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|Vancenase Nasal

CORTICOSTEROIDS (Nasal)

Some commonly used brand names are:

In the U.S.—

• Beconase ¹
• Beconase AQ ¹
• Dexacort Turbinaire ³
• Flonase ⁵
• Nasacort ⁷
• Nasacort AQ ⁷
• Nasalide ⁴
• Nasarel ⁴
• Nasonex ⁶
• Rhinocort ²
• Vancenase ¹
• Vancenase AQ 84 mcg ¹
• Vancenase pockethaler ¹

In Canada—

• Beconase ¹
• Flonase ⁵
• Nasacort ⁷
• Nasacort AQ ⁷
• Nasonex ⁶
• Rhinalar ⁴
• Rhinocort Aqua ²
• Rhinocort Turbuhaler ²
• Vancenase ¹

Another commonly used name for beclomethasone is beclometasone .

Category

• Anti-inflammatory, steroidal, nasal—Beclomethasone; Budesonide; Dexamethasone; Flunisolide; Fluticasone; Mometasone; Triamcinolone
• Corticosteroid, nasal—Beclomethasone; Budesonide; Dexamethasone; Flunisolide; Fluticasone; Mometasone; Triamcinolone

Description

Nasal corticosteroids (kor-ti-ko-STER-oids) are cortisone-like medicines. They belong to the family of medicines called steroids. These medicines are sprayed or inhaled into the nose to help relieve the stuffy nose, irritation, and discomfort of hay fever, other allergies, and other nasal problems. These medicines are also used to prevent nasal polyps from growing back after they have been removed by surgery.

These medicines are available only with your doctor"s prescription, in the following dosage forms:

• Nasal
• Beclomethasone
  • Aerosol (U.S. and Canada)
  • Suspension (U.S.)
• Budesonide
  • Aerosol (U.S.)
  • Powder (Canada)
  • Suspension (Canada)
• Dexamethasone
  • Aerosol (U.S.)
• Flunisolide
  • Solution (U.S. and Canada)
• Fluticasone
  • Suspension (U.S. and Canada)
• Mometasone
  • Suspension (U.S. and Canada)
• Triamcinolone
  • Aerosol (U.S. and Canada)
  • Suspension (U.S. and Canada)

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For corticosteroids, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to corticosteroids. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy—In one human study, use of beclomethasone oral inhalation by pregnant women did not cause birth defects or other problems. Other studies on birth defects with beclomethasone, budesonide, dexamethasone, flunisolide, fluticasone, mometasone or triamcinolone have not been done in humans.

In animal studies, corticosteroids taken by mouth or injection during pregnancy were shown to cause birth defects. Also, too much use of corticosteroids during pregnancy, especially during the first trimester, may cause other unwanted effects in the infant, such as slower growth and reduced adrenal gland function.

If corticosteroids are medically necessary during pregnancy to control nasal problems, nasal corticosteroids are generally considered safer than corticosteroids taken by mouth or injection. Also, use of nasal corticosteroids may allow some patients to stop using or decrease the amount of corticosteroids taken by mouth or injection.

Breast-feeding—Use of dexamethasone is not recommended in nursing mothers, since dexamethasone passes into breast milk and may affect the infant"s growth.

It is not known whether beclomethasone, budesonide, flunisolide, fluticasone or triamcinolone passes into breast milk. Although most medicines pass into breast milk in small amounts, many of them may be used safely while breast-feeding. Levels of mometasone are not measurable in breast milk, thus exposure is expected to be low. Mothers who are taking these medicines and wish to breast-feed should discuss them with their doctor.

Children—Corticosteroids taken by mouth or injection have been shown to slow or stop growth in children and cause reduced adrenal gland function. If corticosteroids are medically necessary to control nasal problems in a child, nasal corticosteroids are generally considered to be safer than corticosteroids taken by mouth or injection. Prolonged or high-dose use of nasal corticosteroids may potentially affect growth; although, most nasal corticosteroids have not been shown to affect growth. Also, use of most nasal corticosteroids may allow some children to stop using or decrease the amount of corticosteroids taken by mouth or injection.

Before this medicine is given to a child, you and your child"s doctor should talk about the good this medicine will do as well as the risks of using it. Follow the doctor"s directions very carefully to lessen the chance of unwanted effects.

Older adults—Although there is no specific information comparing use of nasal corticosteroids in the elderly with use in other age groups, they are not expected to cause different side effects or problems in older people than they do in younger adults.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your health care professional if you are taking any prescription or nonprescription (over-the-counter [OTC]) medicines, such as:

• Ephedrine or
• Phenobarbital or
• Rifampin (e.g., Rifadin)—Ephedrine, phenobarbital, and rifampin may decrease the blood levels of nasal corticosteroids, such as dexamethasone, warranting an increase in corticosteroid dose

Other medical problems—The presence of other medical problems may affect the use of corticosteroids. Make sure you tell your doctor if you have any other medical problems, especially:

• Amebiasis—Nasal corticosteroids may make this condition worse

• Asthma—Nasal corticosteroids may make this condition worse

• Type 2 diabetes mellitus—Use of dexamethasone may decrease carbohydrate tolerance, worsening blood glucose control and warranting an increase in insulin dosage

• Glaucoma—Long-term use of nasal corticosteroids may worsen glaucoma by increasing the pressure within the eye

• Herpes simplex (virus) infection of the eye or
• Infections (virus, bacteria, or fungus)—Nasal corticosteroids may cover up the signs of these conditions

• Injury to the nose (recent) or
• Nose surgery (recent) or
• Sores in the nose—Nasal corticosteroids may prevent proper healing of these conditions

• Liver disease

• Tuberculosis (active or history of)

• Underactive thyroid

• Weak heart or
• Recent heart attack—Use of dexamethasone may worsen these conditions

Proper Use of This Medicine

This medicine usually comes with patient directions. Read them carefully before using the medicine . Beclomethasone, budesonide, dexamethasone, and triamcinolone are used with a special inhaler. If you do not understand the directions, or if you are not sure how to use the inhaler, check with your health care professional.

