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Steroid Nasal Sprays
Steroid nasal sprays, also called corticosteroid nasal sprays, are anti-inflammatory medicines that you spray into your nose.
They can be used to treat a range of conditions, including hay fever, sinusitis, non-allergic rhinitis and nasal polyps.
Some steroid nasal sprays are available to buy from pharmacies and shops, while others are only available on prescription. Steroid nasal drops are also available.
Common examples of steroid nasal sprays include:
How and when to use steroid nasal spraysSteroid nasal sprays can be used as a long-term treatment or just when they're needed.
For hay fever, it's best to use them from 1 to 2 weeks before you think your symptoms will start, as they can take a few days to work.
The leaflet that comes with your spray should explain how to use it and how often. Ask a pharmacist or doctor if you're not sure.
It's important to use your spray regularly, even if you're feeling better. It will only help if it's used every day.
If you miss a dose or take too muchIf you forget to take a dose, take it as soon as you remember. If it's nearly time for your next dose, skip the one you missed.
Do not take a double dose to make up for a forgotten dose.
Accidentally using too much steroid nasal spray is unlikely to be harmful. Speak to a pharmacist or doctor if you're worried.
Using a steroid nasal spray too much over a long period can increase your risk of getting side effects.
Stopping treatmentIf you've bought a steroid nasal spray from a pharmacy or shop, check the leaflet that comes with the medicine. This will tell you how long you can continuously use it for without speaking to a doctor or pharmacist. This is usually between 1 and 3 months.
Stop using it when you think you no longer need it. Ask a pharmacist for advice if you're not sure when to stop.
If you're taking a prescription spray, do not stop using it unless the doctor advises you to do so.
Side effects of steroid nasal spraysSteroid nasal sprays do not usually cause any significant side effects if used correctly and at normal doses.
Side effects can include:
Serious side effects are rare but can include changes to your eyesight, such as blurred vision or a cloudy lens in the eye, or problems with your breathing. See a doctor or contact 111 straight away if you have these.
If you're taking a high dose for a long time, there's also a small chance you could get some of the side effects of steroid tablets, such as increased appetite, mood changes and sleeping problems (insomnia).
You can report any suspected side effect on the UK Yellow Card safety scheme website.
Using steroid nasal sprays with other medicines, food or alcoholSome medicines can interfere with the way steroid nasal sprays work, although this is uncommon.
Check the leaflet that comes with your spray to see if it could be affected by other medicines. Ask a pharmacist or doctor if you're unsure.
You can usually drink alcohol while using a steroid nasal spray and you do not normally need to avoid any particular foods.
Who can use steroid nasal spraysMost people can use steroid nasal sprays.
Ask a pharmacist or doctor for advice before using one if you:
Steroid nasal sprays are normally safe to use while breastfeeding and during pregnancy, but it's a good idea to get medical advice first.
How steroid nasal sprays workSteroids closely copy the effects of hormones normally produced by the adrenal glands, which are 2 small glands above the kidneys.
When sprayed into the nose, steroids reduce inflammation (swelling).
This can help relieve symptoms such as sneezing and a runny or blocked nose. It can also help to reduce the size of any swellings (such as polyps in your nose.
Steroid nasal sprays are not the same as anabolic steroids, which are often used illegally by some people to increase their muscle mass.
Page last reviewed: 15 June 2023Next review due: 15 June 2026
Best Nasal Sprays To Keep Seasonal Allergies Under Control
Choosing the best nasal spray for seasonal allergiesThe changing of seasons is often accompanied by undesirable side effects known as seasonal allergies. Seasonal allergies plague many people due to the sudden presence of specific plant pollen that only appears during certain times of the year.
Allergies can make us feel under the weather, but you don't have to let irritating allergies ruin your fun plans. Nasal sprays are an effective way to relieve common allergy symptoms like congestion, sneezing and runny nose. We've included our top nasal spray picks for seasonal allergies so you can decide which one is best for you.
Shop this article: Afrin Original Maximum Strength Nasal Congestion Relief, Nasacort Allergy 24HR Nasal Spray, Xlear Xylitol Saline Nasal Spray
Types of nasal spraysThere are many different types of nasal sprays, all with different pros and cons. Figuring out which type of nasal spray is best for you will help you narrow down your choices.
