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Nasal Preparations
azelastine (Astelin ® )
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Mechanism of Action Competes with histamine for H1-receptor sites on effector cells and inhibits the release of histamine and other mediators involved in the allergic response. When used intranasally, reduces hyper-reactivity of the airways; increases the motility of bronchial epithelial cilia, improving mucociliary transport Dosage Children >/= 12 years and Adults: Seasonal allergic rhinitis or vasomotor rhinitis: Intranasal: 2 sprays (137 mcg/spray) each nostril twice daily Supplied: Solution, intranasal spray, as hydrochloride (Astelin®): 1 mg/mL [137 mcg/spray] (17 mL, 30 mL) |
beclomethasone (Vancenase ® ,
Beconase ®)
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Mechanism of Action Controls the rate of protein synthesis, depresses the migration of polymorphonuclear leukocytes, fibroblasts, reverses capillary permeability, and lysosomal stabilization at the cellular level to prevent or control inflammation USE: Symptomatic treatment of seasonal or perennial rhinitis and to prevent recurrence of nasal polyps following surgery Dosing: Aqueous inhalation, nasal (Beconase® AQ): Children >/= 6 years and Adults: 1-2 inhalations each nostril twice daily; total dose 168-336 mcg/day Intranasal (Beconase®): Children >/= 12 years and Adults: 1 inhalation in each nostril 2-4 times/day or 2 inhalations each nostril twice daily (total dose 168-336 mcg/day); usual maximum maintenance: 1 inhalation in each nostril 3 times/day (252 mcg/day) |
budesonide (Rhinocort ® )
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Allergic Rhinitis - Dosing: Two sprays twice daily or 4
sprays once daily. (Rhinocort Aqua Nasal Spray®): - Recommended starting dose (adults): 1 spray in each nostril once daily. Maximum recommended dose for adults (12 years of age and older): 256 mcg per day administered as four sprays per nostril once daily [Supplied: Nasal Spray- 32 mcg/spray] |
cromolyn (NasalCrom ® )
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USE: Prevention and treatment of seasonal and perennial allergic rhinitis Mechanism of Action Prevents the mast cell release of histamine, leukotrienes and slow-reacting substance of anaphylaxis by inhibiting degranulation after contact with antigens Dosing Allergic rhinitis (treatment and prophylaxis): Children >/= 2 years and Adults: 1 spray into each nostril 3-4 times/day; may be increased to 6 times/day (symptomatic relief may require 2-4 weeks) |
desmopressin acetate (DDAVP®) Nasal Spray
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Synthetic analogue of the pituitary hormone
vasopressin (ADH). DDAVP Nasal Spray delivers 0.1 L (10 µg) of DDAVP (desmopressin
acetate) per spray. Dosage (adults): Primary Nocturnal Enuresis: Dosage should be adjusted according to the individual. Initial dose: > 6 years of age: 20 µg (0.2 mL) solution intranasally at bedtime. Adjustment up to 40 µg is suggested if the patient does not respond. Some patients may respond to 10 µg and adjustment to that lower dose may be done if the patient has shown a response to 20 µg. It is recommended that one-half of the dose be administered per nostril. Adequately controlled studies with intranasal DDAVP in primary nocturnal enuresis have not been conducted beyond 4-8 weeks. Diabetes Insipidus: Dosage must be determined for each individual patient and adjusted according to the diurnal pattern of response. The usual dosage range in adults is 0.1 to 0.4 mL daily, either as a single dose or divided into two or three doses. Most adults require 0.2 mL daily in two divided doses. |
flunisolide (Nasalide ®)
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USE: seasonal or perennial rhinitis Mechanism of Action Decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability; does not depress hypothalamus Dosing Adults: 2 sprays each nostril twice daily (morning and evening); maximum dose: 8 sprays/day in each nostril |
fluticasone (Flonase ® )
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Seasonal & perennial allergic rhinitis: Adults: Start: 2
sprays (50 mcg of ticasone propionate each) in each nostril qd.
