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Steroid nasal sprays

Peer reviewed by Dr Rosalyn Adleman, MRCGPLast updated by Dr Rachel Hudson, MRCGPLast updated 24 Apr 2023

Meets Patient’s editorial guidelines

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Steroid nasal sprays are medicines that are commonly used to treat symptoms of stuffiness or congestion in the nose. They are used most often for allergies of the nose, such as hay fever. They are also used for other causes of persistent inflammation of the nose (rhinitis). Steroid sprays reduce swelling and mucus in the nose, and usually work well.

People with hay fever only need to use them for a few months of the year. Others may need to use them long-term. You can buy some steroid nasal sprays from your supermarket or local pharmacy, without a prescription.

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What are steroid nasal sprays?

A steroid nasal spray is a small bottle of a solution which you spray into your nose. It contains a medicine called a corticosteroid or steroid. Steroid sprays reduce swelling (inflammation) and mucus in the nose, and usually work well.

Because the medicine is mainly absorbed in your nose, it has very little effect anywhere else in your body. Therefore they are considered to be very safe to use.

A steroid nasal spray is commonly used to treat symptoms of the nose such as:

  • Blocked nose.

  • Runny nose.

  • Congestion of the nose.

  • Itchiness of the nose.

These symptoms may be caused by conditions such as:

A steroid nasal spray may also be used to treat other conditions such as:

There are a number of different steroid nasal sprays - these include beclometasone, budesonide, fluticasone, mometasone and triamcinolone. They come in different brands. Ciclesonide and flunisolide are other steroid nasal sprays (they are not available in the UK).

How to use a steroid nasal spray

Steroid nasal spray administration

Nasal spray administration

  • Blow your nose.

  • Shake the bottle.

  • Tilt your head forwards.

  • Hold the spray bottle upright.

  • Insert the tip of the spray bottle just inside one nostril. Close the other nostril with your other hand, and apply one or two sprays as prescribed.

  • Breathe in as you spray (but do not sniff hard as the spray then travels past the nose to the throat).

  • Do not angle the canister towards the middle or side of the nose, but straight up. With your head tilted forward, the spray should go to the back of your nose.

  • Repeat in the other nostril.

What if my nose is very blocked or runny?

Sometimes a very blocked or runny nose will prevent the steroid spray from getting through to work. A decongestant nasal spray which you can buy at pharmacies may then be useful. These contain decongestant medicines such as xylometazoline.

A decongestant spray has an immediate effect to clear a blocked nose. You can then use the steroid spray once the nose is clear.

Note: decongestant sprays are not usually advised for more than a few days. If you use one for more than 5-7 days, a rebound, more severe congestion of the nose may develop. In contrast, steroid sprays work well to clear symptoms, and can be used for long periods.

What if my symptoms come and go?

If your symptoms are very mild, if they don't happen all that often or if they only start after a particular trigger - for example, if you have a cat allergy - a steroid nasal spray may not be the best treatment for you. A nasal spray containing a type of medicine called an antihistamine (such as azelastine or olopatadine) may be better. Only azelastine is available in the UK.

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How long does it take for steroid nasal sprays to work?

It takes several days for a steroid spray to build up to its full effect. Therefore, you will not have an immediate relief of symptoms when you first start it. In some people it can take up to two weeks or longer to get the maximum benefit.

If you use the spray for hay fever, it is best to start using it at least a couple of weeks before the hay fever season starts.

What is the usual length of treatment?

Some people only need a nasal spray for the hay fever season (a few months). However, if you have a persistent rhinitis, you may have to take treatment long-term to keep symptoms away.

Once symptoms are gone, you are still likely to need to use a steroid nasal spray regularly, to keep symptoms away. Your doctor may advise that you reduce the dose to a lower maintenance dose once symptoms have gone. The aim is to find the lowest dose that controls symptoms.

An occasional forgotten dose should not be a problem, but symptoms usually return after a few days if you stop taking the spray.

