Steroid nasal sprays are a first-line treatment for inflammation, congestion, itching and swelling related to sinusitis and allergies, particularly allergic rhinitis. These medications prevent symptoms of an allergic reaction by inhibiting the chemical process that leads to inflammation. They also may be effective at preventing the regrowth of some nasal polyps after they have been surgically removed and, in some cases, may be effective in treating nasal polyps before surgery.

Steroid drugs include corticosteroids that are synthetic versions of cortisone, hydrocortisone and prednisone. They mimic natural steroids produced by the adrenal glands, a pair of organs located near the kidneys. When prescribed in doses that exceed the body’s natural level, these steroids suppress inflammation. Patients take these powerful drugs on an ongoing basis to treat conditions ranging from lupus and arthritis to asthma.

Taken orally or in large doses, steroid medicines have the potential to cause side effects such as thinning of bones and high blood pressure. However, steroid nasal sprays rarely cause serious problems when used properly as prescribed by a physician. This is because they are delivered directly to the mucous membrane and only a limited amount of the drug is absorbed into the body.

Some steroid drugs, including nasal sprays, may not be appropriate for use in children. Research suggests that some steroid drugs, such as beclomethasone, can slightly retard the growth rates of children. No patient should take steroid drugs without first consulting with a physician.

Steroid nasal sprays are powerful anti-inflammatory medications used to treat the symptoms of allergies such as allergic rhinitis. They help relieve sneezing, nasal congestion, runny nose and other symptoms by decreasing inflammation and mucus production in the nose and sinuses. Steroid nasal sprays are also used to treat sinusitis, an inflammation of the mucous membranes lining the sinuses. Sinusitis can be caused by infection, allergies or irritants. In some cases, steroid nasal sprays may also be effective in treating nasal polyps.

Steroid nasal medications are not the same as anabolic steroids, the dangerous substances used by athletes to increase muscle. Rather, steroid drugs are synthetic substances modeled upon natural steroids (cortisone and hydrocortisone) produced by the adrenal glands. These glands are located on top of the kidneys, and by the ovaries in women and testes in men. Naturally produced steroids control many reactions and functions of the body, including:

• Stress of illness and injury
• Development of sexual characteristics
• Immune function
• Inflammation
• Metabolism
• Salt and water balance

Corticosteroids help control inflammation, although it is not known precisely how. Some theories suggest that they may deactivate a protein associated with inflammation, or they may alter the function of cell membranes.

Steroid nasal sprays are a controller medication, meaning they work to prevent symptoms of an allergic reaction before they start. Daily use of this medication should begin one to two weeks before the start of seasonal allergy symptoms. Patients with perennial allergies should use the medication daily throughout the year, even when symptoms have improved.

The frequency with which steroid nasal sprays are used also varies among those with sinusitis. Individuals with chronic sinusitis may require daily use of the spray, while those with occasional sinusitis may only need the drug from time-to-time.

While the effects of these medications can be apparent within several hours of first using the spray, it can be up to three weeks before their full effect is apparent.

A patient who has near-total obstruction of the nasal passages may need to take more powerful oral corticosteroids for a short time until congestion clears enough to allow a nasal spray to be effective.

Steroid nasal sprays have an excellent safety record when used correctly. Patients must closely adhere to a physician’s directions for using steroid sprays. Using more of the drug, or using the drug more often than recommended, greatly increases the risks of side effects. For this reason, steroid nasal sprays are only available by prescription.

It is also important for patients to continue use of the drug for the duration prescribed, regardless of whether symptoms are present. Discontinuing the drug prematurely can cause symptoms to return.

Steroid medications are available in two forms:

• Aerosol. Delivers a premeasured dose of “dry” medication similar to an asthma spray. Those with post-nasal drip may prefer the aerosol.
  
  
• Spray pump (aqueous). Delivers a water-based spray. Those with dry nasal membranes may prefer the moisturizing effect of the spray pump.  

Dozens of corticosteroid drugs are available, including:

Steroid nasal sprays are primarily prescribed to treat one of two related conditions:

• Rhinitis. An inflammation of the nasal mucous membranes that may be caused by allergies, infection or irritation.

  

• Sinusitis. An inflammation and infection of the mucous membranes lining the sinuses that may be caused by allergies, infection or irritation.

Other conditions commonly treated with steroid nasal sprays include:

• Decreased sense of smell. Swelling high up in the nose due to allergic rhinitis or other conditions can prevent odors from reaching the nerves that detect smells. Steroid nasal sprays can reduce the inflammation, improving the patient’s sense of smell.
  
  
• Nasal polyps. Bag-like collections of fluid in the nasal membranes that develop as a result of allergic rhinitis or other conditions. Steroid nasal sprays can help shrink nasal polyps and prevent polyps from returning. 

Nasal corticosteroids may have adverse effects in patients with the following medical problems:

• Asthma. A condition in which the airways become blocked or narrowed, causing shortness of breath and breathing difficulties. Steroid nasal sprays can worsen this condition.
  
  
• Amebiasis. An infection or disease caused by amoebas. Steroid nasal sprays can worsen this condition.
  
