INDICATIONS AND USAGE Flunisolide nasal solution is indicated for the treatment of the nasal symptoms of seasonal or perennial rhinitis.

Flunisolide nasal solution should not be used in the presence of untreated localized infection involving nasal mucosa.

WARNINGS The replacement of a systemic corticosteroid with a topical corticoid can be accompanied by signs of adrenal insufficiency, and in addition some patients may experience symptoms of withdrawal, e.g., joint and/or muscular pain, lassitude and/or depression.

Patients previously treated for prolonged periods with systemic corticosteroids and transferred to flunisolide should be carefully monitored to avoid acute adrenal insufficiency in response to stress.

When transferred to flunisolide, careful attention must be given to patients previously treated for prolonged periods with systemic corticosteroids.

This is particularly important in those patients who have associated asthma or other clinical conditions, where too rapid a decrease in systemic corticosteroids may cause a severe exacerbation of their symptoms.

The use of flunisolide with alternate-day prednisone systemic treatment could increase the likelihood of HPA suppression compared to a therapeutic dose of either one alone.

Therefore, flunisolide treatment should be used with caution in patients already on alternate-day prednisone regimens for any disease.

Persons who are on drugs that suppress the immune system are more susceptible to infections than healthy individuals.

Chicken pox and measles, for example, can have a more serious or even fatal course in non-immune pediatric patients or adults on corticosteroids.

In such pediatric patients or adults who have not had these diseases, particular care should be taken to avoid exposure.

How the dose, route and duration of corticosteroid administration affects the risk of developing a disseminated infection is not known.

The contribution of the underlying disease and/or prior corticosteroid treatment to the risk is also not known.

If a nonimmune patient is exposed to chickenpox, prophylaxis with varicella zoster immune globulin (VZIG) may be indicated.

If exposed to measles, prophylaxis with pooled intramuscular immunoglobulin (IG) may be indicated.

(See the respective package insert for complete VZIG and IG prescribing information.) If chickenpox develops, treatment with antiviral agents may be considered.

ADVERSE REACTIONS Adverse reactions reported in controlled clinical trials and long-term open studies in 595 patients treated with flunisolide nasal solution are described below.

Of these patients, 409 were treated for 3 months or longer, 323 for 6 months or longer, 259 for 1 year or longer, and 91 for 2 years or longer.

In general, side effects elicited in the clinical studies have been primarily associated with the nasal mucous membranes.

The most frequent complaints were those of mild transient nasal burning and stinging, which were reported in approximately 45% of the patients treated with flunisolide nasal solution in placebo-controlled and long-term studies.

These complaints do not usually interfere with treatment; in only 3% of patients was it necessary to decrease dosage or stop treatment because of these symptoms.

Approximately the same incidence of mild transient nasal burning and stinging was reported in patients on placebo as was reported in patients treated with flunisolide nasal solution in controlled studies, implying that these complaints may be related to the vehicle or the delivery system.

The incidence of complaints of nasal burning and stinging decreased with increasing duration of treatment.

Other side effects reported at a frequency of 5% or less were: nasal congestion, sneezing, epistaxis and/or bloody mucous, nasal irritation, watery eyes, sore throat, nausea and/or vomiting, and headaches.

As with other nasally inhaled corticosteroids, nasal septal perforations have been reported in rare instances with the use of flunisolide nasal solutions.

Temporary or permanent loss of the sense of smell and taste have also been reported with the use of flunisolide nasal solutions.

Systemic corticosteroid side effects were not reported during the controlled clinical trials.

If recommended doses are exceeded, or if individuals are particularly sensitive, symptoms of hypercorticism, i.e., Cushing’s syndrome, could occur.

Cases of growth suppression have been reported for intranasal corticosteroids (including flunisolide nasal solution) ( see PRECAUTIONS, Pediatric Use ) .

To report SUSPECTED ADVERSE REACTIONS, contact Ingenus Pharmaceuticals, LLC at 1-877-748-1970 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.