Xhance
Xhance (fluticasone) is a corticosteroid nasal spray. It treats chronic rhinosinusitis in adults with and without nasal polyps. Unlike most other nasal sprays, Xhance (fluticasone) has a mouthpiece for your mouth and a nosepiece that you insert into your nostrils. In order to use Xhance (fluticasone), you blow into the mouthpiece and press down on the bottle to deliver the sprays into your nostrils. The typical dose is 1 or 2 sprays per nostril twice a day. The special delivery system gets medication high in your nose where polyps are, but can sometimes cause nosebleeds and irritation as side effects.
What is Xhance (fluticasone)?
What is Xhance (fluticasone) used for?
Treatment of chronic rhinosinusitis with or without nasal polyps in adults
How Xhance (fluticasone) works
Xhance (fluticasone) is a corticosteroid. It works in your nose to lower inflammation, which is thought to help shrink nasal polyps.
Drug Facts
More on Xhance (fluticasone) essentials
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What are the side effects of Xhance (fluticasone)?
Common Side Effects
- Nosebleeds (5-12%)
- Nose ulcer (3-8%)
- Nose and throat inflammation (2-8%)
- Stuffy nose (4-6%)
- Redness inside the nose (4-6%)
- Sinus inflammation (4-5%)
- Headache (2-5%)
- Sore throat (1-3%)
Other Side Effects
- Dry nose
- Mouth and throat pain
- Toothache
- Pressure in the ears
- Dizziness
- Stomach discomfort
- Weight gain
Serious Side Effects
- Severe allergic reaction: rash, trouble breathing, swelling of lips, tongue, or face
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Crusting or sores in the nose
- Frequent or severe nosebleeds
- Low adrenal gland function—nausea, vomiting, loss of appetite, unusual weakness, fatigue, dizziness
- Thrush—white patches in the nose or mouth
- Whistling through one or both nostrils that does not go away
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Change in sense of smell
- Change in taste
- Cough
- Headache
- Irritation inside the nose or throat
Pros and cons of Xhance (fluticasone)
Pros
Works well to shrink nasal polyps
Can lessen facial pain and runny nose
Might clear up stuffy nose within 2 weeks of treatment
Special delivery system causes less medication to drip down throat
Cons
Might be difficult to use for people unfamiliar with the delivery system
Can cause nose bleeds
For adults only
Need to use twice daily
Brand-name only
Pharmacist tips for Xhance (fluticasone)
Before using Xhance (fluticasone), get familiar with the Instructions for Use. If you have questions, ask your prescriber or pharmacist.
Xhance (fluticasone) takes time to work, so it won't have an immediate effect on your nasal polyps and symptoms. It works best when you use it regularly every day and don't miss doses.
The first time you use Xhance (fluticasone), you'll need to prime or prepare it. To do this, remove the cap, shake Xhance (fluticasone), then point it away from your face and press the bottle 7 times or until you see a fine mist. This helps make sure that you'll get the correct amount of medication for your doses. If it has been a week or longer since you last used it, spray it twice away from your face to prime it again.
Shake Xhance (fluticasone) every time you use it so you get the correct dose. Make sure to hold the device below the mouthpiece or it might not work as well.
To use Xhance (fluticasone), gently insert the cone-shaped nosepiece deep into your nose. It should create a tight seal, which is important for when you spray your pump so that you get the correct amount of medication in your nose. While keeping the nosepiece in place, put your mouth around the mouthpiece. Then, blow forcefully into the mouthpiece while pushing the bottle up with your thumb (this will make the medication come out).
Avoid sniffing or breathing in while blowing into the mouthpiece and spraying your dose of Xhance (fluticasone) into your nose.
Don't block your other nostril while using Xhance (fluticasone), because it needs to be open for the device to work properly.
Avoid spraying Xhance (fluticasone) in your eyes or mouth, since this can cause irritation or other side effects.
You don't need to clean Xhance (fluticasone). But if you do, remove the cap and use a dry, lint-free cloth to wipe the device after each use. Don't remove the glass bottle from the base, since this can damage it. If it looks broken, call the manufacturer (OptiNose) at 1-833-678-6673.
Never share Xhance (fluticasone) with other people to avoid infection.
Throw away Xhance (fluticasone) after using 120 sprays once it's primed and ready to use. If you continue to use it after reaching 120 sprays, you might not get the correct amount of medication.
Frequently asked questions about Xhance (fluticasone)
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What are the risks and warnings for Xhance (fluticasone)?
Xhance (fluticasone) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk of damage or infections in the nose
Xhance (fluticasone) can cause side effects in your nose. One of the most common side effects is nosebleeds. Rarely, it can also cause ulcers, tears, and slow wound healing. Yeast infections in the nose, throat, esophagus (tube that connects your mouth to your stomach), and gut have also been reported in people taking this medication. Tell your prescriber if you've recently had nose trauma or surgery, since this medication can cause your wounds to heal more slowly. You might need to wait until your nose has healed before you can start Xhance (fluticasone). If you experience nose bleeding, pain, or fever while taking this medication, let your care team know.
