Nasacort Allergy is indicated for the treatment of the symptoms of seasonal allergic rhinitis, including hay fever. It relieves such symptoms of seasonal allergic rhinitis as sneezing, itchy and runny nose, itchy, red or watery eyes, nasal congestion or associated sinus discomfort.

For administration by the intranasal route only.

Patients aged 18 years and over: The recommended dose is 220 micrograms as 2 sprays in each nostril once daily. Once symptoms are controlled patients can be maintained on 110 micrograms (1 spray in each nostril once daily). The minimum effective dose should be used to ensure continued control of symptoms.

The maximum daily dose should not exceed two sprays into each nostril.

Children: not recommended for children or adolescents under 18 years of age.

Medical advice should be sought if symptoms worsen or do not improve within 7 days of treatment.

It is important to shake the bottle gently before each use.

Each actuation delivers 55 micrograms triamcinolone acetonide from the nasal actuator to the patient (estimated from in vitro testing) after an initial priming of 5 sprays until a fine mist is achieved. Nasacort Allergy will remain adequately primed for 2 weeks. If the product is unused for more than 2 weeks, then it can be adequately re-primed with one spray. The nozzle should be pointed away from you while you are doing this.

After using the spray: Wipe the nozzle carefully with a clean tissue or handkerchief, and replace the cap.

If the spray does not work and it may be blocked, clean it as follows. NEVER try to unblock it or enlarge the tiny spray hole with a pin or other sharp object because this will destroy the spray mechanism.

The nasal spray should be cleaned at least once a week or more often if it gets blocked.

TO CLEAN THE SPRAY

1. Remove the cap and the spray nozzle only* (pull off).

2. Soak the cap and spray nozzle in warm water for a few minutes, and then rinse under cold running tap water.

3. Shake or tap off the excess water and allow to air-dry.

4. Re-fit the spray nozzle.

5. Prime the unit as necessary until a fine mist is produced and use as normal.

* Part as indicated on diagram below,

Also, the bottle should be discarded after 30 actuations or within one month of starting treatment. Do not transfer any remaining suspension to another bottle.

Hypersensitivity to any of the ingredients of this preparation or an infection in the nose contraindicates its use.

Concomitant use with HIV medicines.

Treatment should be stopped or the advice of a doctor sought if an improvement is not seen within 7 days. The advice of a doctor or pharmacist should also be sought if symptoms have improved but are not adequately controlled.

Nasacort Allergy should not be used for longer than 1 month continuously without consulting a doctor.

Medical advice should be sought before using this medicine in the case of;

• concomitant use of other corticosteroid products, such as tablets, creams, ointments, asthma medications, similar nasal sprays or eye/nose drops

• an infection in the nasal passages or sinuses.

• recent injury or surgery to the nose, or problems with ulceration in the nose.

If there is any reason to suppose that adrenal function is impaired, care must be taken while transferring patients from systemic steroid treatment to Nasacort Allergy.

In clinical studies with Nasacort Allergy administered intranasally, the development of localised infections of the nose and pharynx with Candida albicans has rarely occurred. When such an infection develops it may require treatment with appropriate local therapy and discontinuation of treatment with Nasacort Allergy.

Because of the inhibitory effect of corticosteroids on wound healing, patients who have had recent nasal surgery or recent prolonged nose-bleeds or any other nasal problems should consult their doctor before using this product.

Systemic effects of nasal corticosteroids may occur, particularly at high doses prescribed for prolonged periods. These effects are much less likely to occur than with oral corticosteroids and may vary in individual patients and between different corticosteroid preparations.

Potential systemic effects may include Cushing's syndrome, Cushingoid features, adrenal suppression, growth retardation in children and adolescents, cataract, glaucoma and more rarely, a range of psychological or behavioural effects including psychomotor hyperactivity, sleep disorders, anxiety, depression or aggression (particularly in children).

Treatment with higher than recommended doses may result in clinically significant adrenal suppression. If there is evidence of using higher than recommended doses, then additional systemic corticosteroid cover should be considered during periods of stress or elective surgery.

Glaucoma and/or cataracts have been reported in patients receiving nasal corticosteroids. Therefore, close monitoring is warranted in patients with a change in vision or with a history of increased intraocular pressure, glaucoma and/or cataracts.

Visual disturbance

Visual disturbance may be reported with systemic and topical corticosteroid use. If a patient presents with symptoms such as blurred vision or other visual disturbances, the patient should be considered for referral to an ophthalmologist for evaluation of possible causes which may include cataract, glaucoma or rare diseases such as central serous chorioretinopathy (CSCR) which have been reported after use of systemic and topical corticosteroids.

Nasacort Allergy contains benzalkonium chloride, long term use may cause oedema of the nasal mucosa.

Co-treatment with CYP3A inhibitors, including cobicistat-containing products, is expected to increase the risk of systemic side-effects. The combination should be avoided unless the benefit outweighs the increased risk of systemic corticosteroid side-effects, in which case patients should be monitored for systemic corticosteroid side-effects.

Pregnancy

Nasacort Allergy should only be used in pregnancy on medical advice. There are no adequate and well-controlled studies in pregnant women with Nasacort Allergy Because animal studies indicate a teratogenic effect, typical of corticosteroids, Nasacort Allergy should not be administered during pregnancy unless the therapeutic benefit to the mother is considered to outweigh the risk to the foetus/baby (see section 5.3 Preclinical Safety Data).

