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.
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:
- Allergies of the nose, such as hay fever.
- Inflammation of the nose (persistent rhinitis).
- Swelling (polyps) in the nose.
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
- 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.
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. Long-term use of a steroid nasal spray is thought to be safe.
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.
What are the possible side-effects?
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.
For a full list of possible side-effects please read the leaflet that came with your medicine.
Can I 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.
How to use the Yellow Card Scheme
If you think you have had a side-effect to one of your medicines you can report this on the Yellow Card Scheme. You can do this online at www.mhra.gov.uk/yellowcard.
The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that medicines or any other healthcare products may have caused. If you wish to report a side-effect, you will need to provide basic information about:
- The side-effect.
- The name of the medicine which you think caused it.
- The person who had the side-effect.
- Your contact details as the reporter of the side-effect.
It is helpful if you have your medication - and/or the leaflet that came with it - with you while you fill out the report.
Further reading and references
BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis; British Society for Allergy and Clinical Immunology (July 2017)
British National Formulary (BNF); NICE Evidence Services (UK access only)
Corticosteroids - topical (skin), nose, and eyes; NICE CKS, September 2015 (UK access only)
Inhaled and intranasal corticosteroids: risk of psychological and behavioural side effects; Medicines and Healthcare products Regulatory Agency (MHRA), September 2010
Allergic Rhinitis; NICE CKS, October 2015 (UK access only)
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