Fluticasone

The selected OTC nasal products relieve nasal allergy symptoms. Propionate Flonase Allergy Relief is for age 4 and older; furoate Flonase Sensimist is for age 2 and older. Both include itchy, watery eye relief in their age 12-and-older directions. Nasal products are not asthma treatment.

The selected propionate HFA inhaler is labeled for asthma maintenance from age 4; furoate Arnuity Ellipta from age 5. Neither treats an acute attack. This reference covers these four single-ingredient products; other devices, prescription nasal indications, and combination inhalers need their own labels.

Doses below are sprays into EACH nostril once daily. Shake propionate gently and Sensimist vigorously before use; prime and clean according to the specific package instructions. Adults should supervise children. Use the least dose that controls symptoms.

For age ≥12 not previously using an inhaled corticosteroid, the starting dose is 88 mcg twice daily, approximately 12 hours apart; prior therapy and severity determine other starting regimens. The maximum labeled dose is 880 mcg twice daily. Age 4–11: 88 mcg twice daily (two 44-mcg actuations each time). Titrate to the lowest effective dose after stability; full benefit may take 2 weeks or longer.

Arnuity: age ≥12 not using an inhaled corticosteroid starts 100 mcg once daily; prior therapy/severity affect other starts. If response is inadequate after 2 weeks, consider 200 mcg once daily, the maximum for this age group. Age 5–11: 50 mcg once daily. Take one actuation at the same time each day, no more than once every 24 hours.

HFA: shake for 5 seconds before each spray. Prime with four sprays before first use; prime with one spray if unused for more than 7 days or dropped. A valved holding chamber, with a mask when appropriate, can help young children. Ellipta: opening the cover prepares one dose; exhale away from the device, inhale steadily and deeply through the mouthpiece, and do not block its air vent. After either asthma inhaler, rinse the mouth and spit out the water.

Do not use a product after hypersensitivity to its ingredients. Both asthma inhalers are contraindicated as primary treatment of status asthmaticus or acute episodes needing intensive care. Arnuity contains lactose with milk proteins and is contraindicated in severe milk-protein allergy. Nasal OTC labels additionally say not to use below their respective age limits, for asthma, or with unhealed nasal injury/surgery.

These selected labels do not contain a boxed warning. Their adrenal, infection, growth, eye, and hypersensitivity warnings remain clinically important.

Nasal irritation, stinging, and bleeding can occur. Inhaled products commonly report upper respiratory symptoms, throat irritation, headache, or oral candidiasis; serious hypersensitivity is possible. Chronic excessive dosing or inhibited metabolism can cause systemic steroid effects and adrenal suppression. Do not add extra maintenance doses for an attack; suspected overdose or systemic steroid toxicity requires assessment.

Propionate HFA labeling advises against strong CYP3A4 inhibitors, including ritonavir and strong azole inhibitors, because systemic exposure and adrenal toxicity may increase. Arnuity advises caution with strong inhibitors, including ritonavir and ketoconazole. Nasal OTC labels require clinician/pharmacist review with HIV medicines such as ritonavir or oral ketoconazole. This is not an identical prohibition for every formulation.

Reconcile oral, injected, nasal, inhaled, and topical steroids. Nasal labels specifically direct review of other steroid medicines. Inhaler labels caution that systemic-steroid withdrawal and total corticosteroid exposure require individualized management.

Nasal labels advise consultation during pregnancy or breastfeeding. Both asthma labels have insufficient human pregnancy data and emphasize the risks of poorly controlled asthma. Human milk data are unavailable for these inhaled ingredients; HFA labeling notes that low plasma concentrations suggest low milk levels. Balance breastfeeding benefits, maternal treatment needs, and potential infant effects rather than declaring proven safety.

Respect the separate nasal and inhaler ages and doses above; monitor pediatric growth and use the lowest effective dose. Older adults need attention to bone and eye risks. Arnuity requires no age-based geriatric dose adjustment; individual inhaler selection also depends on the ability to use the device.

Arnuity requires no renal or mild hepatic dose adjustment; moderate/severe hepatic impairment increases systemic exposure, warranting caution and monitoring for steroid effects. Pediatric hepatic effects were not evaluated. Formal renal/hepatic PK studies were not performed for propionate HFA; its hepatic clearance supports closer monitoring with liver disease. The selected OTC nasal labels provide no organ-specific numeric regimen.

Both esters activate glucocorticoid pathways and reduce inflammatory activity. Their asthma benefit develops with regular use and may take 1–2 weeks or longer to maximize. Receptor-binding comparisons do not establish a clinical dose equivalence.

Swallowed propionate has very low oral bioavailability, but drug delivered to the lung can enter systemic circulation. Propionate and furoate undergo hepatic CYP3A4 metabolism. Furoate inhalation has an approximately 24-hour elimination phase half-life after repeated dosing; these kinetics do not justify swapping the nasal and pulmonary regimens.

Check control, reliever use, exacerbations, adherence, and device technique before stepping up treatment. GINA 2026 prefers an ICS–formoterol reliever strategy for many adults/adolescents; alternatives use a maintenance controller with a separate reliever. Fluticasone alone is not an ICS–formoterol rescue or maintenance-and-reliever inhaler. Coordinate the prescribed reliever and action plan with the clinician.

Demonstrate the exact nasal or inhaler technique; inspect dose counters and do not exceed labeled use. Check thrush, eye symptoms, growth, and systemic steroid effects as appropriate. Seek urgent care for severe breathing difficulty or allergy. A nasal spray that fails after a week or requires prolonged pediatric use needs review; persistent asthma symptoms need controller reassessment.

Examples are Flonase Allergy Relief propionate nasal spray, Flonase Sensimist furoate nasal spray, Prasco propionate HFA authorized generic, and Arnuity Ellipta furoate powder. The HFA product uses an orange actuator and peach cap (44-mcg, 120-actuation package NDC 66993-078-96); Arnuity uses a light-gray/orange inhaler (50-mcg, 30-blister package NDC 0173-0888-10). Appearance can vary across manufacturers; verify the package and dose counter.

Selected strengths: propionate nasal 50 mcg/spray; furoate nasal 27.5 mcg/spray; propionate HFA 44, 110, or 220 mcg per actuation (120 metered actuations); Arnuity 50, 100, or 200 mcg per blister. The 50-mcg Arnuity pack has 30 blisters; 100/200 also have 14-dose institutional packs. These are different formulations, not a substitution table.

Propionate nasal: 4–30°C. Sensimist: 15–30°C; do not refrigerate or freeze. HFA: 20–25°C, excursions 15–30°C, mouthpiece down; protect from excessive heat, do not puncture/incinerate, and discard at counter 000. Arnuity: 20–25°C, excursions 15–30°C, dry and protected from heat/sunlight; keep sealed in its tray until use and discard 6 weeks after opening or at counter 0, whichever comes first. Use each inhaler with its own supplied device components.