TICANASE NASAL SP 12G

Indications

Approved Uses

Management/treatment of nasal symptoms of seasonal and perennial allergic rhinitis; may also be used for non-allergic (vasomotor) rhinitis depending on local labeling.

Off-Label Uses

Chronic rhinosinusitis (with or without nasal polyps) and nasal polyps (adjunctive/maintenance); post-nasal drip related to rhinitis/sinus inflammation.

Dosage & Administration

Dosing by Condition

Allergic rhinitis: Adults/adolescents ≥12 years: 2 sprays in each nostril once daily initially (total 200 mcg/day), then reduce to 1 spray in each nostril once daily (100 mcg/day) when controlled. Children 4-11 years: 1 spray in each nostril once daily (100 mcg/day); may increase to 2 sprays in each nostril once daily if needed per labeling/clinical judgment.

Initial Dose

Adults and adolescents ≥12 years: 2 sprays (50 mcg each) per nostril once daily (total 200 mcg/day)

Maintenance Dose

1 spray per nostril once daily (total 100 mcg/day) once symptoms are controlled

Maximum Dose

Adults/adolescents (≥12 years): up to 2 sprays per nostril once daily (total 200 mcg/day); Children 4-11 years: 1 spray per nostril once daily (total 100 mcg/day).

Children's Dosage

Children 4-11 years: 1 spray (50 mcg) per nostril once daily (100 mcg/day); max 2 sprays per nostril once daily. Not recommended under 4 years of age

Dose Adjustment Notes

No routine dose adjustment is required for renal or hepatic impairment at recommended intranasal doses; use the lowest effective dose for maintenance.

How to Take

Shake gently before each use. Prime the pump before first use (typically 6 sprays) and re-prime if not used for several days (until a fine mist appears). Blow nose gently. Keep head slightly forward, insert nozzle into one nostril while closing the other, aim away from the nasal septum, and spray while breathing in gently through the nose; breathe out through the mouth. Repeat for the other nostril if prescribed. Wipe/clean the nozzle and replace the cap after use.

How to Prepare

Shake well; prime before first use until a fine mist appears (commonly ~6 actuations). Re-prime if the spray has not been used for a prolonged period per the product leaflet (often a few actuations until mist returns).

Side Effects

Common Side Effects

Epistaxis (nosebleed), nasal irritation/burning or dryness, headache, unpleasant taste/smell, throat irritation/pharyngitis; cough can occur.

Side Effect Frequency

Common (>3%): Epistaxis, headache, pharyngitis, nasal burning/irritation. Postmarketing: Nasal ulceration, nasal septal perforation, hypersensitivity reactions (e.g., anaphylaxis, angioedema, rash), glaucoma/cataracts.

Safety & Warnings

Contraindications

Hypersensitivity to fluticasone propionate or any excipients.

Warnings & Precautions

Avoid/monitor with recent nasal surgery/trauma or nasal ulceration (delayed healing), monitor for local infections (e.g., Candida) and use caution with untreated infections/TB/ocular herpes, avoid strong CYP3A4 inhibitors, monitor growth in children with prolonged use, and consider ocular monitoring (glaucoma/cataracts) with long-term therapy.

Age Restriction

Not recommended for children under 4 years of age.

Driving Warning

Safe

Drug Interactions

Drug Interactions

Major: strong CYP3A4 inhibitors (especially ritonavir/cobicistat; also ketoconazole/itraconazole and some macrolides like clarithromycin) can markedly increase systemic fluticasone exposure-avoid or use alternative; additive systemic effects possible with other corticosteroids.

Interaction Severity

MAJOR: Strong CYP3A4 inhibitors (especially ritonavir/cobicistat; also ketoconazole/itraconazole and similar) can markedly increase systemic fluticasone exposure with risk of adrenal suppression/Cushingoid effects. MODERATE: Concomitant other corticosteroids may increase systemic corticosteroid burden. MINOR/none: No clinically significant interactions expected at usual intranasal doses otherwise.

