Nasal Spray

Introduction

Nasal sprays belong to the group of so-called aerosols, i.e. mixtures of liquid components and gas. Through the spray system, the liquid active ingredients are finely distributed in the air and can be inhaled. In principle, a distinction is made between locally acting and systemically acting nasal sprays.

However, the term ‘nasal spray’ usually refers to the first variant. Hygiene must generally be given top priority when using nasal sprays! The applicator should be cleaned after each use to prevent colonization with bacteria and germs. In addition, the nasal spray should only be used by one person at a time. In order to achieve the exact dosage per spray burst, it is recommended to fill the spray head by pumping several times the first time it is used and to activate the first spray burst outside the nose.

Locally acting nasal sprays

Sniffles, e.g. as part of a nasal mucosa inflammation (rhinitis), colds with inflammation of the paranasal sinuses (sinusitis) or infections of the ear trumpet (tube middle ear catarrh) may require treatment with a decongestant nasal spray. With the above-mentioned clinical pictures, the mucous membrane of the nose swells. As a result, the increased secretion can no longer drain off and the paranasal sinuses are no longer sufficiently ventilated.

This creates an excellent breeding ground for numerous germs. To prevent this, the decongestant nasal sprays act as so-called sympathomimetics. In simple terms, it can be imagined that the active ingredients imitate the body’s natural messenger substances (transmitters), in this case adrenaline and noradrenaline.

The nasal mucosa reacts locally by activating the sympathetic nervous system via special sensors (alpha receptors), which are sensitive to adrenaline and noradrenaline, or the active ingredients of the nasal spray. As a reaction, the blood vessels of the nasal mucosa constrict, causing it to swell. The secretion drains off and the paranasal sinuses are sufficiently ventilated again.

The active ingredients of decongestant nasal sprays include xylometazoline hydrochloride, oxymetazoline, tramazoline, naphazoline and tetryzoline. The duration of application must not exceed a period of about 5 days, otherwise a massive habituation effect begins. In the worst case even a “nasal spray addiction” develops!

If the spray is used for too long, the nasal mucous membrane reacts with increased formation of alpha-receptors. Soon the original dosage is no longer sufficient and more nasal spray must be used to achieve the same effect. Eventually, just by omitting the spray, the mucous membrane reacts with a reactive swelling, so that free breathing through the nose is no longer possible.

Although the drug is available without a prescription from a pharmacy, the following persons are generally not allowed to use decongestant nasal spray Special caution is required with: Depending on the manufacturer, the active ingredients and their additives differ. In the following some preparations are mentioned as examples:

Persons with dry inflammation of the nasal mucous membrane and barking (rhinitis sicca)
Patients who have undergone surgical removal of the pineal gland through the nose (transsphenoidal pituitaryectomy) or other operations after which the meninges are exposed
Infants and toddlers
Increased intraocular pressure (narrow angle glaucoma)
Pregnancy
Severe cardiovascular diseases and high blood pressure (hypertension)
Certain metabolic disorders (e.g. hyperthyroidism, diabetes mellitus)
Simultaneous intake of monooxidase inhibitors (MAO inhibitors) to increase blood pressure
Prostate Enlargement
Tumor of the adrenal cortex (pheochromocytoma)
Porphyria (group of metabolic diseases).
NasenSpray-ratiopharm® Adult, 0.1% xylometazoline hydrochloride
Olynth Nasal Spray®, 0.1% Xylometazoline Hydrochloride
Imidin N Nasal Spray®, 0.1% xylometazoline hydrochloride.
Nasic®
Nasic® nasal spray for children

Seawater nasal spray consists of so-called isotonic saline solution, i.e. the salt content of the spray (0.9% sodium chloride) corresponds to the salt content of human cells.

It primarily moistens the nasal mucosa and has a cleansing or rinsing effect by liquefying the nasal mucus. In dry room air, especially in the cold winter months, the spray can have a caring effect on the nasal mucosa. In addition, hard crusts, so-called bark, can be painlessly removed by the treatment.The application of seawater nasal spray does not have a decongestant effect in the true sense of the word, but in the accompanying treatment of colds it is perceived as pleasant and increases well-being.

It can be used over a longer period of time without hesitation, since no habituation or even ‘dependence effect’ is to be expected. Pregnant women and small children may also use seawater nasal spray without any danger. As it does not belong to the group of medicines, it is freely available in drugstores or supermarkets.

When buying the product, make sure that it is free of preservatives. Antihistamine nasal spray has anti-allergic properties. It is suitable for the treatment of hay fever (seasonal allergic rhinitis) and is available over the counter in pharmacies.

The most common active ingredients include levocabastine and azelastine. In the human body, the messenger substance histamine mediates allergic reactions. The nasal spray now blocks the effect of histamine so that an allergic reaction is prevented from developing.

Complaints such as itching and tingling of the nose are relieved. Since the drug is only used locally, the usual side effects of anti-allergic drugs, e.g. tiredness, are not to be expected. Instead, patients often report a bitter taste in the mouth, occasionally the nasal mucous membrane can be irritated and nosebleeds can occur due to nasal spray.

In very rare cases hypersensitivity reactions have been observed. Pregnant women should not use antihistamine nasal spray in the first three months of pregnancy, during lactation treatment should only be carried out after consulting a doctor. The following are examples of preparations:

Livocab direkt Nasal Spray® Active ingredient: Levocabastine
Vividrin akut® Active ingredient: Azelastine.

Livocab® is a nasal spray based on the active ingredient levocabastine.