Lactation

Nasacort Allergy should only be used in lactation on medical advice. It is not known whether triamcinolone acetonide is excreted in human milk. Because other corticosteroids are excreted in human milk, caution should be exercised when Nasacort Allergy is administered to nursing women; therefore, the therapeutic benefit to the mother should outweigh any potential risk to the baby.

Nasacort Allergy has no known effect on the ability to drive and operate machines.

The adverse events reported in clinical trials with Nasacort Allergy most commonly involved the mucous membranes of the nose and throat.

The following frequency rating has been used, when applicable:

Very common ≥ 1/10; Common ≥ 1/100 and <1/10; Uncommon ≥ 1/1,000 and < 1/100; Rare ≥ 1/10,000 and <1/1,000; Very rare < 1/10,000 and not known (cannot be estimated from the available data).

Within each frequency grouping, undesirable effects are presented in order of decreasing seriousness.

The most frequent adverse reactions in adults were:

• Infections and infestations

Common: flu syndrome, pharyngitis, rhinitis

• Immune system disorders

Not known: hypersensitivity (including rash, urticaria, pruritus and facial oedema)

• Psychiatric disorders

Not known: insomnia

• Nervous system disorders

Common: headache

Not known: dizziness and alterations of taste and smell

• Eye disorders

Not known: chorioretinopathy, cataract, glaucoma, increased ocular pressure, blurred vision (see also section 4.4)

• Respiratory, thoracic and mediastinal disorders

Common: bronchitis, epistaxis, cough

Rare: nasal septum perforations

Not known: nasal irritation, dry mucous membrane, nasal congestion, sneezing, dyspnoea

• Gastrointestinal disorders

Common: dyspepsia, tooth disorder

Not known: nausea

• General disorders and administration site conditions

Not known: fatigue

• Investigations

Not known: decreased blood cortisol

Systemic effects of nasal corticosteroids may occur, particularly when prescribed at high doses for prolonged periods.

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

Like any other nasally administered corticosteroid, acute overdosing with Nasacort Allergy is unlikely in view of the total amount of active ingredient present. In the event that the entire contents of the bottle were administered all at once, via either oral or nasal application, clinically significant systemic adverse events would most likely not result. The patient may experience some gastrointestinal upset if taken orally.

Pharmacotherapeutic group: nasal corticosteroid, ATC code: R 01 AD

Mechanism of action

Triamcinolone acetonide is a more potent derivative of triamcinolone and is approximately 8 times more potent than prednisone. Although the precise mechanism of corticosteroid anti-allergic action is unknown, corticosteroids are very effective in the treatment of allergic diseases in man.

Pharmacodynamic effects

Nasacort Allergy does not have an immediate effect on allergic signs and symptoms. An improvement in some patient symptoms may be seen within the first day of treatment with Nasacort Allergy and relief may be expected in 3 to 4 days. When Nasacort Allergy is prematurely discontinued symptoms may not recur for several days.

In clinical studies performed in adults and children at doses up to 440 mcg/day intranasally, no suppression of the Hypothalamic-Pituitary-Adrenal (HPA) axis has been observed.

Single dose intranasal administration of 220 micrograms of Nasacort Allergy in normal adult subjects and in adult patients with allergic rhinitis demonstrated minimal absorption of triamcinolone acetonide. The mean peak plasma concentration was approximately 0.5 ng/mL (range 0.1 to 1 ng/mL) and occurred at 1.5 hours post dose. The mean plasma drug concentration was less than 0.06 ng/mL at 12 hours and below the assay detection limit at 24 hours. The average terminal half-life was 3.1 hours. Dose proportionality was demonstrated in normal subjects and in patients following a single intranasal dose of 110 micrograms or 220 micrograms Nasacort Allergy Following multiple doses in paediatric patients, plasma drug concentrations, AUC, C_max and T_max were similar to those values observed in adult patients.

In pre-clinical studies, only the effects typical of glucocorticosteroids were observed

Like other corticosteroids, triamcinolone acetonide has been shown to be teratogenic in rats and rabbits. Teratogenic effects which occurred in the rat and in the rabbit included cleft palate and/or internal hydrocephaly and axial skeletal defects. Teratogenic effects, including CNS and cranial malformations, have also been observed in non-human primates.

No evidence of mutagenicity was detected in in vitro gene mutation tests

Carcinogenicity assays in rodents show no increase in the incidence of individual tumour types.

- microcrystalline cellulose

- carmellose sodium (Avicel CL-611),

- polysorbate 80,

- purified water,

- anhydrous glucose

- benzalkonium chloride

- edetate sodium

- hydrochloric acid or sodium hydroxide (for pH adjustment).

None known.

The shelf-life of Nasacort Allergy is 24 months.

The shelf life after the bottle is first opened is 1 month.

Do not store above 25° C.

Nasacort Allergy is contained in a 20 ml high density polyethylene (HDPE) bottle fitted with a metered-dose spray pump unit. Each bottle of Nasacort Allergy contains 6.5 g of suspension and provides at least 30 actuations.

No special requirements.