Taking nasal sprays

Nasal sprays (usually containing a steroid medication) are the most commonly-prescribed treatment for nose and sinus problems caused by inflammation (rhinitis and rhinosinusitis).

You are probably familiar with people taking regular steroid-based inhalers for lung conditions such as asthma.  Nasal steroid sprays should be viewed in a similar way: they are intended to achieve long-term control of your nasal symptoms through long-term daily use.

To get the most out of your nasal spray, consistency is key.  Learning the best technique with which to administer your spray, and taking it every day, will give you the best results.

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What kinds of nasal spray are there?

Nasal sprays prescribed for long term conditions most commonly contain a steroid medication.  Each spray will have a brand name and a generic name (the name of the drug itself).  Some brands are available over-the-counter, and others only on prescription, but the effectiveness of most sprays is similar. Commonly-used nasal steroid sprays include:

  • Flixonase (fluticasone proprionate)

  • Nasofan (fluticasone proprionate)

  • Pirinase (fluticasone proprionate, over the counter)

  • Avamys (fluticasone furoate)

  • Nasonex (mometasone furoate)

  • Clarinaze (mometasone furoate, over the counter)

  • Dymista (fluticasone proprionate + azelastine, for allergic rhinitis)

Nasal steroid sprays should not be confused with nasal decongestant sprays (xylometazoline/oxymetazoline, sold as Otrivine or Sudafed sprays).  These work via a different mechanism, and while they are useful for short term problems such as infections and colds, if used long-term they make symptoms worse, leading to an addictive cycle of congestion and spray use.  This does not occur with nasal steroid sprays.

Are nasal steroid sprays safe?

Yes, nasal steroid sprays based on fluticasone or mometasone have an excellent safety profile.  It is natural to be concerned about the long term use of steroid medication.  However in the case of nasal sprays, fluticasone and mometasone have both been shown to have very low absorption into the bloodstream.  Because of this, there is no evidence that they can cause steroid-related side effects.  They can be prescribed to children of most ages, and are generally felt to be safe in pregnancy when necessary.

Nasal steroid sprays do not "thin the skin" inside the nose.  In a few instances they can cause minor nosebleeds: this is usually due to the way the spray is administered rather than the medication itself (see below).  The only significant safety caution is the interaction between fluticasone and some HIV treatments (e.g. ritonavir).

What should I expect from my nasal steroid spray?

You won't feel any immediate benefit from a nasal steroid spray.  Over a few weeks of regular use however, you will gradually experience an improvement in your nasal congestion and other symptoms.  Some patients find their nose feels a little dry, but this is not normally a significant problem.

Because they work so slowly, we normally advise patients to take a new spray consistently for 2-3 months before evaluating whether it has been beneficial.  If helpful, sprays are usually continued long-term.

Spray administration technique

This video summary is an excellent guide to taking nasal sprays effectively. Key points include:

  • Use your right hand to spray your left nostril, and vice versa.

  • Lean your head slightly forward, and insert the nozzle pointing backwards towards your ear, not upwards.

  • Angle the nozzle slightly away from the middle of the nose (to avoid rubbing on the nasal septum which can cause bleeding).

  • After spraying, breathe in gently through your nose but do not sniff.