Effects
Nasal glucocorticoids are antiallergic, anti-inflammatory, and decongestant by locally inhibiting the synthesis of inflammatory mediators. They reduce nasal symptoms such as runny or stuffy nose, itching, sneezing, and sneezing, and may also have a beneficial effect on ocular symptoms such as itching, burning, redness, and tearing. In contrast to oral glucocorticoids, there are significantly fewer adverse effects. Glucocorticoid nasal sprays have a stronger effect against nasal congestion than antihistamine nasal sprays and are more effective against nasal symptoms. Clinical efficacy has been demonstrated in numerous studies.
Indications
Glucocorticoid nasal sprays are used to treat seasonal and year-round allergic rhinitis. Without a physician’s prescription, they are approved only for hay fever. Some glucocorticoid nasal sprays are additionally approved for the treatment of nasal polyps, acute sinusitis, for non-allergic rhinitis, and for vasomotor rhinitis. They are also used to treat rhinitis medicamentosa, which is a dependence on decongestant nasal sprays.
Dosage
According to the drug label. The sprays are administered once or twice daily, depending on the active ingredient. Beforehand, the nose should be cleansed and the spray shaken, since the poorly water-soluble active ingredients are in a suspension. It is also important to direct the spray nozzle outward away from the nasal septum, as this is likely to prevent septal perforation. Regular use is recommended to achieve a full therapeutic effect. An effect may be seen after a short time, but the maximum effect is reached only after a few days, according to some sources even after weeks. The drugs are suitable for long-term use and do not lead to atrophy of the nasal mucosa. Use of nasal sprays (see package insert):
- Clean the nose.
- Shake the nasal spray.
- Remove the protective cap.
- Tilt the head forward.
- Insert the nozzle into the nostril and direct it away from the nasal septum towards the outside of the nose.
- Exhale, inhale through the nose and release the spray.
- Exhale through the mouth.
- Clean nozzle with a dry handkerchief after each use.
- Replace the protective cap.
See also under administering nasal sprays.
Active ingredients
- Beclometasone nasal spray (Otri Hay Fever, formerly Beconase).
- Budesonide (Rhinocort, generic).
- Fluticasone (Avamys (formerly: Flutinase), generic).
- Mometasone nasal spray (Nasonex, generic, Mometasone Pollen Sandoz).
- Tixocortolpivalate (Pivalone + Neomycin)
- Triamcinolone acetonide nasal spray (Nasacort, generic, Nasacort Allergo).
- Flunisolide and other active ingredients are not on the market in many countries
Contraindications
The use of glucocorticoid nasal sprays is contraindicated in hypersensitivity and should not be used during pregnancy or lactation. Because steroids can potentially cause growth retardation in children and adolescents, they should be used with caution and, if possible, only for short periods. In the case of long-term use, growth must be carefully monitored. The active ingredients are degraded and inactivated in the liver by cytochromes (CYP). Therefore, caution is advised in the presence of liver disease. Strong inhibitors of CYP3A such as ketoconazole may increase the availability of the active ingredients. Because of immunosuppressive properties, nasal glucocorticoids should be used with caution or not used in nasal infections, herpes infection of the eye, bacterial infections, and pulmonary tuberculosis.
Interactions
Potent CYP3A4 inhibitors such as ketoconazole may increase the systemic availability of glucocorticoids by reducing their breakdown in the liver.
Adverse effects
One of the most common side effects of treatment is drying and irritation of the nasal mucosa with crusting and nosebleeds. Dose reduction and the use of moisturizing saline sprays or nasal ointments may help against this. Nasal irritation can possibly also be attributed to the preservative benzalkonium chloride.Other possible adverse effects include sneezing, sneezing irritation, nasal ulceration, perforation of the nasal septum, headache, and hypersensitivity reactions. Some sprays have an unpleasant odor or taste. The risk for for the following side effects is considered low, but cannot be completely ruled out: Endocrine disorders, growth retardation in children and adolescents, inhibition of adrenocortical function, increase in intraocular pressure, cataract. Glucocorticoid nasal sprays do not cause atrophy of the nasal mucosa.