Decongestant nasal spraysDecongestant nasal sprays work by temporarily shrinking the blood vessels inside your nasal passages, which often cause allergy symptoms and sinus pressure. Common decongestant nasal sprays include Afrin, Dristan and Sinex. While these tend to work quickly, you should not use them longer than three to five days, as prolonged use is not recommended.
Steroid nasal spraysThe most common type is a steroid nasal spray. These nasal sprays contain corticosteroids which work to reduce inflammation. Some well-known steroid nasal sprays are Nasacort and Flonase. These aren't fast-acting and instead work better after consistent use.
Saline nasal spraysSaline sprays are great for those who want a natural approach to relieving their allergy symptoms. They contain no medication and are just a simple saline solution that works by flushing out your nasal passages. Because they are non-medicated, they may not reduce all allergy symptoms.
Antihistamine nasal spraysWhen you have an allergic reaction, your body produces histamines to get rid of the foreign invader, which could be pet dander, dust mites or seasonal allergens. The histamines cause typical allergy symptoms like sneezing, itching and runny nose. An antihistamine blocks the effects of histamine. These are only available by prescription.
How to use nasal spraysWhile most nasal sprays have similar instructions, it's vital to check the instructions on your nasal spray for specific instructions before following any other advice.
Afrin Original Maximum Strength Nasal Congestion Relief
Afrin uses oxymetazoline in its formula, which is also present in many over-the-counter cold remedies. Afrin works by stimulating the constriction of blood vessels in your nasal passages.
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Nasacort Allergy 24HR Nasal Spray
Nasacort takes a few hours to start working but will provide relief for up to 24 hours. It is an intranasal corticosteroid, which works best for nasal congestion.
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Kid's Xlear Saline Nasal Spray
If your little one is suffering from seasonal allergies, this nasal spray is a great choice. It's all-natural and non-medicated, working by flushing bacteria, airborne allergens and pollutants in your nasal passages.
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Xlear Xylitol Saline Nasal Spray
The same non-medicated formula for kids is also available for adults. The main ingredient is xylitol, a natural substance found in fruits and vegetables.
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Vicks Sinex Severe Nasal Spray
Sinex uses oxymetazoline which relieves sinus pressure and shrinks swollen nasal membranes. It offers relief for up to 12 hours.
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Vicks Sinex Saline Nasal Spray
This version of Sinex is a drug-free saline nasal spray for those who prefer a more natural route to relieve seasonal allergies. The saline spray will clear your nasal passages of allergens, irritants and congestion.
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Bayer Neo-Synephrine Nasal Spray
Allergy symptoms are often caused by dilated blood vessels in your nasal passages. Bayer works by shrinking those blood vessels to relieve congestion and sinus pressure.
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Flonase Allergy Relief Nasal Spray
This non-drowsy nasal spray relieves your seasonal allergy symptoms for up to 24 hours. It uses the active ingredient fluticasone.
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Dristan 12-Hour Nasal Spray
Dristan narrows the blood vessels in your nasal passages. This reduces swelling and congestion caused by allergies, offering relief for 12 hours.
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NasalCrom Nasal Spray
Instead of focusing on damage control after experiencing allergy symptoms, NasalCrom works by preventing your nasal allergy symptoms before they even start. It is not an antihistamine nor a steroid.
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Arm & Hammer Simply Saline Nasal Mist
This saline nasal mist is a natural way to experience allergy relief by flushing nasal passages without medication or steroids. It also moisturizes your nasal passages.
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Mucinex Sinus-Max Severe Nasal Congestion Relief Sinus & Allergy Nasal Spray
Mucinex is a fast-acting nasal spray that relieves allergy symptoms for up to 12 hours. It promotes nasal and sinus drainage to clear nasal passages.
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FlutiCare Nasal Spray
FlutiCare is a glucocorticoid, which fights congestion, sneezing and runny nose. It's non-drowsy and works for up to 24 hours.
