OTCs Today
Mary Warner
Nasal steroid sprays, also known as intranasal corticosteroids, reduce swelling and inflammation in the nasal passages, helping to relieve symptoms such as congestion, runny nose, and sneezing caused by allergies, hay fever, sinusitis, and nasal polyps. They work by targeting the inflammation directly in the nose, providing relief without affecting other parts of the body.
Several nasal steroid sprays, including those containing budesonide, fluticasone furoate, fluticasone propionate, mometasone furoate, and triamcinolone acetonide, are FDA approved for nonprescription use for nasal symptoms. Fluticasone furoate and fluticasone propionate are also FDA approved for nonprescription use to treat ophthalmic symptoms such as itchy or watery eyes.
Proper use
Technique is important for effective use of corticosteroid nasal sprays. Most corticosteroid sprays suggest the following steps:
- Wash hands well.
- Gently blow the nose to clear the passageway.
- Shake the container several times.
- Keep the head upright, without tilting back.
- Breathe out.
- Block one nostril with a finger.
- Insert the nasal applicator into the other nostril.
- Aim the spray toward the outer wall of the nostril.
- Inhale slowly through the nose and press the spray applicator.
- Breathe out and repeat to apply the prescribed number of sprays.
- Repeat these steps for the other nostril.
Patients should avoid sneezing or blowing their nose after spraying to ensure that the medication is absorbed through the nasal membrane.
A corticosteroid spray works best when it is used every day, and starting a corticosteroid spray from 1 to 2 weeks before symptoms start will work best for decreasing allergy symptoms during that season. However, it may take 2 weeks or more for symptoms to improve.
Nasal corticosteroid sprays are safe for all adults, and some are safe for children aged 2 years and older. People who are pregnant and those who are breastfeeding can safely use corticosteroid sprays.
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Medication
|
Brand name
|
Strength
|
Dosage
|
|
Budesonide
|
Rhinocort Allergy Spray
|
32 µg/spray
|
Adults and children ≥12 years: Use two sprays in each nostril once daily; once allergy symptoms improve, reduce to one spray in each nostril per day.
Children 6–11 years: Use one spray in each nostril once daily; if allergy symptoms do not improve, may increase to two sprays in each nostril per day. Once allergy symptoms improve, reduce to one spray in each nostril per day.
Children <6 years: Do not use. |
|
Fluticasone
furoate
|
Flonase Sensimist
|
27.5 µg/spray
|
Adults and children ≥12 years: Week 1: Use two sprays in each nostril once daily.
Weeks 2–26: Use one or two sprays in each nostril once daily.
|
|
Children’s
Flonase
Sensimist
|
|
Children 2–11 years: Use one spray in each nostril once daily.
Children <2 years: Do not use. |
|
Fluticasone propionate
|
Flonase Allergy
Relief
|
50 µg/spray
|
Adults and children ≥12 years: Week 1: Use two sprays in each nostril once daily.
Weeks 2–26: Use one or two sprays in each nostril once daily.
|
|
Children’s
Flonase Allergy
Relief
|
|
Children 4–11 years: Use one spray in each nostril once daily.
Children <4 years: Do not use. |
|
Mometasone furoate
|
Nasonex 24HR
Allergy
|
50 µg/spray
|
Adults and children ≥12 years: Use two sprays in each nostril once daily. Use one spray in each nostril once daily. Do not use.
|
|
Children’s
Nasonex 24HR
Allergy
|
|
Children 2–11 years: Use one spray in each nostril once daily.
Children <2 years: Do not use.
|
|
Triamcinolone acetonide
|
Nasacort
Allergy 24HR
|
55 µg/spray
|
Adults and children ≥12 years: Use two sprays in each nostril once daily; once allergy symptoms decrease, reduce to one spray in each nostril per day.
|
|
Children’s
Nasacort
Allergy 24HR
|
|
Children 6–11 years: Use one spray in each nostril once daily; if allergy symptoms do not subside, may increase to two sprays in each nostril per day. Once allergy symptoms decrease, reduce to one spray in each nostril per day.
Children 2–5 years: Use one spray in each nostril once daily.
Children <2 years: Do not use. |
Adverse effects and medication interactions
Nasal corticosteroids are usually well tolerated and common adverse effects are typically minor and include nasal irritation, dryness, or stinging, as well as sneezing or throat irritation. However, patients who are sensitive to these medications or who use higher-than-recommended doses may experience systemic effects such as headache, dizziness, nausea, and vomiting.
While nasal steroids are generally safe for long-term use, it’s important to be aware of potential adverse effects as long-term use has been linked to changes in vision, glaucoma, cataract formation, increased risk of infection (e.g., Candida), and growth inhibition in children. Nasal corticosteroids have few drug interactions; most notably, protease inhibitors (e.g., ritonavir, tipranavir, telaprevir) should be avoided as their use can result in increased serum concentration of steroids.
What to tell your patients
Advise patients that they should be careful to use the spray correctly, including priming the bottle, blowing their nose before use, and properly aiming the nozzle in the nose. Stress that this medication will only help if it’s used every day, but they should not take a double dose to make up for a forgotten dose.
Ensure that patients know to contact their health care provider if they experience nasal irritation, bleeding, or other new nasal symptoms; continued allergy symptoms after repeated use of nasal corticosteroids; or trouble using the medication.
For further information, please see the section on Colds & Allergy in APhA’s Handbook of Nonprescription Drugs, available from the bookstore on pharmacist.com, or in APhA OTC online at pharmacylibrary.com. ■