High dose nasal corticosteroids

Fluticasone and mometasone are prescription only medicines that can be supplied for sinusitis via a PGD as part of the Pharmacy First scheme in England. 

The use of high dose nasal corticosteroids is off-label in sinusitis and is based on a NICE review of relevant clinical trials. NICE concluded that there is evidence that a high dose nasal corticosteroid (equivalent to mometasone 400 micrograms a day) for 14 to 21 days produced a statistically significant improvement in symptoms in adults and children aged 12 years and over compared with placebo. 

The side-effects listed below appear in the product SPC or BNF as very common or common with intranasal fluticasone (or other intranasal steroids) but as use is off-label these may not reflect all side-effects when used for sinusitis:

Epistaxis, headache, throat irritation, nasal ulceration, dyspnoea, altered smell, altered taste.

The steroid burden of nasal corticosteroids needs to be considered in people already taking oral or inhaled corticosteroids, particularly in children due to systemic effects.