Flunisolide

{{Short description|Chemical compound}} {{Infobox drug | Verifiedfields = changed | verifiedrevid = 461101454 | IUPAC_name = (1''S'',2''S'',4''R'',8''S'',9''S'',11''S'',12''S'',13''R'',19''S'')-19-fluoro-11-hydroxy-8-(2-hydroxyacetyl)-6,6,9,13-tetramethyl-5,7-dioxapentacyclo[10.8.0.02,9.04,8.013,18]icosa-14,17-dien-16-one | image = Flunisolide.png | image_class = skin-invert-image | image2 = Flunisolide ball-and-stick.png | image_class2 = bg-transparent  | tradename = Aerobid, Nasalide, Nasarel, others | Drugs.com = {{drugs.com|monograph|flunisolide}} | MedlinePlus = a681048 | pregnancy_category = | legal_status = | routes_of_administration = Inhaled  | bioavailability = | protein_bound = 40% after inhalation | metabolism = | elimination_half-life = 1.8 hours  | IUPHAR_ligand = 7076 | CAS_number_Ref = {{cascite|correct|??}} | CAS_number = 3385-03-3 | ATC_prefix = R01 | ATC_suffix = AD04 | ATC_supplemental = {{ATC|R03|BA03}} | PubChem = 82153 | DrugBank_Ref = {{drugbankcite|correct|drugbank}} | DrugBank = DB00180 | ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}} | ChemSpiderID = 74144 | UNII_Ref = {{fdacite|correct|FDA}} | UNII = 78M02AA8KF | KEGG_Ref = {{keggcite|changed|kegg}} | KEGG = D00324 | ChEBI_Ref = {{ebicite|correct|EBI}} | ChEBI = 5106 | ChEMBL_Ref = {{ebicite|correct|EBI}} | ChEMBL = 1512  | C=24 | H=31 | F=1 | O=6 | smiles = O=C\1\C=C/[C@]2(/C(=C/1)[C@@H](F)C[C@H]3[C@H]4[C@](C[C@H](O)[C@H]23)([C@@]5(OC(O[C@@H]5C4)(C)C)C(=O)CO)C)C | StdInChI_Ref = {{stdinchicite|correct|chemspider}} | StdInChI = 1S/C24H31FO6/c1-21(2)30-19-9-14-13-8-16(25)15-7-12(27)5-6-22(15,3)20(13)17(28)10-23(14,4)24(19,31-21)18(29)11-26/h5-7,13-14,16-17,19-20,26,28H,8-11H2,1-4H3/t13-,14-,16-,17-,19+,20+,22-,23-,24+/m0/s1 | StdInChIKey_Ref = {{stdinchicite|correct|chemspider}} | StdInChIKey = XSFJVAJPIHIPKU-XWCQMRHXSA-N | synonyms = 6α-Fluoro-11β,16α,17,21-tetrahydroxypregna-1,4-diene-3,20-dione acetone cyclic 16,17-acetal }}  '''Flunisolide''' (marketed as '''AeroBid''' among others) is a corticosteroid often prescribed as a treatment for allergic rhinitis.<ref>{{cite web | title = Flunisolide | url = http://www.drugbank.ca/drugs/DB00180 | work = DrugBank }}</ref> Intranasal corticosteroids are the most effective medication for controlling symptoms.<ref name="auto">{{cite journal | vauthors = Wallace DV, Dykewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA, Lang DM, Nicklas RA, Oppenheimer J, Portnoy JM, Randolph CC, Schuller D, Spector SL, Tilles SA | display-authors = 6 | title = The diagnosis and management of rhinitis: an updated practice parameter | journal = The Journal of Allergy and Clinical Immunology | volume = 122 | issue = 2 Suppl | pages = S1-84 | date = August 2008 | pmid = 18662584 | doi = 10.1016/j.jaci.2008.06.003 | doi-access = free }}</ref>

Flunisolide's principal mechanism of action is to activate glucocorticoid receptors, indicating an anti-inflammatory action. The effects of topical corticosteroids are not immediate and must be used for at least a few days for noticeable relief. As-needed use is less effective than regular recommended use.<ref name="auto"/> Flunisolide should not be used for nasal infections. It should not be continued if symptoms are not relieved after regular use for over two to three weeks.<ref name="nih.gov">{{cite web | title = Flunisolide Nasal Solution | url = https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8ba9cc1c-55e5-40ed-9efe-f7abb73976ea | work = DailyMed | publisher = U.S. National Library of Medicine }}</ref>

Patented in 1958 and approved for medical use in 1978,<ref name=Fis2006>{{cite book | vauthors = Fischer J, Ganellin CR |title=Analogue-based Drug Discovery |date=2006 |publisher=John Wiley & Sons |isbn=978-3-527-60749-5 |page=486 |url=https://books.google.com/books?id=FjKfqkaKkAAC&pg=PA486 |language=en}}</ref> it is on the World Health Organization's List of Essential Medicines.<ref name="WHO22nd">{{cite book | title = World Health Organization model list of essential medicines: 22nd list (2021) | year = 2021 | hdl = 10665/345533 | publisher = World Health Organization | location = Geneva | id = WHO/MHP/HPS/EML/2021.02 | hdl-access=free }}</ref>

==Side effects== Temporary nose and throat dryness, irritation, bleeding, or unpleasant taste or smell may occur.<ref>{{cite web|url=http://www.medicinenet.com/flunisolide-nasal/page2.htm|title=FLUNISOLIDE - NASAL (Nasalide, Nasarel) side effects, medical uses, and drug interactions | work = MedicineNet }}</ref> Nasal septum perforation has been rarely reported.<ref name="auto"/> Rare but localized infections of the nose and pharynx with ''Candida albicans'' have also been reported. Its long-term use may raise the chances of cataracts or glaucoma.<ref name="rxlist.com" />

Flunisolide nasal spray is absorbed into the circulatory system (blood).<ref name="nih.gov"/> Corticosteroid nasal sprays may affect the hypothalamic-pituitary-adrenal axis function in humans.<ref name="rxlist.com">{{cite web|url=http://www.rxlist.com/nasalide-drug/clinical-pharmacology.htm|title=Nasalide (Flunisolide (Nasal Spray)) Drug Information: Clinical Pharmacology - Prescribing Information | work = RxList }}</ref> After obtaining the desired clinical effect, the maintenance dose should be reduced to the smallest amount required to control the symptoms. The amount can be as low as one spray in each nostril daily. Utilizing the minimum effective dose reduces possibility of side effects.<ref name="rxlist.com"/> Recommended amounts of intranasal corticosteroids are generally not associated with systemic side effects.

Corticosteroids inhibit wound healing, so corticosteroid nasal sprays should be used cautiously in patients who have experienced recent nasal septal ulcers, recurrent epistaxis, nasal surgery or trauma, until healing.<ref name="nih.gov"/> In pregnancy, recommended doses of intranasal corticosteroids are safe and effective.<ref name="auto"/>

== References == {{Reflist|2}}

Category:Acetonides Category:Corticosteroid cyclic ketals Category:Diketones Category:Diols Category:Organofluorides Category:Glucocorticoids