steroid nasal spray and increased inr?

[MSG Morrissey]

Al
Is there a link between nasal spray steroid and an increased inr?
Just dc'd a spray for chronic sinusitus, no other changes and my inr went way down. could that be the cause?

 

[DrAllan]

Theoretically nasal steroid sprays are not well absorbed to give significant blood levels, However, that is not strictly true, and in fact there are documented effects especially in children. The effect of steroids on INR can be both to raise and lower it. The effect of chronic infection or inflammation will affect your INR. A more important question would be what happened to your supposedly stable INR when you went on the spray. If there was no change at that time, then the decrease with stopping the drug is not drug related.
Anyway, as Al Lodwick is fond of saying, dose your diet; don?t diet to meet your dose. With some modification this also applies to episodic drug utilization.
(cardiac retired otolaryngologist)

 

[MSG Morrissey]

I noted an increase in my inr when i started the spray, but never put the two together
the spray is:
Flunisolide 0.025%

 

[Marty]

I use Beconase and Nasonex. My ENT's warn me about overdoing it. Enough steroid can be absorbed to cause side effects eg cataracts.

 

[Guest]

I agree that you probably don't absorb enough inhaled steroid to make a difference. Steroids by mouth are another matter. Prednisone 20 mg per day is enough to increase the INR for most people. I saw one man who went to a world-famous repsiratory care center for serious damage to his airway from an industrial accident. He was started on prednisone 100 mg per day by mouth and told that it would not interfere with his warfarin. Five days later he came in with blood leaking out of the pores of his skin. I don't know what his INR was, I rushed him in a wheelchair to the ER. They found the INR to be higher than 11.2 which is the limit of their tester. He got all sorts of vitamin K, fresh-frozen plasma, and blood. He lived but the hematologist conferred with the pulmonologist and since it was likely that he would nbeed more prednisone, they stopped the warfarin.