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Delivery Device Breathes New Life Into Existing Nasal Steroid Treatment
About 30 million Americans suffer from chronic rhinosinusitis, Ramy Mahmoud, M.D., tells MD+DI, and the condition "causes a lot of distress and impairment," he said. About 10 million of these patients have nasal polyps and use nasal corticosteroid sprays for relief. Many patients remain symptomatic, however, and they often turn to injections or even surgery, explained Mahmoud, who serves as president of Optinose.
A system from Optinose for delivering those corticosteroids deep in the nasal cavity may enable an effective next-step treatment option before injections or surgery, according to a recent study. The system is U.S. FDA approved for the treatment of nasal polyps in patients 18 years of age or older and is marketed with fluticasone in the new delivery system under the trade name XHANCE. Published in the International Forum of Allergy & Rhinology, the journal of the American Rhinologic Society, "Efficacy of the exhalation delivery system with fluticasone (EDS-FLU) in patients who remain symptomatic on standard nasal steroid sprays" shares data that XHANCE offers a step to care that enables improvement.
"This isn't just another delivery device," said Mahmoud. "We are looking at something clinically different because of the delivery device technology."
He explains that "the nose is just the 'tip of the iceberg'—most of the nasal cavity is deep in the skull, beneath the eyes. It is a convoluted labyrinth of passages that gets inflamed and creates a lot of symptoms." Some of this inflammation "is much higher up" in the cavity, he added.
"Most inhaled nasal drugs don't reach these areas, and some of them get into the throat," he continued. "We need to be able to take the steroid and put it into new areas."
Optinose has developed the device to get medicine "much farther back and up," explained Mahmoud. It features a "mouthpiece that the patient blows into and a nosepiece that seals to one side of the nose. When the patient blows into it, it elevates and seals the soft palate, which isolates the nasal cavity from the oral cavity. The medication is introduced during that breath, and it can't exit into the back of the mouth because the palate is sealed, so the medication floats around everything and is deposited on all surfaces in the nose."
Ramy Mahmoud, M.D.President of Optinose
The device doesn't use exhalation to deliver medication by force, but rather "creates a different physiology in the nose: a closed palate, bidirectional flow, and positive pressure," he said. That physiology "creates a different pattern of drug deposition—the same drug, in a different spot."
Because a topical corticosteroid "only works where you put it," a device that extends the delivery surfaces beyond those of conventional delivery systems could have a meaningful impact on drug effects. "Everything we've ever tested shows you get non-bioequivalence with an exhalation delivery system compared with a standard nasal spray," he said.
The new study showed that the exhalation delivery system provides just as much benefit to people who continue to have symptoms despite using ordinary nasal steroids as for someone who has never used a one. "Putting the steroid in a new spot is like using a new product," explained Mahmoud. "It's like a brand-new step to care. It is very well tolerated, and its safety profile is like that of other nasal steroids. And it's not nearly as big a deal as surgery or regular injections." FDA did want safety data on the new approach to steroid delivery, because even though it isn't delivering a new drug, it is putting the drug in a new place, he added.
The device used for XHANCE uses a breath-powered mechanism similar to Optinose's first product, a dry powder delivered nasally to treat migraines. The company licensed that drug product to another company but retained the IP for the delivery mechanism.
In addition to the above-mentioned study, the company is in the midst of two large clinical trials worldwide, said Mahmoud. These trials are testing XHANCE for the treatment of chronic sinusitis, an indication with no FDA approved drugs today, noting that early results are expected at the end of 2021.
Optinose is also exploring whether the device could be used for "an antiseptic that the company believes could be used to kill viruses like those that cause COVID-19 or influenza," he said. "Most people are infected through the nasal route. If we can treat patients prophylactically, we could prevent infections. Or if a patient is infected, we could prevent development of symptoms.
"If someone who tests positive for COVID is told to isolate, wouldn't it be great to prevent others in the household from getting infected or to help infected patients from progressing?" he added.
The company had developed the antiseptic internally with ingredients that have an existing safety profile. "We are likely to seek an external partner once we receive feedback from FDA," he said. In the meantime, the company continues lab testing to determine the antiseptic's effectiveness in killing various viruses.
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