Food Interaction

No restriction

Alcohol Interaction

Safe

Special Populations

Pregnancy

Consult Doctor

Breastfeeding

Consult Doctor

Children

Children 4-11 years: 1 spray (50 mcg) per nostril once daily (100 mcg/day); max 2 sprays per nostril once daily. Not recommended under 4 years of age

Elderly

Standard adult dosing.

Kidney Impairment

No adjustment needed

Storage & Patient Advice

Preparation Instructions

Shake well; prime before first use until a fine mist appears (commonly ~6 actuations). Re-prime if the spray has not been used for a prolonged period per the product leaflet (often a few actuations until mist returns).

Missed Dose

Use as soon as remembered on the same day; skip if it is almost time for the next dose. Do not double the dose

Stopping the Medicine

Do not stop abruptly if used regularly for a long period or at higher-than-recommended doses; taper by reducing to the lowest effective dose and/or decreasing frequency over 1-2 weeks to minimize rebound symptoms. If used at usual intranasal doses for a short period, it can generally be stopped without taper; seek medical advice if symptoms recur or if systemic steroid effects are suspected.

Overdose

Acute intranasal overdose is unlikely to cause significant toxicity; chronic excessive dosing or interacting drugs (CYP3A4 inhibitors) may cause systemic corticosteroid effects (e.g., hypercorticism/adrenal suppression)-reduce to recommended dose and assess clinically, including adrenal function if symptomatic.

Patient Counseling

Use TICANASE (fluticasone propionate 0.05% intranasal corticosteroid) regularly every day for best control; symptom relief may start within 12-24 hours but maximum benefit can take several days up to ~1-2 weeks. Shake well before use; prime the pump before first use and re-prime if not used for a period per product leaflet. Blow nose gently, keep head slightly forward, aim the spray away from the nasal septum (toward the outer wall), and avoid spraying into eyes/mouth. Do not exceed the recommended daily dose; if frequent nosebleeds, nasal pain/ulceration, or vision changes occur, stop and seek medical advice. Clean the nozzle/applicator regularly. Tell a clinician if you use other corticosteroids or strong CYP3A4 inhibitors (e.g., ritonavir/cobicistat) or if you develop signs of nasal infection; store below 30°C.

Monitoring Requirements

Monitor for local nasal adverse effects (epistaxis, ulceration, candidiasis, septal perforation) with prolonged use; monitor growth in children on long-term therapy; consider ocular monitoring (cataract/glaucoma) with long-term/high-dose use or risk factors; monitor for systemic corticosteroid effects if used with strong CYP3A4 inhibitors or multiple steroids.

Pharmacology

Mechanism of Action

Binds glucocorticoid receptors in nasal mucosa, downregulating inflammatory gene transcription and inhibiting release of mediators (e.g., cytokines, histamine, leukotrienes), reducing mucosal edema, congestion, and secretions.

Onset of Action

Some symptom improvement can occur within 12 hours (sometimes earlier), but maximal benefit typically requires several days and may take 1-2 weeks of regular daily use.

Duration of Effect

Approximately 24 hours with regular once-daily use.

Half-Life

Approximately 7.8 hours (systemic terminal half-life).

Bioavailability

<2% systemic bioavailability after intranasal administration (very low).

Metabolism

Extensive first-pass metabolism in the liver, primarily by CYP3A4, to an inactive carboxylic acid metabolite.

Product Information

Available Dosage Forms

Intranasal spray (aqueous suspension) in a nasal applicator (metered-dose).

Composition per Dose

Each actuation (100 mg suspension): 50 mcg fluticasone propionate (0.05%)

Generic Availability

Yes

OTC Alternatives

Other OTC intranasal corticosteroids (e.g., budesonide, triamcinolone, mometasone where OTC), oral second-generation antihistamines (e.g., cetirizine, loratadine, fexofenadine), intranasal antihistamines where available OTC, and saline sprays/rinses; cromolyn sodium nasal spray where available.

Symptom Target

Allergy, Congestion, Runny Nose

Sedating

No

Reviewed by Al Mujtama Pharmacy Medical Review Team. Last reviewed 29-06-2026