Is flonase safe to use while pregnant

1. About fluticasone nasal spray or drops

Fluticasone nasal (nose) spray is a steroid nasal spray for cold-like symptoms caused by allergic rhinitis. This is inflammation of the inside of your nose that can be from hay fever.

Fluticasone is a type of medicine called a steroid (or corticosteroid). Corticosteroids are a copy of a substance your body makes naturally. They are not the same as anabolic steroids.

Fluticasone nasal spray is available on prescription for adults and children. Adults can also buy it from pharmacies and supermarkets. Brands include Flixonase, Avamys and Nasofan.

Some nasal sprays, such as Dymista, contain fluticasone mixed with other medicines, such as antihistamines, that help with an allergy.

Fluticasone also comes as nasal drops that shrink nasal polyps. These are only available on a prescription. Brand names include Flixonase.

It also comes as an inhaler and as a cream or ointment. Read about:

• fluticasone inhalers - for asthma and chronic obstructive pulmonary disease (COPD)
• fluticasone skin creams - for skin conditions such as eczema and dermatitis

2. Key facts

• You need to use fluticasone regularly for it to work.
• It works by reducing swelling and irritation in your nose.
• The most common side effects are an unpleasant taste or smell, nosebleeds and a dry or sore throat.
• Not all brands are suitable for children. It's important that your child only uses the spray prescribed for them.
• If you are pregnant, speak to your doctor or a pharmacist before buying fluticasone nasal spray at a pharmacy or supermarket.
• Some nasal sprays contain fluticasone mixed with an antihistamine. Brand names include Dymista.
• If your doctor has prescribed high doses of fluticasone to control your symptoms you may need to carry a steroid emergency card. Ask your pharmacist or doctor.

3. Who can and cannot use fluticasone nasal spray or drops

Most adults can use fluticasone nasal spray.

Children aged 4 years and above can use fluticasone nasal spray if their doctor prescribes it.

Fluticasone nasal drops can be prescribed to adults and young people from the age of 16 years.

Fluticasone is not suitable for some people. To make sure the nasal spray or drops are safe for you, tell your doctor or pharmacist if you:

• are allergic to fluticasone or any other medicines
• are taking or have recently taken other corticosteroid medicines
• have had nose surgery
• have an infection in your nose
• are pregnant or trying to get pregnant

4. How and when to use it

How to use the spray

Fluticasone nasal spray needs to be used regularly for it to work.

You'll generally use the spray once or twice a day (once in the morning and once at night). The usual dose is 1 or 2 sprays into each nostril.

Follow the instructions that come with your nasal spray. Do not use more than the maximum number of sprays in 24 hours.

If you're using a new bottle, it may not work the first time. Pump the spray a few times until a fine mist comes out. You'll also need to do this if you have not used the bottle for a few days.

Remove the cap and gently shake the bottle.

1. Blow your nose gently, then close 1 nostril with your finger.
2. Bend your head forward slightly and carefully put the nozzle into your other nostril.
3. Slowly breathe in through your nose and with your fingers press down on the widest part of the nozzle to squirt the spray once into your nostril.
4. Breathe out through your mouth.
5. Follow steps 3 and 4 again to squirt a second spray (if you need it) into the same nostril.

Repeat the process with the other nostril if you need it.

After using the spray, wipe the nozzle with a clean tissue and replace the cap.

How to use the drops

Fluticasone drops come in small plastic containers called "nasules". Divide the drops equally between each nostril. The usual dose is 6 drops into each nostril. You'll generally use the drops once or twice a day (once in the morning and once at night).

Follow the instructions that come with your nasal drops.

Pull off 1 plastic container from the strip of nasules. Flick the container with your finger and then shake it several times to mix the medicine well.

Hold the bottom of the container firmly. Twist and remove the top to open it. Do not open the container until you are ready to use it.

1. Blow your nose gently.
2. Follow the pictures in the manufacturer's leaflet to get your head into the right position.
3. Carefully put the container into 1 nostril and gently squeeze.
4. Keep squeezing until the sides of the container touch each other, then release. This will mean that you've had about half of the dose (about 6 drops).
5. Follow steps 3 and 4 again to use the rest of the drops in your other nostril.

Do not keep the container. Only use it once.

