What to Know About Using a Nasal Spray

Nasal sprays are used to deliver medications into your nostrils. Most often, they are used to treat allergy or cold symptoms, such as itching, sneezing, or nasal congestion. Some nasal sprays, however, deliver medications that act elsewhere in the body. The lining of your nose is rich in blood vessels, which means it can easily absorb medications into your bloodstream.

Nasal sprays are available by prescription and over the counter (OTC), depending on the medication. Most work by introducing a fine mist of the medication into your nostrils by the action of a hand-operated pump bottle or squeeze bottle.

Types of Nasal Sprays

There is a wide array of over-the-counter and prescription nasal sprays on the market. Some treat nasal congestion and allergies, while others deliver systemic medications and vaccines to manage or prevent illness.

The first step in using a nasal spray correctly is making sure that you are using it for the right reasons.

OTC Cold and Allergy Nasal Sprays

• Afrin (oxymetazolone): Acts as a decongestant to relieve nasal congestion in people with colds and sinus problems
• Nasalcrom (cromolyn): Helps to relieve and prevent symptoms of allergic rhinitis such as sneezing, runny nose, or itching
• Neo-Synephrine (phenylephrine): Acts as a decongestant to relieve nasal congestion in people with colds and sinus problems
• Flonase (fluticasone propionate): Treats sneezing and symptoms of hay fever
• Nasacort (triamcinolone): Treats itchy and runny nose
• Rhinocort (budesonide): Steroid that prevents inflammation, and treats runny and itchy nose

Prescription Allergy Nasal Sprays

• Astelin NS/Astepro (azelastine): A steroid-free antihistamine that reduces nasal allergy symptoms, such as a runny nose, hay fever, or other allergies (available OTC in the U.S. in early 2022 for adults and children 6 and older)
• Nasarel (flunisolide): Helps to shrink nasal polyps and relieve allergy symptoms, such as a runny or stuffy nose, sneezing, and itching of the nose
• Nasonex (mometasone): Used to prevent and treat stuffy nose and other allergy symptoms
• QNASL (beclomethasone): Used to treat allergy symptoms, such as sneezing
• Zetonna/Omnaris (ciclesonide): Used to treat itchy and runny nose, as well as sneezing
• Xhance (fluticasone): Can be prescribed to treat nasal polyps, as well as allergy symptoms
• Dymista (fluticasone/azelastine combination): Treats allergy symptoms, such as runny and itchy nose.
• Patanase (olopatadine): Used to treat allergy symptoms, such as itchy nose and eyes

Other Nasal Sprays

• Fortical (calcitonin): Used to treat osteoporosis, it controls the amount of calcium in your body and helps maintain proper bone density
• Imitrex (sumatriptan): Helps to relieve a migraine attack that starts with or without an aura
• Nicotine nasal sprays: A smoking-cessation device used to wean you off cigarettes

FluMist is the intranasal influenza vaccine. It must be administered by a healthcare professional.

Basics of Nasal Spray Use

Many different medications come as nasal sprays, and instructions for how to use them can vary. If you don't understand the instructions for the particular product you're using, ask your pharmacist to walk you through them.

Before starting:

• Make sure you can breathe through each nostril. If your nostril is blocked, the medication won't go deep enough into the nasal passage to be effective.
• Know that some nasal sprays need to be primed each day before use. To do so, squirt it a few times into the air until a fine mist comes out. Make sure to keep it away from your eyes and others.
• Store your nasal spray as directed and keep the bottle away from direct sunlight. Don't share your nasal spray with other people and, most importantly, keep it where children can't get to it.

Step-by-Step Instructions

To use a pump-bottle nasal spray correctly:

1. Blow your nose gently to remove mucus from your nasal passages.
2. Wash your hands with soap and water.
3. Gently shake the bottle of nasal spray and remove the cap. If needed, prime the dispenser before using it.
4. Tilt your head slightly forward and close one nostril by gently pressing against the side of your nose with your finger.
5. Insert the tip of the nasal spray into the other nostril. Point the tip toward the back and outer side of your nose. Make sure to direct the spray straight back, not up into the tip of your nose.
6. Squeeze the nasal spray bottle as you slowly breathe in through your nose.
7. Remove the tip of the nasal spray from your nostril and breathe out through your mouth.
8. Repeat this procedure for your other nostril (if advised). Make sure to follow the directions and use only the recommended amount of medication.
9. Wipe the tip of the nasal spray with a tissue or alcohol pad and put the cap back on.
10. Try to avoid sneezing or blowing your nose immediately after using the nasal spray.

Some nasal sprays leave an unpleasant taste in your mouth. A drink of water or juice should help eliminate the aftertaste.

Never use your nasal spray after the expiration date on the bottle. Liquid medication can easily be contaminated with dirt or bacteria.

Side Effects

Nasal sprays can cause side effects. Some common ones include:

• Burning
• Bleeding
• Stinging
• Increased runny nose
• Dryness in the nose
• Sneezing
• Nervousness
• Nausea
• Headache

If any side effects are persistent or severe, let your healthcare provider know. Also contact your healthcare provider if you experience any of the following more significant side effects:

• Dizziness
• Insomnia
• Tremors
• Vision changes
• Weakness
• Shortness of breath
• Irregular or rapid heartbeat

Rebound Congestion

Vasoconstriction is the narrowing of blood vessels in the nose, which is what helps decrease congestion and fluid release. It is what makes vasoconstrictive nasal sprays, such as Afrin and neosynephrine, beneficial.

With regular use of such sprays over time, however, you'll need increasing dosages to relieve your stuffiness. The overuse of such sprays decreases their effectiveness and can actually make nasal obstruction worse—what's known as rhinitis medicamentosa, or rebound congestion.