What to Know About Steroid Nasal Spray Side Effects

Nasal steroid sprays are used to treat chronic sinusitis and allergies that affect your breathing, like hay fever. They can also be used to treat snoring and nasal polyps, noncancerous growths in the nasal passages.

Both the short-term and long-term use of nasal steroid sprays are thought to largely be safe for children and adults alike. However, they are not without side effects.

This article reviews possible side effects of steroid nasal sprays—some of which overlap with the very condition you may be trying to treat—and why they occur. It also walks you through when to talk to your healthcare provider about them.

What Is Steroid Nasal Spray?

Intranasal corticosteroids are manmade versions of hormones that are naturally produced in the body's adrenal glands. Better known as steroid nasal sprays, these drugs come in liquid form that is misted into the nostril.

Steroid nasal sprays are used to treat inflammation in your sinuses. These are the hollow spaces in your head that connect with the passages in your nose. When they are irritated, you can experience symptoms such as nasal congestion, pressure, and headaches.

These drugs work by limiting the amount of allergens and other irritants that enter the moist lining of your sinus passages, called mucosa. They help calm your body's response to these irritants, reducing swelling and mucus.

Steroid nasal sprays are not the same as anabolic steroids, drugs that some people use to encourage muscle building.

Examples of Steroid Nasal Sprays

Some forms of nasal steroid spray are available only when prescribed by your healthcare provider. Examples include:

• Beconase AQ (beclomethasone)
• Dymista (azelastine and fluticasone)
• Nasonex (mometasone)
• Omnaris, Zetonna (ciclesonide)

Others are available over the counter (OTC), including:

• Flonase (fluticasone)
• Nasacort (triamcinolone)
• Rhinocort (budesonide)
  

Localized Side Effects

Localized side effects of steroid nasal sprays, or those limited to the areas in and around where the medication directly touches, are the most common.

You may not even realize that your steroid nasal spray is causing side effects, as many of them can mimic those of allergies and sinusitis. That's especially true if you have just started using nasal steroid sprays for allergies.

Common steroid nasal spray side effects include:

• Irritation
• Itching
• Dryness
• Redness
• Nosebleeds
• Crusting
• Burning
• Infection

Local side effects of steroid nasal sprays tend to affect the nasal passage openings most. More rarely, they can be up higher in your nostrils.

These symptoms can occur right after you use the nasal spray or days afterward.

Though they are less common, some side effects involve your eyes and sinuses. These may occur right away or even days after use.

Such side effects include:

• Sneezing
• Watery eyes
• A runny nose or stuffiness
• Headaches
• Aftertaste
• A cough

If you experience these symptoms, talk to your healthcare provider. They may advise you to stop using your nasal steroid spray for a few days. They also may adjust your dose or change your treatment.

Systemic Side Effects

Steroid nasal spray use can sometimes lead to body-wide side effects, though these are less common.

These side effects can be due to the fact that these drugs can suppress your immune system, change your hormone levels, or increase pressure in your eyes.

Systemic side effects of steroid nasal sprays include:

• Nausea or vomiting
• Upper respiratory tract infections
• Abnormal menstrual cycles
• Cataracts (clouding of eye lenses)
• Glaucoma (nerve damage in the eye that can cause loss of vision)
• Body-wide infection

Systemic side effects due to using nasal steroid sprays are relatively rare. However, be sure to see a healthcare provider if you think you may be experiencing any.

Growth and Behavior in Children

Research suggests that nasal corticosteroids are safe for children, but there are some concerns about long-term use and its effects on growth and behavior in children .

Growth

Nasal steroid spray use may have a small impact on a child’s vertical growth. This concern rises when the steroids are used over time.

One study, completed in 2000, followed 90 children between the ages of 6 and 9 for a year. They received either beclomethasone dipropionate (BDP) spray for their allergy symptoms or a fake treatment (placebo).

There was a slightly lower rate of height growth in the group who had BDP spray. It was attributed to the medication itself after ruling out all other factors.

The difference began to show up after just the first month. However, the authors noted that more research was needed, and that the slight change did not suggest an impact on overall growth or final height.

Later nasal steroid spray studies in children have not found any such growth rate change.

Behavior

There has been some concern about hyperactivity, irritability, or behavioral problems in children who regularly use nasal steroid sprays. Studies, however, show mixed results.

It's best to be aware of the potential for this and watch for any changes in a child using nasal steroid spray.

How Technique Affects Your Risk

Following product instructions and those provided by a healthcare provider can help you minimize the side effects of steroid nasal sprays.

Proper technique is very important. One study carried out in the Netherlands found that just 6% of participants actually completed all the steps given in their nasal spray instructions, so it's worth reviewing them—even if you think you have them down pat.

The researchers note that improper technique when using a nasal spray can raise your risk of nosebleed or a perforated septum. That's especially the case when you point the spray toward the inside of your nose, as it causes the tissue to thin with repeated use.

You can avoid these side effects by knowing the correct way to use the spray and applicator.

Basic steps include:

1. Shake the bottle well before using the spray.
2. Point the tip to the back/outer side of your nose upon insertion.
3. Sniff the spray in gently so that it goes into the sinuses and not the throat.
4. Try not to blow your nose, sneeze, or otherwise force the spray back out.

You'll want to be sure you can breathe well before use. The drug can't reach the sinuses if you can't breathe it in through your nostrils. You also may want to gently pump (prime) the bottle before use, making sure that it's ready to spray so that the drug is delivered as you expect.

Contraindications

For some, steroid nasal spray use may be either carefully considered or outright inadvisable, as they are at greater risk for side effects than others.

If you have eye conditions such as cataracts or glaucoma, or a family history of these diseases, nasal steroid sprays may make your eye issue worse. If you use them, then annual eye exams by an optometrist or ophthalmologist (eye specialists) are recommended.

If you have any condition related to your adrenal glands, such as Addison's disease, it is possible for nasal steroid sprays to make them worse. This is more likely if you use the sprays often over a long period of time.

Summary

Nasal steroid sprays will often bring relief for symptoms related to allergies and chronic sinusitis. Your healthcare provider may prescribe one for you. Other nasal steroid sprays are available as over-the-counter drugs.

If you are new to using them, it's important to know that they can lead to side effects. In many cases, you will experience symptoms of these side effects in and around the nose. Side effects that are body-wide, such as nausea or infection, can occur but do so less often.

It's important that you know the proper technique when using nasal sprays. This will help to ensure that your use of steroid nasal sprays is both safe and effective when treating your symptoms.