of the mouth, throat, or lungs; children <3 years

Precautions:

• Pregnancy category C; excretion in breast milk unknown, but considered to be compatible with breast feeding

• Nasal disease/surgery, children <12 years, nasal ulcers, recurrent epistaxis

• Systemic effects such as mental disturbances, increased bruising, weight gain, cushingoid features, and cataracts

Adverse Reactions (Side Effects):

• CNS: headache, paresthesia

• EENT: burning, candidal infection, dryness, earache, nasal irritation, perforation at nasal septum, nasal ulcers, secretions with blood, sneezing, sore throat

• GI: dry mouth, dysphonia

• METAB: adrenal suppression

• RESP: bronchospasm

Dosage:

Administered by oral inhalation and nasally

• Adult:  INH 2-4 puffs 3-4 times daily, not to exceed 20 INH/day; NASAL 1-2 sprays in each nostril 2-4 times daily; double strength (DS) NASAL 1-2 sprays each nostril daily

• Child 2-12 years: INH 1-2 puffs 3-4 times daily, not to exceed 10 INH/day

• Child >12 years:  NASAL 1-2 sprays each nostril 2-4 times daily

Special Considerations:

• Rinse mouth with water following INH to decrease possibility of fungal infections, dysphonia

•  Response to nasal steroids seen in 3 days to 2 weeks; discontinue if no improvement in 3 weeks

•  For prophylactic use, no role in acute treatment of asthma/allergy