Avamys Nasal Spray: Safety, Side Effects and Who Can Use It
How much of the steroid reaches the rest of your body, what the side effects look like in practice, long-term and children’s use, the medicines it interacts with, pregnancy, and the alternatives if Avamys is not right for you.
Part of the Complete Hay Fever Guide.
Key fact: Avamys (fluticasone furoate) is a steroid, but very little of it reaches the rest of the body: around 0.5% of a dose sprayed into the nose is absorbed into the bloodstream. That is why it can be used daily for long periods. The side effects that matter in practice are mostly local — nosebleeds above all — and the cautions that matter are a short list of interacting medicines, eye conditions, and children’s growth.
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Avamys contains fluticasone furoate, a corticosteroid, at 27.5 micrograms per spray. It is a prescription-only medicine in the UK, licensed to treat the symptoms of allergic rhinitis — both seasonal hay fever and year-round allergy to dust mite, pets or mould — in adults and in children from six years old. It works by reducing the allergic inflammation in the lining of the nose, which is why it helps with blockage in a way antihistamine tablets do not.
This guide is about whether Avamys is safe and suitable for you. How to use the spray step by step, when to start it before the season and how quickly it builds up are covered in using Avamys for hay fever, and how it compares with an antihistamine tablet is covered in Avamys vs fexofenadine.
~0.5%
Of each nasal dose absorbed into the bloodstream
6+
Licensed from age six; prescription-only in the UK
1 a day
Once-daily dosing, at the lowest dose that controls symptoms
How much steroid reaches the rest of the body
People are often wary of Avamys because of the word “steroid”, and the concern is usually based on steroid tablets, which act throughout the body and do carry significant side effects with long courses. A nasal spray is a different situation. Avamys is applied directly to the lining of the nose, at a dose measured in micrograms rather than milligrams, and fluticasone furoate is chosen precisely because so little of it is absorbed. The small amount that is swallowed is largely broken down by the liver before it can circulate.
The result is that at normal doses, Avamys acts almost entirely where it is sprayed. That is the basis for its safety in long-term daily use. There are two situations where that picture changes, and both are covered below: taking a medicine that stops the liver breaking fluticasone down, and adding Avamys to other steroid medicines so that the total amount builds up.
Side effects in practice
Most people who use Avamys have no side effects, or only minor ones. The table sets out the ones worth knowing about, how often they occur according to the product information, and what to do.
| Side effect | How common | What to do |
|---|---|---|
| Nosebleeds, usually mild streaks of blood in the mucus | Very common: more than 1 in 10 people, more often after six weeks or more of use | Check your technique (below). Stop and get advice if bleeding is heavy or keeps recurring |
| Headache | Common | Usually settles; seek advice if persistent |
| Small sores or ulcers inside the nose | Common | Often linked to spraying onto the septum. Get advice if your nose is sore or crusting |
| Dryness, discomfort or pain in the nose | Uncommon | Usually mild; review technique and dose |
| A hole in the septum (the wall between the nostrils) | Rare | Seek advice if you notice a whistling sound when breathing through your nose, or persistent crusting and bleeding |
| Blurred vision or other visual change | Not known; reported with steroid medicines in general | Tell your doctor or optician, who may check for cataract, glaucoma or a fluid build-up behind the retina |
| Allergic reaction: rash, swelling of the face, lips or tongue, breathing difficulty | Very rare | Stop using it. Call 999 for swelling of the mouth or throat or difficulty breathing |
Reducing the risk of nosebleeds
Nosebleeds are the side effect that most often makes people give up on Avamys, and they are frequently caused by the nozzle pointing at the septum, the thin central wall of the nose, where the lining is delicate and the blood vessels are close to the surface. Holding the spray in the opposite hand to the nostril — right hand for the left nostril — angles the nozzle outwards, away from the septum, and is usually enough to stop the bleeding. Gentle sniffing rather than a hard snort, and using the lowest dose that controls your symptoms, both help too. A nose that keeps bleeding despite good technique needs reviewing rather than persevering with.
