Medication Use in Special Populations

Introduction to Nasal Corticosteroid Use

Nasal corticosteroids are a common treatment option for various respiratory conditions, and their use in special populations, such as pregnant women, requires careful consideration of safety and efficacy 1, 2

Modern nasal corticosteroids, such as budesonide, fluticasone, and mometasone, can be used safely during pregnancy at recommended doses, with minimal systemic absorption, as recommended by the American College of Allergy, Asthma, and Immunology and supported by observational studies and meta-analyses 1, 2
The use of nasal corticosteroids during pregnancy does not increase the risk of congenital malformations, preterm birth, low birth weight, or pregnancy-induced hypertension, according to expert panels and the American College of Allergy, Asthma, and Immunology 2, 3
Budesonide is classified as category B by the FDA during pregnancy and has the most extensive safety data available, making it a safe option for pregnant women, as recommended by the American College of Allergy, Asthma, and Immunology 2
Fluticasone and mometasone, although classified as category C, have favorable safety profiles and can be used if they have adequately controlled symptoms before pregnancy, as recommended by the American College of Allergy, Asthma, and Immunology 2

The minimum effective dose of nasal corticosteroids should be used to control symptoms, as recommended by the American Academy of Allergy, Asthma, and Immunology, and the same nasal corticosteroid that adequately controlled symptoms before pregnancy should be continued, as recommended by the American College of Allergy, Asthma, and Immunology 2
Unapproved formulations, such as budesonide irrigations or nasal drops, should be avoided, and consultation with an obstetrician is recommended in cases of severe symptoms, as recommended by the Rhinology society 3, 1
Cromolyn sodium (category B) is a safe but less effective alternative to nasal corticosteroids, requiring application four times a day, as recommended by the American Academy of Allergy, Asthma, and Immunology, while oral decongestants should be avoided, especially during the first trimester, due to reports of association with congenital malformations, as recommended by the American College of Allergy, Asthma, and Immunology 2

Nasal corticosteroids are preferred over oral corticosteroids due to lower systemic absorption and potential risks, as recommended by the Rhinology society, and evidence suggests that there are no substantial differences in efficacy and safety between available nasal corticosteroids when used at recommended doses, as stated by the American College of Allergy, Asthma, and Immunology 3, 2
The American College of Allergy, Asthma, and Immunology recommends continuing nasal corticosteroid sprays during pregnancy if symptoms are controlled, using the lowest effective dose, and avoiding off-label formulations and oral decongestants, especially during the first trimester, due to reports of association with congenital malformations, as recommended by the American College of Allergy, Asthma, and Immunology and the Rhinology society 2, 3