Eye problems
Risk factors: History of glaucoma, cataracts, or raised eye pressure
Risk of infections
Risk factors: History of weakened immune system | Taking medications that weaken your immune system | History of tuberculosis (TB) | Current infection
Xhance (fluticasone) is a steroid and can weaken your immune system. This can raise your risk of infection. Your risk is higher if you have medical conditions or are taking medications that weaken your immune system. If you've ever had a tuberculosis (TB) infection, let your prescriber know, since it can come back when your immune system is weak. Also tell your prescriber if you have any current infections. It's important to stay away from people who have chickenpox or measles, since these infections can cause serious problems in people taking steroids. If you think you've been exposed to these infections while taking Xhance (fluticasone), call your prescriber. Also let them know if you develop signs of infection like fever, cough, and chills while taking this medication.
Changes in adrenal hormone levels
Risk factors: High doses | Using Xhance (fluticasone) for a long period of time | Changing dosage forms | Stress (such as trauma, injury, or infection)
Your adrenal glands make a hormone called cortisol for your body. Steroid medications like Xhance (fluticasone) are very similar to cortisol. Taking Xhance (fluticasone) at higher doses than recommended (or sometimes at recommended doses in people with certain medical conditions) can raise your risk for developing Cushing's syndrome. This condition occurs with high cortisol levels and happens when your body is exposed to steroids for a long period of time. Symptoms of Cushing's syndrome include fat deposited in certain areas of your body (e.g., moon face), easy bruising, weight gain, high blood pressure, and muscle weakness. Let your care team know if you experience any of these symptoms.
Taking this medication at higher doses than recommended or sometimes at recommended doses in certain people can also cause adrenal suppression. This is when your adrenal glands stop making their own natural hormones, since your body starts to rely on Xhance (fluticasone) for cortisol. Your risk for adrenal suppression is higher if you're taking this medication for a long period of time (even just for 1 month). Adrenal suppression can lead to low cortisol levels or withdrawal if you're changing from steroids you take by mouth (e.g., prednisone) to other forms that might not be as strong, lowering the dose of Xhance (fluticasone), or stopping the medication suddenly. Symptoms of withdrawal can include low appetite, low energy, feeling tired, weakness, excessive weight loss, low blood pressure, and stomach pain. Talk to your prescriber before making any sudden changes in your medication.
Higher risk of side effects from interactions with other medications
Certain medications, like ritonavir (Norvir), ketoconazole, and clarithromycin, can interact with Xhance (fluticasone). These medications can cause higher levels of Xhance (fluticasone) in your body, which can lead to more side effects from the steroid. Make sure to tell your prescriber or pharmacist all of the medications you're taking before starting Xhance (fluticasone), so they can make sure it's safe for you to take.
Slowed growth and weakened bones
Risk factors: Children | Long-term use
Xhance (fluticasone) might cause slowed growth in children and weakened bones in people taking this medication. For this reason, Xhance (fluticasone) isn't recommended for use in children. Weak bones can raise your risk of fractures. The risk for these problems is higher if you use the medication for a long period of time. If you have other risk factors for weak bones (e.g., menopause, tobacco use, family history of osteoporosis), your prescriber might check your bone health with scans.
Xhance (fluticasone) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 16ml of 93mcg | 1 nasal spray | $572.83 | $572.83 |
Typical dosing for Xhance (fluticasone)
Each spray of Xhance contains 93 mcg of fluticasone.
Adults: The typical dose is 1 to 2 sprays in each nostril twice daily. The maximum dose is 2 sprays in each nostril twice daily.
How much does Xhance (fluticasone) cost?
What are alternatives to Xhance (fluticasone)?
Treatment of chronic rhinosinusitis with or without nasal polyps in adults
Moderate-to-severe allergic asthma
Chronic spontaneous urticaria (CSU) (chronic hives of unknown cause)
Lower risk of severe allergic reactions after accidental exposure to food triggers
Allergies or allergic reactions
Conditions affecting certain hormones (e.g., low adrenal hormones)
Eye conditions
Lung conditions
Gut conditions (e.g., ulcerative colitis)
Conditions related to blood cells
Certain cancers (e.g., leukemia
Nervous system conditions (e.g., multiple sclerosis)
Joint conditions (e.g., rheumatoid arthritis)
What is the latest news about Xhance (fluticasone)?
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References
Best studies we foundCenters for Disease Control and Prevention. (2024). About chickenpox.
Chu, R. (2019). Exhalation delivery system: Novel device for nasal polyps treatment. Pediatric Allergy, Immunology, and Pulmonology.
Margolin, L., et al. (2007). The steroid withdrawal syndrome: A review of the implications, etiology, and treatments. Journal of Pain and Symptom Management.
National Institute of Diabetes and Digestive and Kidney Disease. (2018). Cushing’s syndrome.
OptiNose US, Inc. (n.d.). Getting started with Xhance.
OptiNose US, Inc. (2023). Instructions for use: Xhance® (ex hans) (fluticasone propionate) nasal spray, 93 mg.
OptiNose US, Inc. (2024). Xhance- fluticasone propionate spray, metered [package insert]. DailyMed.
Palmer, J. N., et al. (2018). EXHANCE-12: 1-year study of the exhalation delivery system with fluticasone (EDS-FLU) in chronic rhinosinusitis. International Forum of Allergy & Rhinology.
Sindwani, R., et al. (2019). NAVIGATE I: Randomized, placebo-controlled, double-blind trial of the exhalation delivery system with fluticasone for chronic rhinosinusitis with nasal polyps. American Journal of Rhinology & Allergy.
Wu, D., et al. (2022). Effects of fluticasone exhalation delivery system in patients with chronic rhinosinusitis with nasal polyps: A systematic review. American Journal of Rhinology & Allergy.
You and Your Hormones. (2019). Cortisol.
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