Nasal Sprays – Types, Conditions treated, side effects

Nasal sprays

Also called: Antibiotic & Decongestant Nasal Sprays, Antihistamine Nasal Sprays, Anticholinergic Nasal Sprays, Decongestant Nasal Sprays, Lubricant Nasal Sprays

Summary

Nasal sprays treat many allergy and cold symptoms, including runny nose, sneezing and congestion. The sprays are particularly effective because they deliver medication directly to the source of symptoms. They are also less likely than orally ingested medications to cause side effects in other areas of the body.

Many different medications are sold in nasal spray form, including antihistamines, corticosteroids, decongestants, anticholinergics and cromolyn sodium. Nasal sprays can be obtained both over-the-counter or by prescription, and are effective when used in proper dosages as directed by a physician. However, overuse of some nasal sprays can actually make symptoms worse.

Patients should never take any over-the-counter or prescription medication without first consulting a physician.

About nasal sprays

Nasal sprays are used to treat symptoms of both allergies and colds. Typically, they relieve symptoms such as runny or itchy nose, sneezing and congestion. Like other allergy medications, nasal sprays are divided into two categories:

  • Controller medications. Patients take these on an ongoing basis to prevent symptoms from appearing. Examples include antihistamines, cromolyn sodium and corticosteroids. Some of these prescription nasal sprays may take up to two weeks before the full effects will be evident.

  • Reliever medications. Patients take these over-the-counter or prescription medications to treat symptoms after they appear. These include decongestants and anticholinergics.

Nasal sprays can be a preferred method of treatment because they directly target the source of symptoms. For this reason, they are less likely than orally ingested medications to cause side effects to other areas of the body.

There are two major delivery methods for nasal sprays and their directions for use are different. They are:

  • Pump bottle (metered-dose spray).

    • Blow nose.

    • Shake bottle. Prime pump if necessary by squirting until a fine mist emerges.

    • Hold pump bottle with thumb on bottom and index and middle fingers on top.

    • Insert nosepiece into one nostril. Use a finger to close the other nostril.

    • Aim towards the eye, not towards the middle of the nose (nasal septum).

    • Tilt head forward and slowly breathe out.

    • Breathe in slowly and spray.

    • Repeat in other nostril.

    • Try not to sneeze or blow the nose just after using the spray.

  • Pressurized canister.

    • Blow nose.

    • Shake the canister several times.

    • Insert nosepiece into one nostril. Use a finger to close the other nostril.

    • Keep head upright and slowly breathe out.

    • Breathe in slowly and spray.

    • Repeat in other nostril.

    • Try not to sneeze or blow the nose just after using the spray.

The spray should not drip from the nose or down the back of the throat. This indicates that the patient is using the device incorrectly. It is also important to note that patients should not use a nasal spray unless they can breathe air through each nostril. The medication will prove less effective or ineffective in this situation because it will not be able to reach deep inside the nose.

Additional tips for proper use of nasal sprays include:

  • Wash the canister or bottle at least once a week.

  • Stop using the spray if pain or bleeding develops. Patients experiencing nose pain, a stinging sensation or nosebleeds should cease taking the medication for one to two days.

  • Nasal spray is intended only for use in the nose. Do not swallow the medication.

  • Avoid spraying the medication into the eyes.

  • Use nasal sprays exactly as directed by a physician. Using a nasal spray more frequently than recommended can worsen symptoms.

  • Be patient. It may take up to two weeks for a nasal spray to take full effect. Do not stop using the drug, or begin using more of the drug, without first discussing it with a physician.  

As with any medication, nasal sprays should be stored properly to make sure they maintain their effectiveness and for safety. Tips for proper storage of nasal sprays include:

  • Store medication away from heat and direct light.

  • Do not let nasal spray freeze or become too cold, which lessens effectiveness.

  • Do not puncture, break or burn nasal spray container, even when empty.

  • Throw away outdated medication (expiration date should be on label).

  • Keep all medications out of the reach of children.

