Steroid nasal sprays

A nasal corticosteroid spray is a treatment prescribed by your doctor. The medicine in the spray is placed directly in the nose to help reduce symptoms and make breathing through the nose easier.

Nasal corticosteroid sprays help to reduce swelling and mucus in the nasal passageway and relieve other bothersome nasal symptoms. The sprays work well:

• For people with allergic rhinitis symptoms, such as congestion, runny nose, sneezing, itching, or swelling of the nasal passageway
• To treat nasal polyps (benign growths in the lining of the nasal passage)

Nasal corticosteroid sprays are different from the sprays you can buy at the store without a prescription. They work best when used every day without stopping. Your doctor will recommend a daily schedule of sprays for each nostril.

It may take two weeks or more for your symptoms to improve the most. Be patient. Relieving the symptoms can help you or your child to feel and sleep better and have fewer symptoms during the day.

You may also use them on an as-needed basis only, or as-needed along with regular use. Regular use, however, will typically give you better benefit.

Starting nasal corticosteroids at the beginning of a pollen season will give you the best results in decreasing symptoms during that season.

Several brands of nasal corticosteroids are available, such as Flonase or Nasonex. They all have very similar effects.

Make sure you understand your dosing instructions. Make sure you apply only the prescribed number of sprays in each nostril. You may be asked to use the spray 1 - 2 times per day.

1. Wash your hands.
2. Gently blow your nose to clear the passageway.
3. Shake the container several times.
4. Keep your head upright. Breathe out.
5. Block one nostril closed with your finger.
6. Insert the nasal applicator into the other nostril.
7. Aim the spray toward the outer wall of the nostril.
8. Inhale slowly through the nose and press the spray applicator.
9. Breathe out and repeat to apply the prescribed number of sprays.
10. Repeat the steps for the other nostril.
11. Avoid sneezing or blowing your nose right after spraying.

Nasal corticosteroid sprays are considered safe for all adults. Specific types are safe for children (over age 2). Pregnant women can safely use nasal corticosteroids.

Nasal corticosteroid sprays generally affect only the nasal passageway, where the medicine is deposited, and do not impact other parts of the body. They carry a low risk for widespread side effects unless the drug is used too much.

Side effects of nasal steroids may include:

• Dryness, burning, stinging in the nasal passage. This can be helped by using the nasal corticosteroid after showering or placing your head over a steamy sink or steaming pot for 5 - 10 minutes.
• Sneezing
• Throat irritation
• Headaches and nosebleed (uncommon, but you should report them to your doctor immediately)
• More likely to have an infection in the nasal passages
• Rarely, perforation (hole or crack) in the passageway may occur. This occurs more commonly if you do not use the proper technique of spraying away from the middle of your nose.

Make sure you, or your child, take the corticosteroid spray exactly as prescribed. This is the best way to avoid side effects. If you, or your child, use the spray regularly, see a doctor periodically for examination of the nasal passages to make sure problems are not developing

• You have nasal irritation, bleeding or other new nasal symptoms.
• You have continued allergy symptoms after repeated use of nasal corticosteroids.
• You have questions or concerns about your symptoms.
• You are having trouble taking the medication.

Sur DK, Scandale S. Treatment of allergic rhinitis. Am Fam Physician. 2010 Jun 15;81(12):1440-6.

Wallace DV, Dykewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA, et al. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol. 2008 Aug;122(2 Suppl):S1-84.

Bahls C. In the clinic. Allergic rhinitis. Ann Intern Med. 2007 Apr 3;146(7):ITC4-1-ITC4-16.

American Family Physician. Nasal sprays: how to use them correctly. Available at: http://familydoctor.org/online/famdocen/home/common/allergies/treatment/104.html.

Review Date: 10/27/2011

Stuart I. Henochowicz, MD, FACP, Associate Clinical Professor of Medicine, Division of Allergy, Immunology, and Rheumatology, Georgetown University Medical School. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.