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Clinician’s Corner: Nasal Corticosteroids

Topical nasal corticoids have emerged as the MOST effective treatment of stuffy nose due to allergies. These nasal sprays are more effective than oral antihistamines for relief of total nasal symptoms, including blockage, sneezing, discharge, itch and postnasal drip, and. Currently two are available without prescription, with more to make the switch from Rx to OTC.  Although these drugs are extremely effective, and now very inexpensive, proper administration technique is necessary for optimal results. Consultation with your Thompson Pharmacist is necessary to achieve the best relief of your symptoms.

Warnings/Precautions/Adverse effects

  • Dryness & irritation in the nose. May cause stinging irritation, nosebleeds, sore throat & burning. May cause impaired taste.
  • Yeast infections in the nose have rarely occurred.
  • The growth rate of some children may be slower using these products. It should be used for the shortest amount of time necessary to achieve symptom relief.
  • Adult supervision if used in patients under age 12

Patient counseling points: You may feel better in 2 or 3 days, but peak response takes 2-3 weeks.  This drug is not to be used “as needed”.  It should be used for the entire allergy season.

  • Blow nose first
  • Remove cap
  • Prime bottle (if first use)
  • Shake bottle
  • Tilt head forward and exhale. (“It goes in your nose, look at your toes”)
  • Direct spray toward the ear on the same side. (Use the left hand to spray the right nostril, and the right hand for the left nostril)
  • Place pump into one nostril. Close other nostril with finger.
  • Administer spray in nostril while inhaling slowly and deeply.
  • Do not sneeze or blow the nose for 10-15 minutes after spray administered.

Nasacort- Allergy 24 (triamcinolone) hours first approved 1957. Approved for OTC use in Fall 2013. The liquid vehicle of OTC triamcinolone acetonide nasal spray is alcohol and taste free.

Flonase (fluticasone) first available Rx in 1994. Approved for OTC use Summer 2014. First for relief of itchy watery eyes and nasal symptoms. The liquid vehicle of OTC fluticasone propionate contains phenylethyl alcohol.

Flonase Sensimist (fluticasone furoate) will be available soon in February as an alcohol free and scent free mist.

Your Thompson Pharmacist is the best source of information, especially with this class of drugs.  Using them correctly, and long enough will give you the best results, whether your nasal spray is prescription or over the counter.  See packages for dosing information.