Types and differences of nasal sprays

There are many different nasal sprays that can be used to treat various symptoms related to nasal allergies. These include:

  • Antihistamine nasal sprays. These medications prevent histamine from attaching to special receptors on cells, thus short-circuiting an allergic reaction. Antihistamines can be used to treat symptoms of sneezing, and runny and itchy nose. They are also effective in treating some eye symptoms. Antihistamine nasal sprays include:
    • Azelastine hydrochloride (Astelin) – Prescription reliever


  • Anticholinergic nasal sprays. These block the effects of the chemical acetylcholine, which the body uses to signal the mucous glands to produce mucus. This makes anticholinergic sprays a good treatment for a persistent runny nose. Traditionally prescribed in pill form, anticholinergic nasal sprays are now available. Anticholinergic nasal sprays include:
    • Ipratropium bromide (Atrovent Nasal Spray) – Prescription reliever

  • Decongestant nasal sprays. These reduce nasal congestion by narrowing the blood vessels in the membranes lining the nose. This causes a corresponding drop in swelling, inflammation and mucus production. Patients should not use these drugs for more than three to five consecutive days. Use of nasal sprays for longer periods can result in “rebound congestion,” which causes symptoms to get worse instead of better. Decongestants include:
    • Oxymetazoline (Afrin 12 Hour, Nostrilla) – Over-the-counter (OTC) reliever

    • Phenylephrine (Neo-Synephrine, Vicks Sinex 12 Hour) – OTC reliever

    • Tetrahydrolazine (Tyzine) – Prescription reliever

  • Corticosteroid nasal sprays. Over the past two decades, these anti-inflammatory medications have become an important tool in preventing seasonal and perennial allergic rhinitis (hay fever). They mimic the body’s hormones, boosting the level of steroids in the body. This helps shrink inflamed tissue and reduce mucus flow.

    The latest versions of corticosteroids work best when the patient takes them just prior to the start of allergy season, or at the first sign of symptoms. Most are effective when used once daily and display few side effects over long periods of use. However, physicians often are reluctant to prescribe these drugs to children because there is some evidence that they may slow child growth rates, at least temporarily. The medication must be taken even when the patient is not suffering symptoms. Steroid nasal sprays include:
    • Beclomethasone dipropionate (Beconase AQ, Vancenase AQ) – Prescription controller

    • Budesonide (Rhinocort AQUA) – Prescription controller

    • Ciclesonide (Omnaris) – Prescription controller

    • Flunisolide (Nasalide and Nasarel) – Prescription controller

    • Fluticasone (Flonase) – Prescription controller

    • Mometasone (Nasonex) – Prescription controller

    • Triamcinolone acetonide (Nasacort AQ) – Prescription controller

  • Cromolyn sodium sprays. These non-steroid drugs stabilize mast cells and prevent them from releasing histamine and other chemicals that trigger hay fever symptoms. The advantage of cromolyn sodium is that it produces almost no side effects and is considered safe for young children and pregnant and breastfeeding women. The disadvantage is that patients must use it four to six times a day beginning one to four weeks before allergy season begins. Examples of cromolyn sodium sprays include:
    • NasalCrom – OTC controller and reliever

  • Normal saline. Saline nasal sprays can moisten dry nasal membranes, clear debris from the nasal passageway and improve mucous membrane function. Saline may also be used as a sinus wash or irrigation solution. These solutions are available in pharmacies, or a homemade solution can be made and used by taking the following steps:
    • Add ¼ teaspoon of non-iodized salt, ¼ teaspoon baking soda and 8 ounces of warm water (distilled or filtered) and stir thoroughly.

    • Using a dropper, squirt a half-dropper of the solution into each nostril in the morning and at night.

    • Repeat daily and wait for one to two weeks before looking for results.

Conditions treated with nasal sprays

Nasal sprays can be prescribed to treat any number of symptoms related to colds or allergies. They are also effective in treating symptoms of sinusitis. Some of the symptoms these medications alleviate include:

  • Runny nose or post-nasal drip
  • Congestion
  • Sneezing
  • Nasal itchiness

Underlying conditions that may cause these symptoms include:

  • Allergic rhinitis. Commonly called hay fever, allergic rhinitis is an inflammation of the inner lining of the nose that occurs when an allergic individual encounters an airborne allergen such as pollen, mold, dust mites or animal dander.