Using Avamys for months or years
Avamys is designed for regular daily use and can be used long term, including all year round for people whose allergy is to dust mite or pets. The product information includes safety data from studies lasting up to a year, and steroid nasal sprays as a class have decades of long-term use behind them. Long-term use is safest when a few principles are followed:
| Principle | In practice |
|---|---|
| Use the lowest dose that works | Adults start at two sprays in each nostril once a day. Once symptoms are controlled, many people can step down to one spray in each nostril |
| Use it only for as long as you need it | For seasonal hay fever, stop when your pollen season ends; there is no need to taper |
| Look after your eyes | If you have glaucoma, cataracts or a family history of glaucoma, tell your optician you use a steroid spray and keep up with regular eye checks |
| Review it at least once a year | Particularly if you also use other steroid medicines, or if you have used it continuously for a long time |
If you find you need Avamys all year round and your symptoms are worst indoors, the underlying trigger is probably not pollen. Year-round allergic rhinitis explains what usually drives it.
Avamys for children aged 6 to 11
Avamys is licensed for children from six years old, on prescription. The usual starting dose for children aged 6 to 11 is one spray in each nostril once a day. If that is not enough, it can be increased to two sprays in each nostril, and should be stepped back down to one spray once symptoms are under control. It is not recommended for children under six.
Growth is the question parents ask most often, and it deserves a straight answer. In a one-year study of prepubertal children using 110 micrograms a day — two sprays in each nostril, the higher of the two children’s doses — growth rate was on average 0.27 cm a year lower than in children given a placebo. That is a small difference, but it is the reason for three simple rules:
- use the lowest dose that controls your child’s symptoms, which for most is one spray in each nostril
- use it only when it is needed — through the pollen season for hay fever, not all year by default
- have your child’s height checked regularly if they are on long-term treatment, and let the prescriber know if they seem to be falling behind
Uncontrolled hay fever also carries costs for children, including disrupted sleep and poorer exam performance, so the aim is the right dose rather than avoiding treatment. A child should use the spray under adult supervision. What else is licensed at which age is set out in hay fever in children.
Medicines and conditions to check first
Fluticasone furoate is broken down in the liver by an enzyme called CYP3A4. A small number of medicines block that enzyme strongly, which lets far more fluticasone reach the bloodstream and can cause steroid side effects throughout the body. These are the ones a prescriber needs to know about.
| If you take or have | Why it matters |
|---|---|
| Ritonavir, or other HIV medicines boosted with ritonavir or cobicistat | Not recommended with Avamys. The combination can raise steroid levels enough to cause Cushing’s syndrome and suppress the adrenal glands |
| Ketoconazole or itraconazole tablets, or clarithromycin | Can increase fluticasone levels. Use with caution and tell your prescriber |
| Other steroid medicines: inhalers, creams, tablets or injections | The total amount of steroid adds up. Usually fine, but your prescriber should know everything you use |
| Glaucoma or cataracts | Steroids can contribute to both. Regular eye checks are sensible |
| Recent nose surgery, injury or ulcers inside the nose | Steroids slow healing in the nose. Wait until it has healed, and check with whoever treated you |
| An untreated infection in the nose or sinuses | Should be assessed before starting a steroid spray |
Avamys does not interact with the common hay fever antihistamines, and using it alongside a daily antihistamine tablet or allergy eye drops is standard practice.
Pregnancy and breastfeeding
There is not enough data on fluticasone furoate in pregnancy to say it is definitely safe, and the product information advises using it in pregnancy only if the benefit to the mother outweighs any potential risk. Because so little is absorbed, the amount reaching a baby is expected to be very small. In practice, if a steroid nasal spray is needed during pregnancy, prescribers often choose one with a longer track record of use in pregnancy, such as budesonide or fluticasone propionate.
It is not known whether fluticasone furoate passes into breast milk, though the very low levels in the mother’s blood make significant transfer unlikely. The same principle applies: it should be used only where the expected benefit outweighs any possible risk. If you are pregnant, planning a pregnancy or breastfeeding, tell your prescriber so they can recommend the most suitable option.
Pregnancy itself can block the nose. Hormonal changes in pregnancy commonly cause nasal congestion without any allergy, particularly in the second half. It does not respond to allergy treatment and settles after the birth. If your blocked nose started in pregnancy and nothing itches, mention it, as the right treatment may be different.
