Steroid nasal sprays

There are a number of different steroid nasal sprays that come in different brands.

Examples of steroid nasal sprays available in Aotearoa New Zealand are:

• Beclometasone (Becloclear®))
• Budesonide (SteroClear®)
• Fluticasone (Flixonase®, Histoleve®) 
• Fluticasaone combined with the antihistamine Azelastine (Dymista®)
• Mometasone (Azonaire®, Mometasone Neo Health®, Teinasal®)

Some of these nasal sprays are available in different strengths. The lower strength steroid nasal sprays that contain 50 mcg of steroid per spray can be bought from your pharmacy without a prescription, but the higher strengths containing 100 mcg/spray are only available with a prescription from your doctor.

Most people can use a steroid nasal spray, unless they have ever had an allergic reaction to this medicine.

You should talk to your doctor or pharmacist before using a steroid nasal spray if you:

• have recently had nasal ulcers, or an injury to (or surgery on) your nose
• have an infection in your nose or sinus
• have frequent nose bleeds
• have pulmonary tuberculosis (TB)
• are taking any other medicines
• are pregnant or breastfeeding.

How often do I need to use my steroid nasal spray?

To get the maximum benefit from a steroid nasal spray you will need to use the nasal spray regularly every day.

• It takes a few days for a steroid spray to build up to its full effect. When you first start using the spray, you won't get immediate relief of symptoms. In some people it can take up to 2 weeks or longer to get the maximum benefit.
• The dose for steroid nasal sprays will vary depending on what you are using it for, the strength of the medicine and your symptoms. The usual dose is one to two sprays in each nostril once or twice daily.
• If it is once daily, it is best to use it in the morning. For twice daily, use it in the morning and at night.
• Always take your nasal spray exactly as your healthcare provider has told you. The pharmacy label on your medicine will tell you how many sprays to use, how often to take it and any special instructions.

How long do I need to use my steroid nasal spray for?

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

If you use the spray for hay fever, it's best to start using it at least a week before the hay fever season starts.

The long-term use of steroid nasal sprays is thought to be safe.

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

• tilting your head forward
• directing the nozzle slightly away from the middle to avoid contact with the septum (the middle of the nose which separates the left and right airways in the nose). This will avoid damaging the septum and causing nose bleeds.

The picture below shows the correct position to hold the tip of the spray in the nostril.

Image credit: ©2023 BMJ Publishing Group Ltd. From Teaching patients to use nasal sprays(external link) 2023.

The following steps are a guide to using a steroid nasal spray:

• Gently blow your nose with a tissue to clear the nostrils.
• Remove the cap and shake the bottle before use.
• The first time you use the pump spray each day, you may have to 'prime' it. Do this by squirting it a few times into the air until a fine mist comes out.
• Hold the pump spray with your index and middle fingers on each side of the bottle with your thumb on the bottom of the bottle.
• Tilt your head forward and gently put the nozzle into 1 nostril aiming the tip toward the back of your head and away from the middle of the nose.
• Close the other nostril with your other hand.
• With your mouth closed, pump 1 or 2 sprays into the nostril as advised by your healthcare provider.
• Breathe in slowly and gently as you spray.
• Remove the bottle and sniff gently once or twice. Don’t sniff too hard because it will go past the nose to the throat and give you an unpleasant taste.
• Try to avoid blowing your nose for at least 5 to 10 minutes. You want as much of the medicine to stay in your nose and sinus.
• Repeat the steps for the other nostril if required.
• Wipe the spray tip with a clean tissue after each use.
• Replace the cap after each use.

Video: How to use a nasal spray

(Asthma Australia, 2021)

Read more about using nasal sprays in children.

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.

Read more about medicines and side effects and reporting a reaction you think might be a side effect.