(total: 200 mcg/day). Alternatively: 1 spray each nostril bid. After the first few days, patients may be able to reduce their dosage to 100 mcg (1 spray in each nostril) once daily for maintenance therapy. The maximum total daily dosage should not exceed 2 sprays in each nostril (200 mcg/day). |
Ipratropium bromide (Atrovent Nasal ®)
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Dosage (adults):
2 sprays 2 to 4 times per day. [rhinitis: 0.03%,
colds:0.06%] Common cold rhinorrhea: Recommended dose (Nasal Spray 0.06%): 2 sprays (84 mcg) per nostril 3-4 times daily in adults and children age 12 years and older. Seasonal Allergic Rhinitis: 2 sprays (84 mcg) per nostril 2 to 4 times daily in adults and children age 5 years and older. The safety and effectiveness of the use of Atrovent Nasal ® Spray 0.06% beyond 4 days in patients with the common cold or beyond 3 weeks in patients with seasonal allergic rhinitis has not been established. MOA: Anticholinergic agent - inhibits secretions from the serous and seromucous glands lining the nasal mucosa. [Supplied: 0.03% and 0.06% Nasal Spray] |
mometasone (Nasonex ® )
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Nasal spray: Allergic rhinitis: Children 2-11 years: 1 spray (50 mcg) in each nostril daily Children >/= 12 years and Adults: 2 sprays (100 mcg) in each nostril daily; when used for the prevention of allergic rhinitis, treatment should begin 2-4 weeks prior to pollen season Nasal polyps: Adults: 2 sprays (100 mcg) in each nostril twice daily; 2 sprays (100 mcg) once daily may be effective in some patients |
oxymetazoline (Afrin ®)
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Nasal decongestant. Mechanism of Action Stimulates alpha-adrenergic receptors in the arterioles of the nasal mucosa to produce vasoconstriction Use Adjunctive therapy of middle ear infections, associated with acute or chronic rhinitis, the common cold, sinusitis, hay fever, or other allergies Dosage Intranasal: Children >/= 6 years and Adults: 0.05% solution: Instill 2-3 drops or 2-3 sprays into each nostril twice daily |
phenylephrine (Neo-Synephrine ®)
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Nasal decongestant. Mechanism of Action Potent, direct-acting alpha-adrenergic stimulator with weak beta-adrenergic activity; causes vasoconstriction of the arterioles of the nasal mucosa and conjunctiva Dosage Nasal decongestant (therapy should not exceed 3 continuous days): Children: 2-6 years: Instill 1 drop every 2-4 hours of 0.125% solution as needed 6-12 years: Instill 1-2 sprays or instill 1-2 drops every 4 hours of 0.25% solution as needed Adults: Children >12 years and Adults: Instill 1-2 sprays or instill 1-2 drops every 4 hours of 0.25% to 0.5% solution as needed; 1% solution may be used in adult in cases of extreme nasal congestion; do not use nasal solutions more than 3 days Supplied Solution, intranasal spray, as hydrochloride: Neo-Synephrine® Extra Strength: 1% (15 mL) Neo-Synephrine® Mild: 0.25% (15 mL) Neo-Synephrine® Regular Strength: 0.5% (15 mL) |
Saline nasal spray (Ocean ®, SeaMist ® )
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USE: Restores moisture to nasal membranes. Dosing: Use 1-3 sprays in each nostril as needed. |
Sumatriptan (Imitrex ®)
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May increase blood pressure and should not be given to patients with
uncontrolled hypertension. The safety of treating an average of more than 4 headaches in a 30-day period has not been established. Serotonin (5-HT 1) agonist --> vasoconstriction of cranial arteries. Dosing (Adults): Acute treatment of migraine: Nasal spray: Single doses of 5, 10, or 20 mg administered into 1 nostril are effective for the acute treatment of migraine in adults. Individualize dose based on response. A 10-mg dose may be achieved by the administration of a single 5-mg dose in each nostril. There is evidence that doses above 20 mg do not provide a greater effect than 20 mg. If the headache returns, the dose may be repeated once after 2 hours, not to exceed a total daily dose of 40 mg. Supplied: Nasal Spray 5 mg and 20 mg are each supplied in boxes of 6 nasal spray devices. Each unit dose spray supplies 5 and 20 mg, respectively, of sumatriptan. |
triamcinolone (Nasacort ®)
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Dosing (Adults): Use 2 sprays in each nostril once or twice daily. Maximum: 8 sprays/day. Nasacort AQ ® Use 2 sprays in each nostril once daily. Use: Nasal inhalation: Management of seasonal and perennial allergic rhinitis in patients >/= 6 years of age Dosage Nasal spray: Shake well prior to use. Gently blow nose to clear nostrils. Children 6-11 years: 110 mcg/day as 1 spray in each nostril once daily. CChildren >/= 12 years and Adults: 220 mcg/day as 2 sprays in each nostril once daily Nasal inhaler: Children 6-11 years: Initial: 220 mcg/day as 2 sprays in each nostril once daily CChildren >/= 12 years and Adults: Initial: 220 mcg/day as 2 sprays in each nostril once daily; may increase dose to 440 mcg/day (given once daily or divided and given 2 or 4 times/day) |
Zolmitriptan (Zomig ® )
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Serotonin agonist: (5-HT1B and 5-HT1D receptors) -->
vasoconstriction in cranial. Dosing (Adults): Nasal spray: Initial: 1 spray (5 mg) at the onset of migraine headache. If the headache returns, the dose may be repeated after 2 hours; do not exceed 10 mg within a 24-hour period. Controlled trials have not established the effectiveness of a second dose if the initial one was ineffective. |
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Listed dosages are for - Adult patients ONLY. PLEASE READ THE
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any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. |
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