Corticosteroid (Nasal Route)

Corticosteroid nasal sprays are used to relieve the discomfort of nasal irritation that is caused by hayfever or other problems of the nasal passage.

Overview

Corticosteroid sprays are prescribed treatments for hayfever, allergies and other nasal problems. They are either sprayed or inhaled into the nasal passage in order to relieve a blocked nose, nasal irritation or nasal discomfort.

Corticosteroid sprays can also be used to prevent the return of nasal polyps following their removal by surgery.

There is a wide range of brands that supply these treatments including:

• Zetonna
• Veramyst
• Vancenase AQ Double Strength
• Vancenase AQ
• Vancenase
• Tri-Nasal
• Rhinocort
• Omnaris
• Nasonex
• Nasarel
• Nasalide
• Nasacort
• Flonase
• Beconase

These products are available with a prescription in the form of sprays, aerosol liquids and aerosol powders.

It is possible to overdose on this medication and you should exercise extreme caution during use. Use only as directed to by your doctor. Effects may take up to 3 weeks to be realized from use.

Condition treated

  • Nasal irritation

Type of medicine

  • Steroid

Side Effects

In addition to the desired side effects from the use of this treatment, the use of Corticosteroid nasally can also have unwanted side effects. These side effects may not all occur, but in some cases the occurrence of side effects may require the patient to seek medical attention for further treatment.

You should check with your doctor immediately if you experience any of the following side effects:

Occurring only uncommonly:

• Bad smell after use
• Blindness
• Bloody mucus
• Blurring of vision
• Burning and/or stinging immediately following use of spray
• Coughing
• Decreased sense of taste or smell
• Development of sores inside the nose
• Discharge produced from the eye
• Eye pains
• Gradual loss of vision
• Headaches
• Hives
• Hoarseness
• Lightheadedness or feeling of dizziness
• Muscle pains
• Nausea
• Ringing heard in the ears
• Shortness of breath without exertion
• Skin rash
• Soreness of the throat
• Stomach pain
• Swollen eyelids, face or lips
• Tightness across the chest
• Troubled breathing
• Unexplained nosebleeds
• Unusual tiredness
• Unusual weakness
• Vomiting
• Watering of the eyes
• Wheezing
• White patches on the throat
• White spots appearing inside the nose

Other side effects can occur that would not normally require you to seek the assistance of a medical professional. If, however, these side effects develop, become bothersome or are ongoing, then you can contact your doctor for advice on how to alleviate these side effects. These side effects that would not normally require medical attention include:

• Dryness of the nose
• Irritation inside the nose
• Irritation of the throat
• Itchiness of the throat
• Short-term burning feeling inside the nose
• Sneezing

It is possible to overdose on this medication. You should seek emergency medical attention if you believe that you or someone else has overdosed on this treatment. The symptoms of an overdose include the following:

• Acne
• Blurring of vision
• Bone fracturing
• Excess hair growth (in females only)
• Impotence (in males only)
• Increased blood pressure
• Increased thirstiness
• Increased volume of urine
• Menstrual changes (in females only)
• Muscle weakness
• Wasting of muscles
• Weight gain around face, neck and trunk

This medication comes in a wide range of forms. Not all side effects have been reported from all medication brands, but all side effects listed herein have been reported for at least one of them. All nasal corticosteroids are very similar and as such you should be prepared for the occurrence of all of the listed side effects from the use of any of the listed brands of medication.

Other side effects that have not been listed herein may also occur. If you experience other side effects then you should contact your doctor for advice. If, however, you believe your health to be at immediate risk then you should always contact the emergency services.

Dosage

These medications will all come with a patient direction booklet. You should ensure that you have read these instructions carefully before use and you should contact your doctor if you have any questions about the treatment.

Some of these treatments will also come with special equipment for application of the treatment. Ensure you understand how to operate this before use.

Before use of this medication you should clear the nasal passage as much as possible by blowing.

Insert the nosepiece into the nostril and spray in the direction of your inner eye on the same side of the face.

This medication will be required to be used regularly as directed by your doctor in order for it to have an effect. It will usually take a week or more for it to take effect and it can take up to 3 weeks to have full effect in some cases.

This medication should only be used as you have been directed by your doctor. Overuse can increase the chance of too much of the treatment being absorbed into the body, which can lead to serious side effects occurring.

Do not use this medication for the treatment of conditions for which it was not directly prescribed. This treatment will not have the desired effect on bacterial, viral or fungal infections and can actually make them worse.

Keep the inhalers that are provided as refills can be purchased at a lower cost. Ensure they are cleaned as directed between uses.

