Contraindications and Precautions for Fluticasone Propionate Nasal Spray

Situations Requiring Medical Consultation Before Use

Patients with pre-existing ocular conditions, such as glaucoma or cataracts, should consult a physician before using fluticasone propionate nasal spray, as individual patient variability may allow for ocular effects, especially in older patients, despite overall safety data 1
The American Academy of Allergy, Asthma, and Immunology recommends that patients with glaucoma or cataracts use fluticasone propionate nasal spray with caution, as prospective 24-week studies have shown no increased risk, but individual patient variability may occur 1

The use of HIV protease inhibitors, particularly ritonavir, and ketoconazole, can increase systemic fluticasone concentrations, potentially causing Cushing syndrome and adrenal suppression, and therefore requires caution 2
Concurrent use of systemic corticosteroids or other inhaled/intranasal corticosteroids with fluticasone propionate nasal spray increases the risk of systemic effects, including adrenal suppression, according to the American College of Allergy, Asthma, and Immunology 2

Children aged 4-11 years can use fluticasone propionate nasal spray for up to 2 months per year, but longer duration requires physician consultation due to potential growth velocity suppression, as recommended by the American Academy of Pediatrics 2
Growth suppression has been observed in children on low-to-medium doses of fluticasone propionate nasal spray, though effects may be transient, according to the American Academy of Allergy, Asthma, and Immunology 2

Patients with nasal septal abnormalities should direct the spray away from the septum to prevent repetitive trauma that may lead to septal perforation, though this is rare, as advised by the American Rhinologic Society 1
The nasal septum should be examined periodically for mucosal erosions, which may precede perforation, according to the American Academy of Otolaryngology 1

Pharmacists should ensure proper technique and screening for contraindications when consulting patients about over-the-counter fluticasone propionate nasal spray, as recommended by the American Pharmacists Association 3