Nasarel


flunisolide

APO-Flunisolide (CA), Nasarel, PMS-Flunisolide (CA), Ratio-Flunisolide (CA), Rhinalar Nasal Mist (CA)

Pharmacologic class: Intranasal steroid

Therapeutic class: Respiratory inhalant

Pregnancy risk category C

Action

Unknown. Thought to diminish capillary permeability and suppress migration of polymorphonuclear leukocytes, decreasing inflammation.

Availability

Spray solution: 25 ml (each actuation delivers approximately 25 mcg)

Indications and dosages

➣ Relief of seasonal or perennial rhinitis

Adults: Two sprays in each nostril b.i.d.; may increase to two sprays in each nostril t.i.d. Maximum daily dose is eight sprays in each nostril. For maintenance, after desired clinical effect occurs, reduce dosage to smallest amount needed to control symptoms.

Children ages 6 to 14: One spray in each nostril t.i.d. or two sprays in each nostril b.i.d.; maximum daily dose is four sprays in each nostril. For maintenance, after desired clinical effect occurs, reduce dosage to smallest amount needed to control symptoms.

Contraindications

• Hypersensitivity to drug or its components

• Untreated local infections of nasal mucosa

Precautions

Use cautiously in:

• localized Candida albicans infection; tuberculosis; untreated fungal, bacterial, or systemic viral infections; ocular herpes simplex

• patients receiving immunosuppressive therapy.

Administration

• Don't increase dosage or discontinue drug abruptly.

Adverse reactions

CNS: headache, light-headedness, nervousness, dizziness

EENT: cataracts; glaucoma; blurred vision; conjunctivitis; increased intraocular pressure; lacrimation; dry, irritated eyes; tinnitus; otitis; otitis media; rhinorrhea; rhinitis; nasal irritation, burning, and dryness; nasal stuffiness and pain; sneezing; nasal ulcer; epistaxis; localized Candida albicans nasal infections; nasal mucosa ulcerations; nasal septum perforation; throat discomfort, soreness, and dryness; mild nasopharyngeal irritation; pharyngitis; dry mucous membranes; nasal and sinus congestion; sinusitis; hoarseness, voice changes

GI: nausea, vomiting, diarrhea, abdominal pain, dyspepsia, dry mouth

Metabolic: hyperadrenocorticism

Musculoskeletal: myalgia, arthralgia, aseptic necrosis of femoral head

Respiratory: wheezing, dyspnea, increased cough, bronchitis, bronchospasm, asthma symptoms

Skin: rash, pruritus, urticaria, contact dermatitis, alopecia, herpes simplex infection

Other: altered taste and smell, facial edema, fever, flulike symptoms, aches and pains, infections, angioedema, anaphylaxis

Interactions

Drug-diagnostic tests. Aspartate aminotransferase: increased level

Patient monitoring

See Monitor patient closely for serious adverse reactions, including anaphylaxis, angioedema, hyperadrenocorticism, and serious infections.

Patient teaching

See Teach patient to recognize and immediately report serious adverse reactions.

• Teach patient proper use of drug. Caution him not to use more than prescribed amount; doing so may cause serious side effects.

• Tell patient maximum drug effects may not occur for several weeks.

• Tell patient to avoid people with measles, chickenpox, and other transmissible infections.

• Caution patient to withhold dose and contact prescriber if infection occurs.

• Instruct female patient to tell prescriber if she becomes pregnant.

• Tell female patient not to breastfeed without consulting prescriber.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the tests mentioned above.

flunisolide (nasal)

(floo-niss-oh-lide) flunisolide,

Nasarel

(trade name),

Rhinalar

(trade name)

Classification

Therapeutic: anti inflammatories steroidal
Pharmacologic: corticosteroids
Pregnancy Category: C

Indications

Seasonal or perennial allergic rhinitis.

Action

Potent, locally acting anti-inflammatory and immune modifier.

Therapeutic effects

Decrease in symptoms of allergic rhinitis.

Pharmacokinetics

Absorption: 50%; action is primarily local following nasal use.Distribution: Crosses the placenta and enters breast milk in small amounts.Metabolism and Excretion: Rapidly and extensively metabolized by the liver; 50% excreted in urine; 50% in feces.Half-life: 1–2 hr.

Time/action profile (improvement in symptoms)

ROUTEONSETPEAKDURATION
Intranasalfew daysup to 3 wkunknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity (product contains propylene glycol and polyethylene glycol).Use Cautiously in: Active untreated infections; Diabetes or glaucoma; Underlying immunosuppression (due to disease or concurrent therapy); Systemic corticosteroid therapy (should not be abruptly discontinued when intranasal therapy is started); Recent nasal trauma, septal ulcers, or surgery (wound healing may be impaired by nasal corticosteroids); Obstetric / Lactation / Pediatric: Pregnancy, lactation, or children < 6 yr (safety not established; prolonged or high-dose therapy may lead to complications).

Adverse Reactions/Side Effects

Ear, Eye, Nose, Throat

  • nasal burning (most frequent)
  • epistaxis
  • nasal dryness
  • nasal irritation
  • nasopharyngeal fungal infection
  • pharyngitis

Gastrointestinal

  • aftertaste (most frequent)
  • nausea

Endocrinologic

  • adrenal suppression (increased dose, long-term therapy only)
  • ↓ growth (children)

Respiratory

  • cough

Interactions

Drug-Drug interaction

None known.

Route/Dosage

Intranasal (Adults and Children >14 yr) 2 sprays in each nostril twice daily; may be ↑ to 2 sprays in each nostril 3 times daily if greater effect needed after 4–7 days (not to exceed 8 sprays in each nostril/day).Intranasal (Children 6–14 yr) 1 spray in each nostril 3 times daily or 2 sprays in each nostril twice daily (not to exceed 4 sprays in each nostril/day).

Availability (generic available)

Nasal spray: 25 mcg/metered spray in 25-mL bottle (200 metered sprays)

Nursing implications

Nursing assessment

  • Monitor degree of nasal stuffiness, amount and color of nasal discharge, and frequency of sneezing.
    • Patients on long-term therapy should have periodic otolaryngologic examinations to monitor nasal mucosa and passages for infection or ulceration.
    • Monitor growth rate in children receiving chronic therapy; use lowest possible dose.
  • Lab Test Considerations: Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal (HPA) axis suppression in chronic therapy. Children and patients using higher than recommended doses are at highest risk for HPA suppression.

Potential Nursing Diagnoses

Ineffective airway clearance (Indications)
Risk for infection (Side Effects)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

  • After the desired clinical effect has been obtained, attempts should be made to decrease dose to lowest amount. Gradually decrease dose every 2–4 wk as long as desired effect is maintained. If symptoms return, dose may briefly return to starting dose.
  • Intranasal: Patients also using a nasal decongestant should be given decongestant 5–15 min before corticosteroid nasal spray. If patient is unable to breathe freely through nasal passages, instruct patient to blow nose gently in advance of medication administration.

Patient/Family Teaching

  • Advise patient to take medication exactly as directed. If a dose is missed, take as soon as remembered unless almost time for next dose.
  • Instruct patient in correct technique for administering nasal spray (see ). Shake well before use. Before first-time use, prime unit by spraying 5–6 times or until fine mist appears. If not used for at least 5 days or if unit has been disassembled, reprime unit. Warn patient that temporary nasal stinging may occur.
  • Instruct patient to notify health care professional if symptoms do not improve within 3 wk, if symptoms worsen, or if sneezing or nasal irritation occurs.

Evaluation/Desired Outcomes

  • Resolution of nasal stuffiness, discharge, and sneezing in seasonal or perennial allergic rhinitis.