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flunisolide (Nasalide, Nasarel AeroBid)

Tradenames: Nasalide, AeroBid. Indications: 1) seasonal or perennial rhinitis 2) prophylaxis for asthma 3) chronic bronchitis & COPD 4) atopy [6] Dosage: 1) nasal spray: start 2 sprays (50 ug) BID, max 8 sprays/day 2) inhaler: 2 puffs BID Pharmacokinetics: onset of action is 1-4 weeks Adverse effects: 1) common (> 10%) - bitter taste, nervousness, headache, hoarseness, GI irritation, oral candidiasis, increased susceptibility to infection, dizziness, anorexia, coughing, upper respiratory tract infection, pounding heartbeat, menstrual problems, itching, rash, bronchitis 2) less common (1-10%) - epistaxis, insomnia, diaphoresis, increased appetite, dry mouth & throat, psychic changes, acne, hives, cataracts, loss of smell & taste 3) uncommon (< 1%) - bronchospasm, shortness of breath, abdominal fullness 4) other - irritation of nasal mucosa - rarely nasal ulceration - oral candidiasis (thrush) Laboratory: - flunisolide in serum/plasma - flunisolide in urine Mechanism of action: 1) inhaler - no significant cortisol suppression at 2 mg/day (8 puffs) - no effect on bone density after 1 year at 1 mg/day (4 puffs) 2) nasal preparation - does NOT inhibit IgE synthesis or mast cell degranulation - inhibits cytokine production, arachidonate metabolism, inflammation & mast cell proliferation

Interactions

drug interactions drug adverse effects (more general classes) monitor with drug (more general classes)

General

antiasthmatic agent glucocorticoid

Properties

MISC-INFO: elimination route LIVER 1/2life 1.8 HOURS pregnancy-category C safety in lactation - ?

Database Correlations

PUBCHEM correlations

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 85
  3. Forest Pharmaceuticals
  4. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 743
  5. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  6. Deprecated Reference
  7. Department of Veterans Affairs, VA National Formulary