If Avamys is not suitable
Avamys is one of several steroid nasal sprays, and they are broadly similar in effectiveness. If Avamys is not suitable — because of an interacting medicine, pregnancy, side effects or preference — another spray, or a different type of treatment, may be.
| Option | How often | Worth knowing |
|---|---|---|
| Fluticasone propionate, such as Flixonase | Usually once a day | A related but different molecule, with a long record of use, including in pregnancy |
| Budesonide, such as Benacort | Once a day | Often chosen in pregnancy |
| Mometasone | Once a day | Also licensed for nasal polyps |
| Beclometasone | Twice a day | An older steroid; the twice-daily dosing is less convenient |
| Non-drowsy antihistamine tablet | Once a day | Not a steroid. Good for sneezing, itching and eyes, but does little for blockage |
Avamys is licensed for allergic rhinitis. It is not licensed for sinusitis or nasal polyps, where other sprays and doses are used; those are covered in the best nasal spray for sinusitis.
When to stop and get advice
Stop using Avamys and call 999 if you develop swelling of the face, lips, tongue or throat, or difficulty breathing or swallowing. These are signs of a rare but serious allergic reaction.
Stop and speak to a pharmacist or doctor if you have:
- nosebleeds that are heavy, last more than a few minutes, or keep coming back despite good technique
- blurred vision or any other change in your eyesight
- a whistling sound when you breathe through your nose, or persistent crusting and soreness inside it
- signs of infection in the nose, such as pain, swelling or yellow crusting
- started a new medicine for HIV, a fungal infection or a bacterial infection, in case it interacts
If Avamys has been used correctly every day for two weeks and has made little difference, the problem is often something other than the spray; hay fever treatment not working works through the usual reasons.
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Start an Avamys consultation →Frequently Asked Questions
Is it safe to use Avamys every day for years?
For most people, yes. Only around 0.5% of each dose reaches the bloodstream, so Avamys acts almost entirely in the nose, and it is designed for regular daily use. Long-term use is safest at the lowest dose that controls your symptoms, with a review at least once a year and regular eye checks if you have glaucoma or cataracts. Tell your prescriber about any other steroid medicines you use.
How can I stop Avamys causing nosebleeds?
Most nosebleeds from steroid sprays come from spraying onto the septum, the thin wall between the nostrils. Hold the spray in the opposite hand to the nostril you are spraying, so the nozzle points outwards, sniff gently rather than hard, and use the lowest dose that works. If nosebleeds are heavy or keep coming back despite good technique, stop and get advice.
Does Avamys affect children's growth?
It can have a small effect. In a one-year study of prepubertal children using 110 micrograms a day, the higher children's dose, growth rate was on average 0.27 cm a year lower than with a placebo. Children should use the lowest dose that controls their symptoms, usually one spray in each nostril, only for as long as needed, and have their height checked regularly if treatment is long term.
Which medicines should not be taken with Avamys?
Ritonavir and other HIV medicines boosted with ritonavir or cobicistat are not recommended with Avamys, because they stop the liver breaking down fluticasone and can cause steroid side effects throughout the body. Ketoconazole and itraconazole tablets and clarithromycin need caution. Avamys can be used with antihistamine tablets and allergy eye drops.
Can I use Avamys with a steroid inhaler?
Yes, and many people with asthma and hay fever use both. The amount of steroid from each adds up, so your prescriber should know about every steroid medicine you use, including inhalers, creams and tablets. Treating the nose properly also tends to improve asthma control.
Can Avamys affect my eyesight?
Visual problems are not a common side effect of Avamys, but blurred vision has been reported with steroid medicines in general, including sprays. If your vision changes while using Avamys, tell your doctor or optician, who may check for cataract, glaucoma or fluid behind the retina. If you already have glaucoma or cataracts, keep up with regular eye checks.
References
- electronic Medicines Compendium. Avamys 27.5 micrograms/spray nasal spray suspension: Summary of Product Characteristics. GlaxoSmithKline UK. medicines.org.uk
- National Institute for Health and Care Excellence. Clinical Knowledge Summary: Allergic rhinitis. cks.nice.org.uk
- Joint Formulary Committee. British National Formulary: fluticasone (nasal preparations). bnf.nice.org.uk
- Scadding GK, et al. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (2017 revised edition). Clinical & Experimental Allergy. bsaci.org
- Medicines and Healthcare products Regulatory Agency. Corticosteroids: rare risk of central serous chorioretinopathy with local as well as systemic administration. Drug Safety Update. gov.uk
- NHS. Fluticasone nasal spray and drops. nhs.uk
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Avamys is a prescription-only medicine and is not suitable for everyone, including people taking certain HIV, antifungal or antibiotic medicines. Always read the patient information leaflet and consult a qualified healthcare professional before starting, stopping or changing treatment. In a medical emergency, call 999.