Fluticasone Nasal Spray (Flomist) - Correct Dosing

Why 4 Sprays Per Nostril is Too Much

• The maximum recommended dose is 2 sprays per nostril (= 200 mcg total per day), per the FDA official label.
• 4 sprays per nostril would give you 400 mcg per nostril = 800 mcg/day total, which is 4x the recommended maximum.
• The FDA label explicitly states: "There is no evidence that exceeding the recommended dose is more effective."
• Higher doses increase the risk of side effects without added benefit.

Risks of Exceeding the Dose

• Nosebleeds (epistaxis) - already a common side effect even at normal doses
• Nasal irritation, burning, and dryness
• Nasal septum damage or, rarely, perforation with chronic overuse
• Systemic corticosteroid effects (though low with intranasal route, risk rises with very high doses): adrenal suppression, growth suppression in children, cataracts, glaucoma

What You Should Do

• Stick to 2 sprays per nostril once daily (adults).
• If 2 sprays per nostril are not controlling your symptoms, do not increase the dose - speak to your doctor, as you may need a different medication or an evaluation for underlying nasal polyps or sinusitis.
• After symptoms are well-controlled for a few days, you can try reducing to 1 spray per nostril once daily as a maintenance dose.

If you have already taken 4 sprays in each nostril as a single dose, a single overdose of intranasal fluticasone is unlikely to cause a medical emergency, but you should not repeat this. Contact your doctor or pharmacist for guidance.