Before using this medicine, clear the nasal passages by blowing your nose. Then, with the nosepiece inserted into the nostril, aim the spray towards the inner corner of the eye.

In order for this medicine to help you, it must be used regularly as ordered by your doctor . This medicine usually begins to work in about 1 week (for dexamethasone), but up to 3 weeks may pass before you feel its full effects.

Use this medicine only as directed . Do not use more of it and do not use it more often than your doctor ordered. To do so may increase the chance of absorption through the lining of the nose and the chance of unwanted effects.

Check with your doctor before using this medicine for nasal problems other than the one for which it was prescribed , since it should not be used on many bacterial, virus, or fungus nasal infections.

Save the inhaler that comes with beclomethasone or dexamethasone, since refill units may be available at lower cost.

Dosing—The dose of nasal corticosteroids will be different for different patients. Follow your doctor"s orders or the directions on the label . The following information includes only the average doses of nasal corticosteroids. If your dose is different, do not change it unless your doctor tells you to do so.

• For beclomethasone
• For allergies or other nasal conditions:
  • For nasal aerosol dosage form:
    • Adults and children 6 years of age and older—One spray in each nostril two to four times a day.
    • Children up to 6 years of age—Use and dose must be determined by your doctor.
  • For nasal suspension dosage form:
    • Adults and children 6 years of age and older—One or two sprays in each nostril two times a day.
    • Children up to 6 years of age—Use and dose must be determined by your doctor.

• For budesonide
• For allergies or other nasal conditions:
  • For nasal powder dosage form:
    • Adults and children 6 years of age and older—Two inhalations in each nostril once a day in the morning.
    • Children up to 6 years of age—Use and dose must be determined by your doctor.
  • For nasal suspension dosage form:
    • Adults and children 6 years of age and older—One or two sprays in each nostril one or two times a day.
    • Children up to 6 years of age—Use and dose must be determined by your doctor.

• For dexamethasone
• For allergies or other nasal conditions:
  • For nasal aerosol dosage form:
    • Adults and children 12 years of age and older—Two sprays in each nostril two or three times a day for up to two weeks.
    • Children 6 to 12 years of age—One to two sprays in each nostril two times a day for up to two weeks.
    • Children up to 6 years of age—Use and dose must be determined by your doctor.

• For flunisolide
• For allergies or other nasal conditions:
  • For nasal solution dosage form:
    • Adults and children 6 years of age and older—One or two sprays in each nostril one to three times a day.
    • Children up to 6 years of age—Use and dose must be determined by your doctor.

• For fluticasone
• For allergies or other nasal conditions:
  • For nasal suspension dosage form:
    • Adults and children 4 years of age and older—One or two sprays in each nostril one or two times a day.
    • Children up to 4 years of age—Use and dose must be determined by your doctor.

• For mometasone
• For allergies or other nasal conditions:
  • For nasal suspension dosage form:
    • Adults and children 12 years of age and older—One or two sprays in each nostril one time a day.
    • Children up to 12 years of age—Use and dose must be determined by your doctor.

• For triamcinolone
• For allergies or other nasal conditions:
  • For nasal aerosol dosage form:
    • Adults and children 6 years of age and older (In Canada, children 12 years of age and older)—One or two sprays in each nostril once a day.
    • Children up to 6 years of age (In Canada, children up to 12 years of age)—Use and dose must be determined by your doctor.
  • For nasal suspension dosage form:
    • Adults and children 6 years of age and older—One or two sprays in each nostril one time a day.
    • Children up to 6 years of age—Use and dose must be determined by your doctor.

Missed dose—If you miss a dose of this medicine and remember within an hour or so, use it right away. However, if you do not remember until later, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store budesonide powder in the bathroom, near the kitchen sink, or in other damp places, especially if the cap has not been tightly screwed back on. Moisture may cause the medicine to break down.
• Keep the medicine from getting too cold or freezing. This medicine may be less effective if it is too cold when you use it.
• Do not puncture, break, or burn the beclomethasone, dexamethasone, or triamcinolone aerosol container, even after it is empty.
• Do not keep outdated medicine or medicine no longer needed. Also, discard any unused beclomethasone or flunisolide solution 3 months after you open the package. Be sure that any discarded medicine is out of the reach of children.

Precautions While Using This Medicine

If you will be using this medicine for more than a few weeks, your doctor should check your progress at regular visits.

Check with your doctor :

• if signs of a nose, sinus, or throat infection occur.
• if your symptoms do not improve within 7 days (for dexamethasone) or within 3 weeks (for beclomethasone, budesonide, flunisolide, fluticasone, mometasone, or triamcinolone).
• if your condition gets worse.

When you are being treated with dexamethasone, and after you stop treatment with it, do not have any immunizations (vaccinations) without your doctor"s approval. Dexamethasone may lower your body"s resistance and there is a chance you may get the infection the immunization is meant to prevent. In addition, other persons living in your household should not take or have recently taken oral polio vaccine since there is a chance they could pass the polio virus on to you. Also, avoid other persons who have taken oral polio vaccine. Don"t get close to them, and do not stay in the same room with them for very long. If you cannot take these precautions, you should consider wearing a protective face mask that covers the nose and mouth.

Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

Not all of the side effects listed above have been reported for each of these medicines, but they have been reported for at least one of them. All of the nasal corticosteroids are very similar, so any of the above side effects may occur with any of these medicines.

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

Revised: 06/27/2000

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