Flunisolide spray

Nasarel is a metered-dose manual-pump spray unit containing 0.025% w/w flunisolide in an aqueous medium containing benzalkonium chloride, butylated hydroxytol-uene, citric acid, edetate disodium, polyethylene glycol 400, polysorbate 20, propylene glycol, sodium citrate 

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Intranasal steroids are considered to have a slow onset of action (12-24 hours). Some patients may experience relief within a few days. Maximum treatment response may take up to several weeks to be observed.9,10,12 To achieve optimal effects, use at regular intervals is recommended.15 With the exception of beclomethasone and flunisolide, which are administered twice daily, the recommended doses for the intranasal corticosteroids are one to two sprays in each nostril once daily.15... 

Beclomethasone dipropionate, triamcinolone acetonide, budesonide, flunisolide, and mometasone furoate are available as nasal sprays for the topical treatment of allergic rhinitis. They are effective at doses (one or two sprays one, two, or three times daily) that in most patients result in plasma levels that are too low to influence adrenal function or have any other systemic effects. 

Topical administration to the nose The safety of nasal glucocorticoids in the treatment of allergic rhinitis has been reviewed (434,435). The local application of glucocorticoids for seasonal or perennial rhinitis often results in systemic adverse effects. The use of nasal sprays containing a glucocorticoid that has specific topical activity (such as beclomethasone dipropionate or flunisolide) seems to reduce the systemic adverse effects, but they can nevertheless occur, even to the extent of suppression of basal adrenal function in children (436). Local adverse effects include Candida infection, nasal stinging, epistaxis, throat irritation (437), and, exceptionally, anosmia (438). 

Nasal sprays are available as squeeze bottles, which would not be expected to give reproducible dosing. They are also available as metered-dose devices, which would be expected to give more reproducible dosing, as a mechanical actuation delivers a pre-determined volume to the patient. Thus the dose of drag received by the patient will be dependent on the concentration of drag in the formulation. Commercial examples of metered-dose sprays include Syntaris, Beconase and Rhinocort which deliver flunisolide, beclomethasone and budesonide respectively. 

As a nasal spray, flunisolide is effective in allergic rhinitis in clinical use [32-34], and their protective effects in patients with bronchial asthma have also been studied. The efficacy and safety of a new metered-dose inhaler of flunisolide has recently been reported [35]. 

Brown HM, Engler C, English JR. A comparative trial of flunisolide and sodium cromoglycate nasal sprays in the treatment of seasonal allergic rhinitis. Clin Allergy 1981 ll(2) 169-73. 

Corticosteroids — Beclomethasone dipropionate (17) aerosol has been tested extensively clinically. It is used prophylactically (400 fig per day), not therapeutically, in the treatment of chronic asthma, particularly in children.52 An evaluation of the drug has been published.53 One of the most important clinical advantages is that 1 7 effectively can replace oral corticosteroids in steroid-dependent patients and avoid many of the adverse effects of adrenal suppression.52,54 Most patients with impaired adrenal function due to oral corticosteroids show recovery of adrenal function within 6 months.55 The combination of 17 and disodium cromoglycate (DSCG) showed no additive therapeutic effects.5 Flunisolide (18), when administered as a nasal spray for 4 weeks during the hay fever season in 51 patients, showed significant symptomatic improvement with no systemic steroid effects observed.57... 

NASAREL Dura (U.S.) SYNTARIS Roche OU.S./UK Flunisolide 0.025% SAI, Mr = 444 BKC, BHT, cit, Na2edta, PEG 400, Tw20, PG, NaCit, sorbitol, NaOH, HCI, (pH 5.2) Spray bottle fitted with metered pump... 

Flunisolide nasal solution is available in an aqueous solubilized form, which delivers 25 pg per spray. The total daily adult dose for flunisolide from the nasal spray is 200 to 400 pg. Flunisolide inhalation aerosol for pulmonary delivery is a microcrystalline suspension in a chlorofluorocarbon propellant that delivers 250 pg per metered spray. The total daily adult inhalation dose for flunisolide is 1,000 pg. Doses exceeding 2,000 pg/day need to be monitored for FIFA suppression. 

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