Flunisolide:

Generic Name Flunisolide

Brand Name Aerospan, Bronalide, Nasalide, Nasarel,

Rhinalar
Classification Chemical class: Corticosteroid

Therapeutic class: Antiasthmatic, anti-

inflammatory
Mode Action

Inhibits cells involved in inflammatory

response, such as mast cells,
eosinophils, basophils, lymphocytes,
macrophages, and neutrophils. Also
inhibits production of chemical mediators,
such as histamine, eicosanoids,
leukotrienes, and cytokines
Dosage

For adults, the recommended starting

dose of flunisolide nasal solution
(flunisolide nasal spray .025%) is 2
sprays (58 mcg) in each nostril 2 times a
 day (total dose 232 mcg/day): the effect
should be assessed in 4 to 7 days. Some
relief can be expected in approximately
two-thirds of patients within that time.
This dose may be increased to 2 sprays
in each nostril 3 times a day (total dose
348 mcg/day) if greater effect is needed.
For adults, maximum total daily doses
should not exceed 8 sprays in each
nostril per day (464 mcg/day). After the
desired clinical effect is obtained, the
maintenance dose should be reduced to
the smallest amount necessary to control
the symptoms.

For pediatric patients 6 to 14 years of
age, the recommended starting dose of
flunisolide nasal solution (flunisolide nasal
spray .025%) is one spray, (29 mcg) in
each nostril 3 times a day (total dose 174
mcg/day) or 2 sprays (58 mcg) in each
nostril 2 times a day (total dose 232
mcg/day). For pediatric patients 6 to 14
years of age, maximum daily doses
should not exceed 4 sprays in each
nostril per day (total dose 232 mcg/day)
as the safety and efficacy of higher doses
have not been established.

Flunisolide nasal solution (flunisolide

 nasal spray .025%) is not recommended
for use in pediatric patients less than 6
years of age as safety and efficacy,
including possible adverse effects on
growth, have not been assessed in this
age group.
Indication Indicated for the treatment of the nasal
symptoms of seasonal or
perennial rhinitis. Flunisolide nasal
solution should not be used in the
presence of untreated
localized infection involving the nasal
mucosa.
Contraindication Hypersensitivity to flunisolide or its
components, primary treatment of status
asthmaticus or other asthma episodes
that require emergency care, recent nasal
surgery (nasal form), untreated localized
infection of nasal mucosa (nasal form)
Side Effects  headache

 nasal irritation, burning, stuffiness,

or dryness

 watery eyes

 sneezing

 nausea

 vomiting

 lack of energy
  joint or muscle pain

 muscle weakness

Adverse Effects cells.

Reproductive
System: infertility, ovarian failure, ovarian
disorder, amenorrhea, oligomenorrhea,
testicular atrophy, azoospermia, oligosper
mia.

Respiratory: pulmonary veno-occlusive
disease, acute respiratory distress
syndrome, interstitial lung disease as
manifested by respiratory
failure (including fatal outcomes),
obliterative bronchiolitis,
organizing pneumonia, alveolitis allergic,
pneumonitis, pulmonary hemorrhage;
respiratory distress, pulmonary
hypertension, pulmonary
edema, pleural effusion,
bronchospasm, dyspnea, hypoxia,
cough, nasal congestion, nasal

nail disorder, facial

swelling, hyperhidrosis.

Drug Interaction CNS: Anxiety, chills, depression,

dizziness, headache, hyperactivity,
insomnia, irritability, lethargy, mood
 changes, nervousness, tremor, vertigo

CV: Hypertension

EENT: Candidiasis (oral and throat), dry

mouth and throat, earache, eye infection,
hoarseness, loss of smell or taste, mouth
irritation, pharyngitis, rhinitis, sinusitis,
sneezing

GI: Abdominal pain, anorexia,

constipation, diarrhea, flatulence,
heartburn, increased appetite,
indigestion, nausea, vomiting

GU: Menstrual irregularities

HEME: Eosinophilia

RESP: Bronchitis, dyspnea, pleurisy,

pneumonia SKIN: Acne, eczema,
pruritus, rash, urticaria Other: Growth
suppression (children), lymphadenopathy

Nursing Responsibilities •Use flunisolide cautiously in patients

with ocular herpes simplex, pulmonary
tuberculosis, or untreated systemic
bacterial, fungal, parasitic, or viral
infection.

•Use flunisolide cautiously in patients with

ocular herpes simplex, pulmonary
tuberculosis, or untreated systemic
bacterial, fungal, parasitic, or viral
infection.
 Warning: Assess patient switched from
systemic corticosteroid to flunisolide for
adrenal insufficiency (fatigue,
hypotension, lassitude, nausea, vomiting,
weakness) during initial treatment and
during stress, trauma, surgery, infection,
or other electrolyte-depleting conditions.
Notify prescriber immediately if signs or
symptoms arise.

•Monitor growth in children;

corticosteroids may increase risk of
growth suppression.
Patient teaching Teach patient how to use inhaler. When
starting a new canister, advise spraying
once into the air (avoiding her eyes) to
check for mist.

•Instruct patient to gargle or rinse after

each use of flunisolide to help prevent
mouth and throat dryness, relieve throat
irritation, and prevent oropharyngeal
infection.

•Urge patient to contact prescriber if

symptoms haven’t improved after 3
weeks. warning Caution patient not to use
flunisolide to relieve acute
bronchospasm.

•If patient switches from an oral

 corticosteroid to flunisolide, advise her to
carry medical identification indicating the
need for supplemental systemic
corticosteroids during stress or severe
asthma attack. Advise her to ask
prescriber how to respond to these
problems.

•Caution patient to avoid exposure to

chickenpox and measles and to contact
prescriber immediately if exposure
occurs.

Reference: KIZIOR, R. O. B. E. R. T. J. (2020). Saunders Nursing Drug Handbook.

PHILADELPHIA: ELSEVIER HEALTH SCIENCES.