The nasal spray is used to treat the symptoms of allergic rhinitis (hay fever). It has an antihistaminic, anti-allergic and anti-inflammatory effect. Levocabastine belongs to the group of H1-blockers.

It prevents the binding of the body’s own messenger substance histamine to this receptor. This leads to a reduction of the allergic symptoms. Like the active ingredient azelastine hydrochloride in Vividrin® nasal spray, levocabastine in Livocab is a second-generation H1 blocker and therefore only rarely leads to central nervous symptoms such as fatigue.

Possible side effects include local reactions and hypersensitivity reactions in and around the nose, as well as headaches. Livocab® is approved for children over one year of age. It is applied twice daily with 2 sprays per nose.

The nasal spray can be used for the entire period of the allergen (e.g. pollen). For use during pregnancy, lactation and combination with other medications, the treating physician should be consulted. Vividrin® Nasal Spray is an antiallergic or antihistamine.

It is mainly used in the area of seasonal allergic rhinitis (hay fever). The medical ingredient is azelastine hydrochloride. This substance acts as a blocker on the H1-receptor and thus prevents the binding of the body’s own messenger substance histamine.

This reduces the development of allergy symptoms. Vividrin belongs to the group of second generation H1-blcokers. This means that they are a further development of an original active ingredient.

The advantage of this second generation is that they do not cross the blood–brain barrier and cause no or less central nervous symptoms (fatigue). Vividrin is approved for children 6 years of age and older, adolescents and adults. The recommended use is one spray per nostril twice a day.

The nasal spray can be used permanently. However, this should be done in consultation with a doctor. During pregnancy and lactation Vividrin should not be used or only after consultation with a medical specialist.

Overdosage is unlikely as Vividrin only works locally in the nose. However, swallowing the contents may cause fatigue, drowsiness or agitation. In this case a doctor should be consulted urgently.

In Germany there is also a second nasal spray available which uses the active ingredient azelastine: AllergodilHind the product name Olynth® there are several products from the range of nasal drops and nasal spray. The nasal sprays with the name Olynth are based on the active ingredient xylometazoline hydrochloride. The nasal sprays are available in two concentrations.

In 0.1% solution for children and adolescents over 6 years and adults. For children between 2 and 6 years Olynth is available in the solution concentration of 0.05%.As an additional product there is Olynth Ectomed Nasal Spray on a natural basis; it is based on the active ingredient Ectoin. This binds water and creates a watery film on the nasal mucosa, which should have a protective effect.

The areas of application of Olynth Nasal Spray based on xylometazoline hydrochloride are rhinitis (to reduce swelling of the irritated nasal mucosa), allergic rhinitis (rhinitis allergica) and so-called runny nose (rhinitis vasomotorica). Olynth can also be used for sinusitis and inflammation of the middle ear. The dosage for children over 6 years of age and adults is up to 3 times daily one spray per nose.

For children between 2 and 6 years the dosage is the same, except that the solution is used with a 0.05% concentration of the active ingredient. Children under 2 years of age should not receive the nasal spray in either concentration. It should not be used for longer than one week, as long-term use may cause damage to the nasal mucous membrane.

Olynth Nasal Spray should not get into the hands of children. Overdosage may cause a variety of symptoms (e.g. change in body temperature, pupils, circulatory status, heartbeat and also psychological condition). A doctor should be consulted urgently.

Like the product Olynth® , the nasal spray is based on the active ingredient xylometazoline hydrochloride. The active ingredient is contained in a concentration of 0.1%. The effect is based on the vasoconstrictive effects that lead to a decongestant effect of the mucous membrane.

Otriven is used for swelling of the nasal mucous membranes, for colds, runny nose (rhinitis vasomotorica), allergic rhinitis (e.g. hay fever) and also for inflammation of the middle ear and paranasal sinuses. It can be used in adolescents and adults over 12 years of age. The recommended daily dosage is one spray per nostril three times a day.

A higher dosage as well as an application longer than one week of Otriven® is not recommended due to potential damage to the nasal mucosa. Use during pregnancy and lactation should be discussed with a doctor or pharmacist. The use of Otriven nasal spray in the case of a barking inflammation of the nose (rhinits sicca), after a pineal gland removal and existing glaucoma should not be used unless it has been discussed with the treating physician.

The Nasic® Nasal Spray is used to reduce swelling of the nasal mucosa in the case of a rhinitis, to support healing of minor injuries to the nasal mucosa, in the case of a runny nose (rhinits vasomotorica), and to support nasal breathing after operations in the nasopharynx. The active ingredients are dexpanthenol 5% (wound healing and mucous membrane protection) and xylometazoline hydrochloride 0.1% (decongestant due to vasoconstriction). Nasic in this concentration must not be used in children under 6 years of age, in patients with bark formation in the nose (rhinits sicca) and after pineal gland surgery.

Regular use should be limited to one week, as prolonged use can cause damage to the nasal mucosa. Patients who are pregnant, nursing or with glaucoma should discuss the use of Nasic Nasal Spray with their doctor beforehand. Nasic should not be used in this concentration in children under 6 years of age, in patients with bark formation in the nose (rhinits sicca) and after pineal gland surgery.

The dosage for children over 6 years of age and adults is one spray per nostril up to three times a day. Nasic nasal sprays with a lower concentration of active ingredient (0.05%) are available for children between 2 and 6 years of age. Higher dosages and overdoses should be avoided urgently, especially in younger children. Regular use should be limited to one week, as prolonged use can cause damage to the nasal mucosa. Patients who are pregnant, nursing or with glaucoma should discuss the use of Nasic Nasal Spray with their doctor beforehand.