Steroid nasal sprays

Steroid nasal sprays are medicines that are sprayed into the nose, to prevent and treat allergy symptoms of the nose such as stuffy or runny nose, itching, and sneezing. These usually occur with hay fever (also called allergic rhinitis). Steroid nasal sprays are also used to treat certain growths in the nose called nasal polyps. They work by reducing swelling (inflammation) and mucus in the nose. Because the medicine mainly works in your nostrils, it has very little effect anywhere else in your body. People with hay fever only need to use them for a few months of the year, during the hay fever season, but others may need to use them long-term.

There are a number of different steroid nasal sprays that come in different brands. Examples of steroid nasal sprays available in New Zealand are:

• Beclometasone (Becloclear®, Beconase®)
• Budesonide (SteroClear®)
• Fluticasone (Flixonase®) 

These nasal sprays are available in different strengths. Some lower strength steroid nasal sprays can be bought from your pharmacy, without a prescription but the higher strengths are available on prescription only.

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

• recently had surgery on your nose.
• an infection in your nose.
• pulmonary tuberculosis (TB).

People with hay fever only need to use steroid nasal sprays for a few months of the year, for the hay fever season, but people with ongoing rhinitis may need to use them long-term. The long-term use of steroid nasal sprays is thought to be safe.

It takes a few days for a steroid spray to build up to its full effect. When you first start using the spray, you will not have an immediate relief of symptoms. In some people it can take up to 2 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 week before the hay fever season starts.

To get the most benefit, use the correct technique when using a nasal spray. The best spray technique involves:¹

• tilting the head forward
• directing the nozzle slightly away from the middle to avoid contact with the septum.

The following steps are a guide:

• Shake the nasal spray bottle before use.
• Gently blow your nose with a tissue to clear the nostrils.
• Tilt your head slightly forward and gently put the nozzle into one nostril.
• Do not push the nozzle into the nostril too hard, as you may damage the nasal septum (the middle of the nose which separates the left and right airways in the nose).  
• 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.
• Wipe the tip of the spray device with a dry tissue and put the cap back on.

Watch this video on how to use a nasal spray

Key points

• Do NOT blow your nose hard after spraying (the medicine is lost)
• Do NOT sniff hard after spraying. If you do, the medicine will go down your throat instead of staying in the nose where it is needed)

Like all medicines, nasal decongestants can cause unwanted side effects, although not everyone gets them. Because the medicine mainly works in your nostrils, it has very little effect anywhere else in your body.

The following links provide further information on steroid nasal sprays. Be aware that websites from other countries may contain information that differs from New Zealand recommendations.

Medsafe Consumer Information Sheets (NZ)

• Becloclear(external link)
• Flixonase(external link)

Steroid nasal sprays(external link) Patient Info, UK (UK)

Hay fever | Mate hei
Nasal polyps

1. Intranasal corticosteroid spray technique(external link) National Asthma Council Australia, 2017