  • Rhinosinusitis. More commonly known as sinusitis, it is an inflammation of the mucous membranes lining the paranasal sinuses, four pairs of cavities that connect the nose to the throat. Allergic sinusitis is an allergy-triggered inflammation of the paranasal sinuses.

  • Cold. This is the result of an infection in the upper respiratory tract caused by a variety of viruses or bacteria.

Conditions of concern with nasal sprays

Before using nasal sprays, patients should inform a physician if they have experienced or been diagnosed with any of the following:

  • Allergic reactions to medications
  • Special dietary habits or concerns
  • Allergic reactions to food or additive sensitivities
  • Diabetes
  • Glaucoma (eye disease characterized by increased pressure inside the eyeball)
  • Asthma
  • Herpes simplex of the eye
  • Bacterial, viral or fungal infections
  • Recent nose surgery
  • Injury to the nose or sores inside the nose
  • Osteoporosis (a disorder in which the bones lose mass and density)
  • Heart problems
  • Nose bleeds

Potential side effects of nasal sprays

Using decongestant nasal sprays over a long period of time or overusing them can result in rebound congestion (rhinitis medicamentosa). This occurs when the nose becomes so conditioned to the medication that it goes through “withdrawal” after being deprived of it. This triggers swelling that causes congestion to increase.

For this reason, nasal decongestants should never be used for more than three to five consecutive days. To prevent rebound congestion:

  • Closely adhere to the directions on the packaging and from physicians and pharmacists.

  • Use the medication only as directed.

  • Use the smallest dose possible. Try to limit frequency of use, and do not use the medication at all unless absolutely necessary.

  • Never use for more than three to five days. If there is no improvement after that time, call a physician.

Patients who develop rebound congestion can reverse their body’s “addiction” to the drug by ceasing use of the spray for several weeks. Other forms of medication, such as oral medications or saline nasal sprays, can be used during this time to treat nasal congestion and other symptoms.

Other potential side effects of nasal sprays include:

  • Nasal ulcers
  • Headache
  • Nasal congestion
  • Nasal bleeding
  • Nose bleeds
  • Pain, burning or irritation in the nose
  • Runny nose
  • Sore throat
  • Drowsiness
  • Thrush infection in the mouth
  • Unpleasant taste
  • Mild dryness
  • Abdominal pain
  • Diarrhea
  • Vomiting
  • Dizziness

Drug or other interactions with nasal sprays

Patients should consult their physicians or pharmacists before taking any additional prescriptions, over-the-counter medications, nutritional supplements or herbal medications. The drugs used in nasal sprays can potentially interact with various drugs, depending on which formula is used.

Symptoms of nasal spray overdose

Symptoms of overdose can be similar to the medication’s side effects, but are usually more severe. Patients exhibiting any of these symptoms should contact their physicians immediately:

  • Change in menstruation
  • Excessive hair growth in females
  • Rounding of the face, neck and upper body

Pregnancy use issues with nasal sprays

Many drugs delivered in nasal sprays could potentially be passed from a mother to her fetus or nursing child. However, cromolyn sodium is known to be safe for these population groups.

Pregnant women and nursing mothers should consult a physician before using over-the-counter or prescription nasal spray medications.

Child use issues with nasal sprays

Nasal sprays are generally considered safe for children 6 years old and older. Parents should consult a physician to make sure dosages are appropriate for a child’s age and weight. Children over age 12 generally will take adult dosages of nasal spray medications. However, children should not be given prescription or over-the-counter nasal sprays without first consulting a physician.

Questions for your doctor about nasal sprays

Preparing questions in advance can help patients to have more meaningful discussions with their physicians. Patients may wish to ask their doctors the following questions about nasal sprays:

  1. Are nasal sprays safe for me to use?

  2. What type of nasal spray do you recommend for me?

  3. How long will I require this medication?

  4. What side effects may I develop from taking this drug?

  5. How and when should I use this medication?

  6. Do I need to take this nasal spray at the same time each day?

  7. Is it possible to over-use nasal spray?

  8. How long will it take for the drug to take effect?

  9. How will I know if the drug is working?

  10. What are other possible treatments if the drug does not improve my condition?

  11. Are there medications, nutritional supplements or herbal medications I should avoid while taking this drug?

  12. Will nasal sprays interact with my oral allergy medications?
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