Fluticasone Furoate-Oxymetazoline Hydrochloride Combination Nasal Spray for Managing Allergic Rhinitis With Nasal Congestion: Current Evidence and Clinical Implications

Intranasal corticosteroids (INCS) are the primary treatment for allergic rhinitis (AR) owing to their anti-inflammatory effects. Fluticasone furoate (FF), an INCS, is widely used because of its high glucocorticoid receptor affinity and once-daily dosing. Despite adequate INCS therapy, nasal congestion often remains the predominant symptom of moderate-to-severe AR. Guidelines recommend the short-term use of nasal decongestants as adjunctive therapy for AR with significant nasal congestion. Oxymetazoline (OXY), a long-acting α-adrenergic agonist, relieves nasal congestion by vasoconstriction. It starts working within 25 seconds and lasts approximately 10-12 hours. However, its use as monotherapy is limited to three to five days to avoid rhinitis medicamentosa (RM), a condition characterized by increased nasal congestion resulting from extended use of this medication. The combination of an INCS (FF) and a nasal decongestant (OXY) may provide a synergistic approach, with FF targeting inflammation and OXY providing rapid symptomatic relief from nasal congestion. This review summarizes the efficacy and safety of the FF+OXY fixed-dose combination (FDC) nasal spray, with a focus on pharmacological synergy. A literature review using PubMed and Google Scholar identified studies on the FF+OXY (27.5/50 µg) FDC nasal spray. Clinical evidence has shown that short-term use (≤14 days) of the FF+OXY (27.5/50 µg) FDC nasal spray provides rapid and sustained relief without a significant risk of RM. While few clinical trials have demonstrated the potential efficacy and safety of this FDC, there is a need for additional clinical trials and real-world evidence, given the widespread use of the FF+OXY (27.5/50 µg) FDC nasal spray for managing moderate to severe AR with nasal congestion in India.