It may take a few weeks for the medicine to work. Keep using it even though you may not feel better immediately.

Will my dose go up or down?

Once your symptoms are under control, you'll be able to use your nasal spray less often. For example, you might go from using 2 sprays twice a day, to 1 spray once a day.

If you bought a fluticasone nasal spray from a pharmacy, stop using it when you think you no longer need it. Ask a pharmacist for advice if you're not sure when to stop. Do not use it continuously for more than 1 month without speaking to a doctor.

If your symptoms get worse after reducing your dose, you may want to increase it again.

If you have fluticasone nasal spray or nasal drops on prescription, your doctor will tell you how often to use it and when to change your dose.

What if I forget to use it?

If you forget to take a dose, take it as soon as you remember. Unless it's almost time for your next dose, in which case skip the missed dose and take your next one as usual.

Do not take a double dose to make up for a forgotten one.

If you forget doses often, it may help to set an alarm to remind you. You could also ask a pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

Using too much fluticasone nasal spray or drops by accident is unlikely to harm you.

5. Side effects

Like all medicines, fluticasone can cause side effects, although not everyone gets them.

With fluticasone nasal spray or drops, very little medicine is absorbed into the rest of your body, so it's not likely to give you serious side effects.

If your doctor has prescribed high doses of fluticasone, or you’re also taking other steroid medicines or tablets for fungal infections or HIV, you may get underactive adrenal glands as a side effect. Ask your doctor if you need to carry a steroid emergency card.

Common side effect

These common side effects can happen in more than 1 in 100 people.

Keep taking the medicine but talk to your doctor if these side effects bother you or do not go away:

• an unpleasant taste or smell
• a dry or sore nose, or nosebleeds
• a dry or sore throat, or hoarse voice
• headache

Serious side effects

Serious side effects are rare. Less than 1 in 10,000 people have a serious side effect when using fluticasone nasal spray or drops.

You are more likely to have a serious side effect if you use high doses of fluticasone for more than a few months.

Tell a doctor immediately if you get:

• problems with your breathing
• damage to your nose or sores inside your nose
• changes in your eyesight, such as blurred vision or a cloudy lens in the eye – these can be signs of increased pressure in your eyes (glaucoma) or a cataract

Serious allergic reaction

It happens rarely, but it is possible to have a serious allergic reaction (anaphylaxis) to fluticasone.

Immediate action required: Call 999 or go to A&E if:

• you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
• you're wheezing
• you get tightness in the chest or throat
• you have trouble breathing or talking
• your mouth, face, lips, tongue or throat start swelling

You could be having a serious allergic reaction and may need immediate treatment in hospital.

These are not all the side effects of fluticasone. For a full list see the leaflet inside your medicines packet.

Information:

You can report any suspected side effect to the UK safety scheme.

6. How to cope with side effects

What to do about:

• unpleasant taste or smell – rinse your mouth with water or have a drink of water.
• dry or sore nose, or nosebleeds – stop using your nasal spray for a few days, then start again. Speak to your doctor or a pharmacist if these side effects do not go away.
• dry or sore throat, or hoarse voice – rinse your mouth with water or brush your teeth after you use your nasal spray or drops to help prevent this.
• headache – try to rest and drink plenty of fluids. Do not drink too much alcohol. Talk to your doctor if the headache does not go away or is severe.

7. Pregnancy and breastfeeding

Fluticasone and pregnancy

If you are pregnant, speak to your doctor or a pharmacist before buying fluticasone nasal spray at a pharmacy or supermarket.

You can usually use fluticasone nasal spray and drops in pregnancy. There is no clear evidence that it will harm your baby.

However, for safety, your doctor will only prescribe fluticasone in pregnancy if the benefits outweigh the risks. They will prescribe the lowest dose that works for you. Ask your doctor if you have any concerns.

Find out more information about how using a steroid nasal spray to treat allergic rhinitis might affect you and your baby during pregnancy on the Best Use of Medicines in Pregnancy (BUMPS) website.

Fluticasone and breastfeeding

It's generally OK to use your fluticasone nasal spray or drops as normal while you're breastfeeding.

However always check with your doctor or a pharmacist first. Your baby may need extra monitoring if you use a high dose of the nasal drops.