The dose of this medication will vary dramatically depending on a range of factors. You should follow the dosing instructions given to you by your doctor. The following information is a guideline for expected use only:

For treatment with beclomethasone:

For the treatment of allergies or other nasal conditions:

When using nasal aerosol:

• Adults and children aged 6+ — 1 spray per nostril 2-4 times daily.
• Children younger than 6 — Use must be determined by the doctor.

When using nasal suspension:

• Adults and children aged 6+ — 1-2 doses per nostril twice daily.
• Children younger than 6 — Use must be determined by the doctor.

For treatment with budesonide:

For the treatment of allergies or other nasal conditions:

When using nasal powder:

• Adults and children aged 6+ —2 doses in each nostril twice daily
• Children younger than 6 — Use must be determined by the doctor.

For nasal suspension dosage form:

• Adults and children aged 6+ —1-2 doses per nostril once or twice daily.
• Children younger than 6 — Use must be determined by the doctor.

For treatment with dexamethasone:

For the treatment of allergies or other nasal conditions:

When using nasal aerosol:

• Adults and children aged 12+ — 2 doses per nostril twice or thrice daily. Use for a maximum of 2 weeks.
• Children aged 6 to 12 —1-2 doses per nostril once or twice daily. Use for a maximum of 2 weeks.
• Children younger than 6 — Use must be determined by the doctor.

For treatment with flunisolide:

For the treatment of allergies or other nasal conditions:

When using nasal solution:

• Adults and children aged 6+ —1-2 doses per nostril used 1-3 times daily.
• Children younger than 6 — Use must be determined by the doctor.

For treatment with fluticasone:

For the treatment of allergies or other nasal conditions:

When using nasal suspension:

• Adults and children aged 4+ —1-2 doses per nostril used once or twice daily.
• Children younger than 4 — Use must be determined by the doctor.

For treatment with mometasone:

For allergies or other nasal conditions:

When using nasal suspension:

• Adults and children aged 12+ —1-2 doses per nostril once daily.
• Children younger than 12 — Use must be determined by the doctor.

For treatment with triamcinolone:

For the treatment of allergies or other nasal conditions:

When using nasal aerosol:

• Adults and children aged 12+ —1-2 doses per nostril once daily.
• Children aged 6 to 12 —1 spray per nostril once daily. Can be increased to 2 doses on doctor’s order.
• Children aged 2 to 5 —1 spray per nostril once daily. Do not exceed.
• Children younger than 2 —Use would not be recommended.

When using nasal suspension:

• Adults and children aged 6+ — 1-2 doses per nostril once daily.
• Children younger than 6 — Use must be determined by the doctor.

If a dose of this treatment is missed then you should take it as soon as possible. If, however, it is then close to your next dose being due then you should skip the dose and return to the usual dosing schedule. Do not take double doses of this treatment under any circumstances.

Interactions

Medications can interact with one another and you should take care to avoid using other medications with this treatment unless you have discussed the use with your doctor. In particular, you should not use other nasal treatments in addition to this spray and nor should you use any other steroid medications as this will increase the risk of overdose. Before beginning treatment with this medication, you should inform your doctor of all medications which you are taking including all prescription treatments, over the counter treatment, vitamin supplements and herbal remedies.

Medications can also impact or be impacted by other medical conditions from which you suffer. You should ensure that you inform your doctor of any and all medical conditions from which you suffer or from which you have suffered in the past. This is especially important with the following conditions, which are known to affect the use of Corticosteroid:

• Amebiasis – Condition may be worsened.
• Asthma – Condition may be worsened.
• Type II diabetes – Can cause a worsening of control of glucose. May require an increase in insulin dosage.
• Glaucoma – Use can increase the pressure in the eye.
• Herpes simplex – Can cover up symptoms of condition.
• Infections - Can cover up symptoms of condition.
• Injury to nose – Can prevent proper healing.
• Recent nose surgery - Can prevent proper healing.
• Nasal sores - Can prevent proper healing.
• Liver disease – May worsen medical condition.
• Tuberculosis - May worsen medical condition.
• Underactive thyroid - May worsen medical condition.
• Weakness of the heart - May worsen medical condition.
• Recent heart attack - May worsen medical condition.

Other medical conditions that have not been listed herein may also affect this use of nasal Corticosteroid. You should ensure that you inform your doctor of all conditions from which you suffer before using this treatment.

Warnings

Before using any medication you should consider the risks of doing so in relation to the benefits. You and your doctor should consider the side effects, interactions and also all of the following to make this decision:

Allergies – Inform your doctor of any allergies that you have. This includes allergies to dyes, preservatives, foods, animals and other substances. You should be especially sure to inform your doctor if you have ever had an allergic reaction to any other medications containing steroids.

