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Which nose spray is right for me?

There is a plethora of nasal sprays available over the counter now and it may be difficult to figure out exactly what purpose each has. Let’s try and classify nose sprays and this should clarify their use.

Nasal Steroids: Examples include Flonase and Nasacort as well as generic variations of these. Nasal steroids have been in use for decades. They have a high safety profile although there are a few contraindications such as patients with glaucoma. Steroids decrease inflammation and have indications for allergic rhinitis. Patients with allergies may note symptoms of nasal congestion and excessive mucus. Nasal steroids act to reduce these symptoms. Common side effects may include nasal dryness, nose bleeds and transient headache.

Nasal antihistamines: These include Astepro. Nasal antihistamines offer a way to deliver antihistamines directly to nasal and sinus mucosa without the side effects of oral antihistamines such as Claratin or Allegra. They reduce symptoms of pruritis (sneezing) and rhinorrhea (runny nose) and act quite quickly (15-30 minutes). They may be used together with nasal steroids for allergy management.

Nasal decongestants: These include Afrin (oxymetazoline) and neosynphrine. These sprays act very quickly (5-10 minutes) to reduce congestion. However, they are not recommended for long term use. They are safe for short 3-5 day durations. Long term use can lead to rhinitis medicamentosa, a condition in which there is damage to the nasal lining with increasing levels of congestion.

Nasal Saline: Saline sprays are very safe and serve to cleanse the nasal airway and may help wash irritants and allergens (dust, pollen, etc) from the nasal airway, reducing inflammation. Saline sprays typically use buffered (pH adjusted to the same level as mucosa) and isotonic (tha same salinity as the body fluids) saline solution.

Anticholinergic nasal sprays: This spray is available only by prescription. Other names include Atrovent and ipratopium bromide. This solution reduces the activity of certain nerves that signal mucus production and congestion. It is often very effective for a condtion called vasomotor rhinitis.

Compound nasal sprays: For particular conditions such as nasal and sinus infections your ENT physician may prescribe special sprays containing an antibiotic or anti-inflammatory medication through a compounding pharmacy. These have limited indications but may be very effective for selct patients.

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