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Side-effects of steroid nasal sprays

Steroid nasal sprays rarely cause side-effects. This is because they are applied directly to the nose and very little of this medicine is absorbed into the body. Therefore, they are much less likely to cause side-effects in other parts of the body. Occasionally, they cause dryness, crusting, and bleeding of the nose.

If this occurs, stop it for a few days and then restart. There have been reports of nasal steroids possibly having an effect on behaviour, particularly in children. This is thought to be rare. However, a few people have reported hyperactivity, problems sleeping, anxiety, depression, and aggression.

Are nasal steroid sprays safe?

Long-term use of a steroid nasal spray is thought to be safe.

For a full list of possible side-effects please read the leaflet that came with your medicine.

Where to buy steroid nasal sprays

You can buy a number of steroid nasal sprays from the supermarket and your local pharmacy. These include beclometasone, fluticasone and triamcinolone.

Who cannot use a steroid nasal spray?

Most people can use a steroid nasal spray, unless they have ever had an allergic reaction to this medicine. However, you should talk with your doctor or pharmacist before using a steroid nasal spray if you:

  • Have recently had surgery on your nose.

  • Have infection in your nose.

  • Have pulmonary tuberculosis (TB).

  • Are pregnant, trying for a baby or breastfeeding.

You may still be able to have this medicine - your doctor will advise you.

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by Dr Doug McKechnie, MRCGP

Cough medicines

Treatment and medication

Cough medicines

Cough medicines are commonly bought to treat various types of coughs that occur when you have an upper respiratory tract infection (URTI). Cough medicines that you can buy are often divided into those for a dry or tickly cough, and those for a chesty cough. It is thought that cough medicines do not really work. However, some people feel that they work for them and they are thought to be reasonably safe to use, though it is important to check with a pharmacist if you are taking other medications. Children who are aged 12 years and younger should only be given cough syrups which state they are suitable for the child's age. EDITOR NOTE Dr Krishna Vakharia, 21st February 2024 A note on pseudoephedrine-containing products. The Medicines and Healthcare products Regulatory Agency has issued a caution for those using pseudoephedrine-containing products. There have been rare reports of two conditions associated with pseudoephedrine use - posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS). Following a review by MHRA - the safety information of all pseudoephedrine-containing medicines will be updated to provide clearer descriptions of these risks and potential risk factors for these conditions for both patients and healthcare professionals. PRES- also known as reversible posterior leukoencephalopathy syndrome (RPLS). This is a rare condition in which parts of the brain are affected by swelling - usually as a result of an underlying cause. Symptoms include headache, changes in vision, and seizures, with some developing other neurological symptoms such as confusion or weakness of one or more limbs. Most patients fully recover. RCVS - is a neurological disorder. There is a sudden onset of severe headache associated with narrowing of the blood vessels that supply blood to the brain. On brain imaging the narrowing of the blood vessels can look similar to a “string of beads”. Very rarely, RCVS can present as a medical emergency with strokes (ischaemic strokes or bleed), seizure or as brain swelling. Usually, the narrowing resolves by itself within three months, and most patients fully recover. MHRA is reminding users that: Pseudoephedrine is for short term use only and should only be used to relieve symptoms of nasal and sinus congestion in colds, flu, and allergies. No one should take pseudoephedrine if they have high blood pressure (hypertension) or hypertension not controlled by their medicines, or if they have severe acute (sudden onset) or chronic (long-term) kidney disease or kidney failure. If you experience a severe headache that develops very quickly or you suddenly feel sick or are vomiting, confused or experiencing seizures or changes in vision while taking this medicine, stop taking it immediately and seek urgent medical attention. A reminder that this is extremely rare - there have only been 4 cases reported by the Yellow Card scheme to date- out of 4 million packets sold in 2022.

by Dr Doug McKechnie, MRCGP

Further reading and references

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Article history

The information on this page is written and peer reviewed by qualified clinicians.

  • Next review due: 22 Apr 2028
  • 24 Apr 2023 | Latest version

    Last updated by

    Dr Rachel Hudson, MRCGP

    Peer reviewed by

    Dr Rosalyn Adleman, MRCGP
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