  
• Diabetes mellitus (sugar diabetes). Dexamethasone may decrease carbohydrate tolerance, worsening blood glucose control and requiring higher doses of insulin.
  
  
• Glaucoma. An ocular disease in which pressure increases within the eyeball, eventually leading to vision impairment. Long-term use can worsen glaucoma by increasing pressure within the eye.
  
  
• Herpes simplex (virus) infection of the eye. Steroid nasal sprays may mask signs of this condition.
  
  
• Viral, bacterial and fungal infections. Steroid nasal sprays may mask signs of this condition.
  
  
• Nasal injury, sores or post-surgery condition. Steroid nasal sprays may prevent proper healing of these conditions.
  
  
• Heart conditions. Dexamethasone may worsen some heart-related conditions.
  
  
• Liver disease. Steroid nasal sprays may exacerbate this condition.
  
  
• Tuberculosis. Steroid nasal sprays may worsen this condition.
  
  
• Hypothyroidism (underactive thyroid gland). Dexamethasone may worsen this condition in which too little thyroid hormone circulates in the blood.

Side effects of steroid nasal sprays are usually minor, especially when compared to other forms of corticosteroid delivery. Potential side effects of steroid nasal sprays include:

• Burning sensation in the nose
• Unpleasant aftertaste
• Dryness in the nasal mucous membranes
• Nosebleeds
• Yeast infection
• Hoarseness
• Sore throat
• Cough and bronchospasm
• Growth suppression
• Osteoporosis (a disorder in which the bones lose mass and density)
• Thinning of the skin and increased bruising
• Impairment of the adrenal glands
• Increased risk of chickenpox or measles
• Metabolic changes (causing weight gain and increased blood glucose levels)
• Mood changes
• Insomnia
• Menstrual irregularities

Dryness, hoarseness and related side effects can usually be relieved by gargling and rinsing with water after each inhalation. More serious but much less common side effects include:

• Sores in the nose
  
• A hole (perforation) that forms in the wall (septum) that separates the nostrils

Patients must be very careful to use steroid nasal sprays exactly as directed by a physician. Using too much of the drug, or using it too often can cause the body’s adrenal glands to stop making its own steroids, which are needed when the body is under stress from infections, surgery or other conditions.

Tapering off from long-term steroid medicine usage can be a slow process. Patients frequently will feel dizzy, lightheaded, tired or have stomach pain during this process. This should be reported to a physician. Patients should not abruptly stop taking steroid medicines and should consult their physician about the best way to taper off. Suddenly discontinuing the use of steroid medications can be dangerous.

Patients experiencing any steroid nasal spray-related side effects should consult their physician. In addition, patients should immediately contact their physician if they suspect exposure to chickenpox or measles while using steroid nasal sprays. Using corticosteroids can lower the body’s resistance and cause unusually severe infections in those exposed to these diseases. It can also lead to a fatal course.  

Patients using steroid nasal sprays should consult their physicians before taking any additional prescriptions, over-the-counter medications, nutritional supplements or herbal medications. Some medications may interfere with the body's ability to eliminate steroids from the body. These include:

• Ketoconazole. An antifungal medication primarily used for infections of the nails, mouth (thrush), lungs, vagina and blood. May hamper the elimination of budesonide from the body, leaving high amounts in the bloodstream.
  
  
• Ephedrine. A powerful bronchodilator that quickly opens breathing passages. May decrease blood levels of some nasal corticosteroids. Patients taking ephedrine may need a higher dosage of steroid nasal sprays.
  
  
• Phenobarbital. A barbiturate, or sedative, used in the treatment of epilepsy, insomnia and anxiety. May decrease blood levels of some nasal corticosteroids. Patients taking ephedrine may need a higher dosage of steroid nasal sprays.
  
  
• Rifampin. An antibacterial medication primarily used to treat tuberculosis. May decrease blood levels of some nasal corticosteroids. Patients taking ephedrine may need a higher dosage of steroid nasal sprays.

Nasal corticosteroids are considered safer for pregnant women than corticosteroids taken orally or through injection. The latter forms of the medication may cause birth defects, slower growth or reduced adrenal gland function in fetuses. However, pregnant women should always discuss the use of steroid nasal sprays with their physicians before using the medication.

It is known that some steroids, such as dexamethasone, pass into the breast milk of breastfeeding mothers. The effect of other steroids on breast milk is unknown. For this reason, breastfeeding mothers should consult a physician before taking steroid drugs.

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

1. Am I a candidate for steroid nasal spray?
   
   
2. What type of steroid nasal spray do you recommend for me?
   
   
3. How and when should I use the spray?
   
   
4. How long will I require a steroid nasal spray?
   
   
5. What side effects may I develop from using this steroid nasal spray?
   
   
6. How long will it take for the drug to take effect?
   
   
7. What risks do I face by using this medication?
   
   
8. What side effects may I develop?
   
   
9. How will I know if the drug is working?
   
   
10. Can I use the drug more often if my symptoms persist?
    
    
11. Can I use the drug less often if I feel better?