Bea asked
I take symbicort inhaler twice a day, 4mg methylprednisolone once a day, 600mg of guaifenesin mucinex twice a day, and 0.5mg of lorazepam once a day, can I also take fluticasone propionate nasal spray 50mcg since it is also a steroid? I've had a runny nose off and on throughout the day.
Answer
Fluticasone is a nasal corticosteroid used in the treatment of allergies, nonallergic rhinitis (runny nose and congestion not caused by allergies) and nasal polyps. Fluticasone can be taken with Symbicort inhaler, methylprednisolone, Mucinex (guaifenesin) and lorazepam. Let's take a look at each individual drug and discuss why adding fluticasone may help with your runny nose symptoms.
Fluticasone
Fluticasone works by relieving nasal congestion and having anti-inflammatory properties that also work on allergy symptoms and causes. Full results from using fluticasone may not be seen for up to 1 week. The bottle should be gently shaken before using and care should be taken not to spray into the eyes. Fluticasone is a generally well tolerated medication with the most common side effects being nasal discomfort, bleeding, sneezing, throat irritation and headache.
Symbicort
Symbicort (budesonide and formoterol) is a long acting beta agonist and inhaled corticosteroid used in the treatment of asthma and chronic obstructive pulmonary disease (COPD). Budesonide is the corticosteroid that helps control inflammation of the airways in the lungs. Formoterol is a long acting beta agonist that relaxes the bronchial smooth muscles allowing for easier breathing.
Some common side effects of Symbicort (budesonide and formoterol) include pharyngitis (throat irritation or pain), headache, abdominal pain and upper respiratory tract infection. The inhaler should be gently shaken for 5 seconds before each use. Rinse mouth out with water and spit after each use and the mouth piece should be cleaned with a dry wipe every 7 days.
Methylprednisolone
Methylprednisolone is a oral corticosteroid that can be used in the treatment of many allergic, dermatologic, endocrine, gastrointestinal, hematologic (blood), neoplastic (cancer), nervous system, ophthalmic, renal (kidney) and respiratory conditions. Oral corticosteroids can be taken on a short term basis or for long term therapy.
Some common side effects include nausea, vomiting, insomnia and agitation. Some side effects associated with longer term use include ulcers, gastrointestinal bleeding, increased risk of infections, high blood sugar, osteoporosis (thinning of the bones), suppressed adrenal production, weight gain, elevated blood pressure and fluid retention. For patients taking methylprednisolone for longer term therapy, the drug should not be stopped abruptly. Patients will need to be safely tapered off the drug by their doctor or other health care provider.
Mucinex (Guaifenesin)
Mucinex (guaifenesin) is an expectorant used to loosen mucus and make a cough more productive. Mucinex (guaifenesin) is generally well tolerated. The most common side effects reported are nausea, vomiting, dizziness, headache, diarrhea, stomach upset and drowsiness.
Guaifenesin can be found in stand alone products like Mucinex or in combination products, like Mucinex DM (guaifenesin and Dextromethorphan) where there is more than one drug present and it works on a variety of symptoms like congestion and cough suppression in Mucinex DM.
Lorazepam
Lorazepam is in a class of drugs known as the benzodiazepines. Lorazepam can be used in the treatment of anxiety and status epilepticus. Some of the most common side effects are sedation, drowsiness, dizziness, coordination problems, headache and fatigue. Caution should be used in the geriatric population and when driving or when using machinery.
Lorazepam is a Schedule IV Controlled Substance. Drugs in Schedule IV class have a low potential for abuse but the possibility for abuse still exists. Caution should be used when combining with other medications that can cause drowsiness, sedation or abuse (like opioids).
Discussion
While taking Mucinex (guaifenesin) may help thin some nasal secretions, it will not do anything to help with the runny nose. Using fluticasone is appropriate therapy to help with the runny nose and any congestion that may be present. Relief may be seen in a couple of days though it can take up to a week for the full benefits of the drug to be seen.
Another option, should fluticasone not be effective, would be to add a non-sedating antihistamine, like Claritin. Claritin also works on runny nose and allergy symptoms and does a better job of drying nasal secretions. Claritin comes in a 24 hour once a day formulation and is generally well tolerated with the most common side effects being drowsiness, fatigue and headache. Even though Claritin is typically non-sedating, care would need to be taken when taking with lorazepam. The effect of the two drugs (Claritin and lorazepam) could cause an increase in drowsiness or sedation.