Non-urgent advice: Talk to your doctor if you're:

• trying to get pregnant
• pregnant
• breastfeeding

8. Cautions with other medicines

Some medicines and fluticasone interfere with each other. This can increase your chance of side effects. It may mean you need to change your dose of fluticasone.

Check with a pharmacist or your doctor if you're taking:

• medicines used to treat HIV, such as ritonavir or cobicistat
• medicines used to treat fungal infections, such as ketoconazole or itraconazole
• other medicines that contain steroids, such as eczema creams, asthma inhalers, tablets, injections, other nasal sprays and drops, or eye drops

Mixing fluticasone with herbal remedies or supplement

There's very little information about taking herbal remedies and supplements together with fluticasone. Ask a pharmacist for advice.

Important: Important

Tell your doctor or a pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.

9. Common questions

How does fluticasone work?

Fluticasone is a corticosteroid (steroid) medicine.

Steroids closely copy the effects of natural hormones produced in your adrenal glands (which are next to your kidneys).

Fluticasone works on your immune system to reduce the symptoms of inflammatory conditions and allergic reactions such as swelling, redness and itching.

The nasal spray reduces swelling and mucus in your nose. It can take a little longer to work than antihistamine nasal sprays but the effects last for longer.

If you have nasal polyps, fluticasone drops work by reducing the swelling and irritation of the lining of your nose. This can make the polyps shrink.

How long does fluticasone take to work?

You will not notice an immediate improvement in your symptoms when you first start using fluticasone nasal spray. This is because it takes a few days for fluticasone to take full effect.

Tell your doctor if you feel no better after using the spray for 7 days.

For some people it can take 2 weeks or more to get the maximum benefits.

If you use the spray for hay fever, it's best to start using it at least a couple of weeks before hay fever season starts. Many people notice they get symptoms at about the same time each year.

If you are using fluticasone drops to shrink nasal polyps, it is important to follow the instructions and use the drops each day. You may not see any improvement for a few weeks. If your symptoms do not improve after 4 to 6 weeks, tell your doctor. They may want to change your medicine.

How long will I use it for?

If you buy fluticasone nasal spray from a pharmacy or supermarket, check the leaflet that comes with the medicine. This will tell you how long you can use it for. This is usually between 1 and 3 months.

If you are prescribed fluticasone nasal spray, your doctor may advise you to use it for longer.

If you are using fluticasone drops to shrink nasal polyps, your doctor will tell you how long to use them for. It will usually be for several weeks.

Is it safe to use for a long time?

Fluticasone nasal spray and drops are unlikely to have any lasting harmful effects if you follow the instructions that come with your medicine, or use it as your doctor recommends.

However, children and teenagers may need to have their height and weight monitored carefully if they’re using high doses of a steroid nasal spray, like fluticasone, for a long time. This is to make sure the steroid is not affecting their growth.

The nasal spray or drops deliver a small amount of steroid medicine exactly where you need it. This limits the amount of steroid reaching the rest of your body. It also keeps the risk of side effects as low as possible.

Do I need a steroid card?

If you're using steroid medicines such as fluticasone, your adrenal glands may not make as much of some of the hormones your body needs such as cortisol (known as the stress hormone). This is known as adrenal insufficiency.

It’s more likely to happen if you take high doses for a long time (especially tablets and injections) or if you regularly use different kinds of steroids at the same time (such as a steroid nasal spray and a steroid inhaler).

Your doctor or pharmacist will assess your risk of adrenal insufficiency based on the type and dose of steroids you’re taking, and may recommend that you carry a steroid emergency card (red card). This card is the size of a credit card and fits in your wallet or purse.

The Addison's Disease Self-Help Group (ADSHG) website has more information about the NHS steroid emergency card.

Important: Important

If you need any medical or dental treatment, or are having surgery or an invasive procedure, show your steroid emergency card to your doctor or dentist. This is important so they know you're having steroid treatment and can give you extra steroids as needed.

Can I drink alcohol with it?

Yes, you can drink alcohol while taking fluticasone.

Will it affect my fertility?

There's no clear evidence to suggest that taking fluticasone will reduce fertility in either men or women.

However, speak to a pharmacist or your doctor if you are trying to get pregnant.

Can I drive or ride a bike?

For most people, using fluticasone nasal spray or drops will not affect their ability to drive a car or cycle.