Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For corticosteroids, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to corticosteroids. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy—In one human study, use of beclomethasone oral inhalation by pregnant women did not cause birth defects or other problems. Other studies on birth defects with beclomethasone, budesonide, dexamethasone, flunisolide, fluticasone, mometasone or triamcinolone have not been done in humans.

In animal studies, corticosteroids taken by mouth or injection during pregnancy were shown to cause birth defects. Also, too much use of corticosteroids during pregnancy, especially during the first trimester, may cause other unwanted effects in the infant, such as slower growth and reduced adrenal gland function.

If corticosteroids are medically necessary during pregnancy to control nasal problems, nasal corticosteroids are generally considered safer than corticosteroids taken by mouth or injection. Also, use of nasal corticosteroids may allow some patients to stop using or decrease the amount of corticosteroids taken by mouth or injection.

Breast-feeding—Use of dexamethasone is not recommended in nursing mothers, since dexamethasone passes into breast milk and may affect the infant's growth.

It is not known whether beclomethasone, budesonide, flunisolide, fluticasone or triamcinolone passes into breast milk. Although most medicines pass into breast milk in small amounts, many of them may be used safely while breast-feeding. Levels of mometasone are not measurable in breast milk, thus exposure is expected to be low. Mothers who are taking these medicines and wish to breast-feed should discuss them with their doctor.

Children—Corticosteroids taken by mouth or injection have been shown to slow or stop growth in children and cause reduced adrenal gland function. If corticosteroids are medically necessary to control nasal problems in a child, nasal corticosteroids are generally considered to be safer than corticosteroids taken by mouth or injection. Prolonged or high-dose use of nasal corticosteroids may potentially affect growth; although, most nasal corticosteroids have not been shown to affect growth. Also, use of most nasal corticosteroids may allow some children to stop using or decrease the amount of corticosteroids taken by mouth or injection.

Before this medicine is given to a child, you and your child's doctor should talk about the good this medicine will do as well as the risks of using it. Follow the doctor's directions very carefully to lessen the chance of unwanted effects.

Older adults—Although there is no specific information comparing use of nasal corticosteroids in the elderly with use in other age groups, they are not expected to cause different side effects or problems in older people than they do in younger adults.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your health care professional if you are taking any prescription or nonprescription (over-the-counter [OTC]) medicines, such as:

• Ephedrine or
• Phenobarbital or
• Rifampin (e.g., Rifadin)—Ephedrine, phenobarbital, and rifampin may decrease the blood levels of nasal corticosteroids, such as dexamethasone, warranting an increase in corticosteroid dose

Other medical problems—The presence of other medical problems may affect the use of corticosteroids. Make sure you tell your doctor if you have any other medical problems, especially:

• Amebiasis—Nasal corticosteroids may make this condition worse

• Asthma—Nasal corticosteroids may make this condition worse

• Diabetes mellitus (sugar diabetes)—Use of dexamethasone may decrease carbohydrate tolerance, worsening blood glucose control and warranting an increase in insulin dosage

• Glaucoma—Long-term use of nasal corticosteroids may worsen glaucoma by increasing the pressure within the eye

• Herpes simplex (virus) infection of the eye or
• Infections (virus, bacteria, or fungus)—Nasal corticosteroids may cover up the signs of these conditions

• Injury to the nose (recent) or
• Nose surgery (recent) or
• Sores in the nose—Nasal corticosteroids may prevent proper healing of these conditions

• Liver disease

• Tuberculosis (active or history of)

• Underactive thyroid

• Weak heart or
• Recent heart attack—Use of dexamethasone may worsen these conditions