Over-the-Counter Nasal Steroids Pros and Cons (2024)

Nasal corticosteroid sprays work by reducing swelling and mucus in the nasal passages to relieve sneezing, runny nose, and other allergy symptoms. Unlike oral steroids, which treat allergy symptoms throughout the whole body, nasal sprays treat nasal symptoms only.

Nasacort Allergy 24 Hour (triamcinolone) was the firstintranasal corticosteroid nasal sprayavailable over-the-counter (OTC) without a prescription. Soon after, Flonase (fluticasone) and Rhinocort (budesonide) also became available OTC as effective corticosteroid sprays.

Deciding whether to use a nasal corticosteroid spray or an oral OTC antihistamine like Zyrtec or Allegra can be confusing. This article discusses the pros and cons of using OTC nasal sprays.

Nasal Sprays vs. Antihistamines

The intranasal corticosteroids—Nasacort, Flonase, and Rhinocort—are probably the most effective OTC medications for the treatment of nasal allergy symptoms. A downside to them is that they will not work on an as-needed basis.

Intranasal corticosteroids take timeto work. They may begin to give relief to allergy symptoms after about six to 10 hours, but full relief may not be obtained for three to six weeks with daily use.

Antihistamines, such as Zyrtec (cetirizine), Allegra (fexofenadine), and Claritin (loratadine), on the other hand, tend to work fairly quickly, usually within a couple of hours (or less) of taking the medication. Therefore, these medications work well when taken on an as-needed basis.

Antihistamines work best for the treatment of itchy nose, itchy eyes, and sneezing—and less well for symptoms of nasal congestion or arunny nose. Of the three newer (and less sedating) oral antihistamine options, Zyrtec and Allegra work especially well in relieving nasal allergy symptoms, usually within an hour.

Claritin, on the other hand, doesn't work as welland takes about three hours to take effect. All three of these antihistamines are a good choice for spring allergy reliefand are generally preferred over a sedating antihistamine such as Benadryl.

Another antihistamine option is Astepro (azelastine hydrochloride), a nasal spray that has been approved for nonprescription use in adults and children over the age of 6.

The only other medicated nasal sprays available OTC are nonsteroidal decongestants like Afrin (oxymetazoline) and NasalCrom (cromolyn).

Controversies and Considerations

Another aspect to consider is that many professional organizations of allergists, pediatricians, and otolaryngologists were against intranasal corticosteroids beingmade available OTC. They previously opposed the antihistamine Claritin becoming available without a prescription.

However, during the 1990s, the FDA labeled allergic rhinitis as a disease that could be recognized and treated without a healthcare professional. This means that the FDA felt that it was safe to have the general public self-diagnose and treat allergic rhinitis using OTC products.

Intranasal corticosteroids may not be as safe as antihistamines, however, and therefore the risks and benefits should be considered. OTC nasal decongestants should not be used for more than two days at a time to avoid rebound nasal congestion and worsening of nasal obstruction.

Pros

Nasal corticosteroid sprays have been available on the market by prescription for more than 30 years, with large amounts of safety data collected during that time.

Side effects are usually mild. The most common include:

• Nasal irritation
• Sneezing
• Throat irritation
• Headaches

Overuse or misuse of nasal sprays can damage the cartilage in the septum, eventually leading to nosebleeds. Although rare, people with damaged septum cartilage who continue to use nasal sprays may develop septum perforations. Septum perforations won't heal on their own and require surgery.

Outside of localized symptoms, intranasal corticosteroids rarely cause whole-body side effects. Studies investigating the use of intranasal corticosteroids have yet to show any evidence of hypothalamic-pituitary-adrenal (HPA) axis suppression in which the excessive use of corticosteroids affects the body's own cortisol production.

Insurance coverage may vary, but medical insurance providers usually do not cover the cost of OTC drugs. However, there are some exceptions for Medicare Advantage OTC cardholders. Medicare Advantage OTC offers allowances for some non-prescription drugs, including generic fluticasone nasal sprays.

Cons

Some medical organizations believe that OTC intranasal corticosteroids are a bad idea. The reasons are mostly related to product safety, particularly in young children and elderly adults.

There have been concerns about growth suppression in children using intranasal corticosteroids, although these effects are considered small and inconsistent. Despite this, children using intranasal or inhaled corticosteroids should be monitored by a medical professional.

At present, there is no clinical evidence of an increased risk of cataracts in elderly corticosteroid users. While the drugs can increase the risk of osteoporosis if overused, there is no evidence that they increase the risk of fractures.

Opponents of OTC intranasal corticosteroids also believe that consumers won’t understand that this medication needs to be used routinely for it to work.

Unlike topical nasal decongestants, which bring relief in a matter of minutes, intranasal corticosteroids takehours to days to work. Therefore, people might use higher doses than recommended, which may lead to more side effects.

Many of the side effects and misunderstandings of how intranasal corticosteroids workcould be avoided by having these medications remain prescription only, which allows for frequent monitoring by a healthcare professional.

Summary

Nasal corticosteroid sprays can effectively reduce symptoms of allergic rhinitis, like runny nose, nasal irritation, and sneezing. But, it can take hours, days, or even weeks for their effects to set in. Nasal sprays may cause side effects, like headache and throat irritation, but they tend to be mild. More serious side effects can also occur. OTC nasal sprays should be used with caution in children and elderly people. To reduce the risk of side effects, never use more than the recommended dosage.