Pediatric – Corticosteroids are known to affect growth in young children. However, this has been demonstrated for treatments taken by mouth or by injection. Corticosteroid taken nasally are generally considered to be safer than when taken in other forms. Before your child is administered with nasal Corticosteroid you should ensure that it is absolutely medically necessary to do so and you should discuss all of the risks with your doctor.

Geriatric – There are no known age-related limitations to the use of these treatments on the elderly. However, it is known that the elderly are more likely to suffer from other conditions that may limit the use of this treatment. Be cautious of other medical conditions that can impact use.

Pregnancy – There is a risk to the use of nasal Corticosteroid treatments in patients who are pregnant. If Corticosteroids are required medically during pregnancy then nasal Corticosteroids are generally considered to be safer than use by oral or injected routes, but there are still risks. If you are pregnant at the time of prescription then you should discuss these risks with your doctor before you proceed with use. Different nasal Corticosteroid brands also carry different risks that should be considered.

Breastfeeding – There is a risk to the use of nasal Corticosteroids when you are breastfeeding. For some brands it is unknown whether there may be an effect on the infant, but use of dexamethasone would not be recommended when nursing. If you are breastfeeding at the time of prescription then you should discuss this with your doctor before you begin use of the treatment.

If you are using this treatment for longer than 2 weeks then your doctor should check on your progress with the treatment regularly.

You should contact your doctor to check your condition if you develop the following:

• Signs of a nasal infection
• Signs of a sinus infection
• Signs of a throat infection
• If symptoms do not begin to improve after 7 days
• If symptoms do not begin to improve after 21 days (when using flunisolide, fluticasone, beclomethasone, mometasone, budesonide or triamcinolone)
• If your condition worsens after you start using the treatment.

Dexamethasone can have the effect of lowering the body’s ability to fight infections. This prohibits the use of immunizations or vaccines when you are using this treatment. There is a chance that this lowered ability to fight infection could actually lead to you catching the infection that you are trying to protect yourself against. You should also ensure that those you share a household with avoid these treatments too as they can expose you to risk. This is particularly important in the case of the oral polio vaccine. You should not get close to someone who has recently received this and should consider wearing face protection when in their proximity to protect yourself from the contraction of polio.

Storage

Always store this treatment out of the reach of children, even when it is prescribed for the child in question.

Keep this medication in a sealed container at room temperature. Keep away from moisture, direct light and heat.

Do not keep outdated medication. Dispose of this properly and appropriately as directed by your doctor.

Do not crush, pierce or in any way damage any aerosol cans after they have been emptied.

Summary

Corticosteroid is a type of steroid that can be administered in a range of different manner. Nasal corticosteroids are considered to be one of the safer and lower risk forms of treatment for conditions requiring their use.

Nasal corticosteroids are available with a prescription only and are administered as a spray, liquid aerosol or powder aerosol. They are available in a wide range of different brands and use a wide range of delivery methods.

Nasal corticosteroids are used to treat conditions of the nasal passage including hayfever and allergies. They work to alleviate the irritation of the nasal passage.

Corticosteroid sprays can also be used to prevent the return of nasal polyps following their removal by surgery.

Nasal corticosteroids can be used in both adults and children, although dosing will be different and caution should be used. Corticosteroids taken orally or by injection are known to pose a risk of stunting growth in children, but nasal Corticosteroids are generally considered to be safer for use in children. They should, however, only be used where clearly medically necessary.

Corticosteroids can also pose a risk to developing fetus and to nursing infants. If you are pregnant or breastfeeding at the time of prescription then you should ensure that your doctor is aware of this and discuss the risks and benefits of use. When pregnant this treatment should only be used when it is clearly medically necessary to use it.

It is possible to overdose on this treatment and you should exercise extreme caution during application. You should familiarize yourself with the symptoms of overdose before you begin treatment with this medication.

To administer this treatment the patient must spray the does directly into the nostril. The nosepiece should be inserted and the dose should be sprayed towards the inner corner of the eye on the same side.

Side effects may occur from the use of this treatment and some of these side effects may require you to seek medical attention. Familiarize yourself with these potential side effects before use and ensure that you have read the patient information booklet issued with each type of nasal corticosteroid medication for full details. If you have any questions about this then you should consult your healthcare professional.

Prolonged use of this treatment can increase the risk of and severity of unwanted side effects. Do not use this treatment contrary to directions given by your doctor.

It may take up to 3 weeks for this medication to have its full effect. Ensure that you use it properly and as directed to ensure it can be effective as a treatment.