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CPAP May Make Nasal Spray Ineffective at Night?
came across this tip online and wanted to see whether others agree.
"Hold the Spray Until Morning
Advise patients who are receiving continuous positive airway pressure (CPAP) therapy and who use a corticosteroid nasal spray for allergies to spray in the morning rather than at bedtime. If the spray is used in the evening, CPAP may dry it out, making it less effective.
—— Richard A. Honaker, MD
Carrollton, Tex"
"Hold the Spray Until Morning
Advise patients who are receiving continuous positive airway pressure (CPAP) therapy and who use a corticosteroid nasal spray for allergies to spray in the morning rather than at bedtime. If the spray is used in the evening, CPAP may dry it out, making it less effective.
—— Richard A. Honaker, MD
Carrollton, Tex"
Views: 1137
Replies to This Discussion
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Permalink Reply by Tim on
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Banyon; Thank you for pointing out the error in my post. When I said "OTC nasal sprays", I meant, and should have said "OTC decongestant nasal sprays". I should have included that Phenylephrine is also used in OTC decongestant nasal sprays, such as Neo-Synephrine Regular Strength Nasal Decongestant Spray.
Instead of saying " ... they are not absorbed and are in very low concentration, so they have very little systemic effect.”, I should have said that the absorption of fluticasone propionate (Flonase) is negligible. From http://www.pharmcom.com/flonase_data.html:
"Following intranasal dosing of fluticasone propionate, (200mcg/day) steady-state maximum plasma concentrations were not quantifiable in most subjects (<0.01ng/mL). The highest Cmax observed was 0.017ng/mL. Direct absorption in the nose is negligible due to the low aqueous solubility with the majority of the dose being eventually swallowed. When administered orally the systemic exposure is <1% due to poor absorption and pre-systemic metabolism. The total systemic absorption arising from both nasal and oral absorption of the swallowed dose is therefore negligible."
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Permalink Reply by chrischris1 on
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It is is prescription drug, but I use the same drug for my allergies. I used generic flonase.
susan mccord said:So it's like OTC nasal sprays? I (rarely) use a mild 4-hour spray before I go to sleep if I feel stuffy, which I hardly ever do anymore. One shot of it qhs is sufficient for me to get to sleep.
Is Flonase Rx or OTC? Am wondering if he's talking about a prescription spray that Rx'd for specific conditions.
McCord
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I use my Flonase in the morning and then around 5PM. Is that a long enough span, do you think, Doctor?
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Permalink Reply by Banyon on
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Kathleen G said:I use my Flonase in the morning and then around 5PM. Is that a long enough span, do you think, Doctor?
The studies on Flonase were done with use once per day and that is what is recommended. What did your doctor prescribe? How many times per day and how many "shots" in each nostril?
BTW, there is no doctor posting on this thread at this point.
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Permalink Reply by Mary Z on
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I think we may be talking apples and oranges here with so many different nasal sprays and the defininations of adsorb and absorb and the different amounts of pressure needed to maintain an open airway. If we just take Flonase it would seem to me a matter of what worked better- using it in the morning, or at night- and this something I missed- is it once a day, or more often during the day? Different formulations? If all other things are equal it might be useful to know that if it's a once a day spray and it doesn't help at night, to try it in the morning and vice versa.
Adsorption is interesting- what good does something do sitting on the nasal mucosa in a condensed layer?
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Permalink Reply by 99 on
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there are two different words here and to highlight them i will show you
ADSORB and
ABSORB
The difference is ad and ab
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99!
99 said:there are two different words here and to highlight them i will show you
ADSORB and
ABSORB
The difference is ad and ab
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a sponge is absorbant that is that it soaks up
carbon is adsorbbant in that things stick to the outside
Mary Z said:99!
99 said:there are two different wordss here and to highlight them i will show you
ADSORB and
ABSORB
The difference is ad and ab
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Permalink Reply by RL on
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I have been using prescription Flonase, actually, the generic "fluticasone propionate" nasal spray, 50 mcg, for about four months now. My initial review of the product protocols supports the comments by Tim and Banyon as to frequency of use. I had to go over this carefully, as my Rx label was initially written vaguely and I wanted to clarify it. What I learned was that the maximum dose per day should be 2 sprays per nostril per day. Further research indicated that the 2 spray dose was intended to be at the same time (not spread out over the day). Some users were able to use only 1 spray per nostril after a while. Using more than the 2 sprays per nostril could cause the steroid to enter the blood stream with resulting potential negative side effects.
I was initially confused when my doctor recommended the Flonase Rx as I had previous negative experience with OTC Flonase brand nasal spray causing severe sinus pain. So the OTC Flonase brand is not the same medication as the Rx product at all. (decongestant vs corticosteroid)
All the comments in this thread are interesting to me and I may try different ways of using the fluticasone propionate to see what works better. Currently, I use the spray in the evening, before bedtime. Sometimes I forget to do it until right before starting the CPAP, but I was trying to use it an hour or so before to give it some time to work. I do notice a difference of congestion level if I forget to use it, and usually use just one spray per nostril, except if I am having excessive congestion, then I will use 2 sprays. I may try doing the saline flush first to reduce mucus that may prevent the medication from contacting the tissues it is intended for. I believe using the humidifier with the CPAP would prevent the drying out of the medication as initially noted, so each person should be aware of that per their own equipment set up.
I occasionally use other types of nasal sprays during the day on an as needed basis, including a Rx antihistamine and an OTC capsaicin homeopathic spray. I thought that using the Rx flonase at night would make for less conflict with my daytime use of these other sprays, which is why I decided to take that dose in the p.m. This is an ongoing, day by day management process, and finding what works best is unique for each of us and can change over time as well. Thanks for the info Mike and everyone. I'll let you know if I my experience changes per this advise, but it will take some time to try it.
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RL said:.... So the OTC Flonase brand is not the same medication as the Rx product at all. (decongestant vs corticosteroid) ....
There is no such thing as OTC Flonase.
Flonase is the GlaxoSmithKline tradename for their proprietary formulation of fluticasone propionate.
Good luck with controlling the allergies.
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Permalink Reply by RockRpsgt on
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Banyon what is it that you did before retiring? Your knowledge at times can be overwhelming. I find it hard to believe that you are just a pt.
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Usually people say my obnoxiousness is the overwhelming part.
Let me give you some career advice about " .... just a pt.", .... well, you can figure it out. ;)
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