What to Know About Using a Nasal Spray (2024)

Nasal sprays can treat congestion and other symptoms of seasonal allergies or a cold. They work by delivering a fine mist of medication into your nostrils. And since the lining of your nose is rich with vessels and can easily absorb medications into your bloodstream, nasal sprays can also end up delivering medications to other parts of your body.

Nasal sprays are available by prescription or over-the-counter (OTC). Most products come in a hand-operated pump bottle or squeeze bottle. Knowing how to use a nasal spray is important, as doing it incorrectly could affect the dose you receive.

In this article, you will learn about the different types of nasal sprays and their possible side effects. You’ll also learn the right way to use a nasal spray so you get the best effects.

Types of Nasal Sprays

There are many OTC and prescription nasal sprays to choose from. OTC nasal sprays for congestion and allergies are popular products at pharmacies, groceries, and other retailers.

There are also other nasal sprays that deliver vaccines to prevent illness or medication to help manage it.

OTC Cold and Allergy Nasal Sprays

• Afrin (oxymetazoline): Relieves nasal congestion from colds and sinus problems
• NasalCrom (cromolyn): Relieves and prevents symptoms of allergic rhinitis such as sneezing, runny nose, or itching
• Neo-Synephrine (phenylephrine): Relieves nasal congestion from colds and sinus problems
• Flonase (fluticasone propionate): Treats sneezing and symptoms of hay fever
• Nasacort (triamcinolone): Treats an itchy or runny nose
• Rhinocort (budesonide): Steroid medication that prevents inflammation and treats a runny and itchy nose

Can I Use OTC Nasal Sprays for COVID?

If you have COVID-19 and have nasal symptoms like congestion and sneezing, you might wonder if a medicated nasal spray would be helpful. Researchers are still looking into this and whether these sprays are safe for people with COVID.

One study in 2021 found that people who were already using steroid nasal sprays before they got COVID didn’t get as sick as people who weren’t using them. However, the researchers did not think there was enough evidence to support nasal sprays as a treatment for COVID or as a way to prevent COVID.

If you have COVID and are looking for relief from nasal congestion and other symptoms, ask your provider if you can use an OTC nasal spray or if they can prescribe one for you.

Prescription Allergy Nasal Sprays

• Astelin (azelastine): A steroid-free antihistamine that reduces nasal allergy symptoms, such as a runny nose, hay fever, or other allergies (also available OTC in the U.S.under the name Astepro Allergy for adults and children ages 6 years and older)
• Nasarel (flunisolide): Relieves allergy symptoms, such as a runny or stuffy nose; sneezing, and itching (now available only as a generic)
• Nasonex (mometasone): Shrinks nasal polyps and prevents and treats stuffy nose and other allergy symptoms
• QNASL (beclomethasone): Treats allergy symptoms, such as sneezing
• Zetonna/Omnaris (ciclesonide): Treats itchy and runny nose, and sneezing
• Xhance (fluticasone): Prescribed to treat nasal polyps
• Dymista (fluticasone/azelastine combination): Treats allergy symptoms, such as a runny and itchy nose
• Patanase (olopatadine): Treats allergy symptoms, such as itchy nose and eyes

Other Types of Nasal Sprays

• Fortical (calcitonin): Treatment for osteoporosis that controls the amount of calcium in the body and helps maintain proper bone density
• Imitrex (sumatriptan): Relieves attacks of migraine with or without an aura
• Nicotine nasal sprays: Smoking-cessation device
• FluMist: Intranasal influenza vaccine that can only be given by a healthcare professional

How to Use Nasal Spray

Instructions on how to use a nasal spray differ somewhat depending on the type of spray. If you don’t understand the instructions for the product you’re using, ask your pharmacist to walk you through them.

Before using a nasal spray:

• 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 work.
• Know that some nasal sprays need to be primed before use. To prime your nasal spray, squirt it a few times into the air until a fine mist comes out. Keep it away from your eyes and others.
• Store your nasal spray as directed. Keep the bottle away from direct sunlight. Don’t share your nasal spray with other people. Keep nasal sprays where children cannot reach them.

Step-by-Step Nasal Spray Instructions

Here are the steps for using 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.
5. Close one nostril by gently pressing against the side of your nose with your finger.
6. Insert the tip of the nasal spray into the other nostril.
7. 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.
8. Squeeze the nasal spray bottle as you slowly breathe in through your nose.
9. Remove the tip of the nasal spray from your nostril and breatheout through your mouth.
10. Repeat these steps for your other nostril (if advised). Follow the directions and use only the recommended amount of medication.
11. Wipe the tip of the nasal spray with a tissue or alcohol pad and put the cap back on.
12. Try to avoid sneezing or blowing your nose immediately after using the nasal spray.

If you’re using a nasal spray the right way, the medication should not drip down your nose or the back of your throat. However, some nasal sprays may leave an unpleasant taste in your mouth. A drink of water or juice should help clear the aftertaste.

Nasal Spray Side Effects and Risks

Nasal sprays can cause side effects. Common side effects of nasal sprays include:

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

If mild side effects don’t go away or get worse, or if you have any of the following serious side effects, call your provider:

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

Nasal Spray Use During Pregnancy and Nursing

If you are pregnant or breastfeeding, ask your provider before using nasal spray—even one that’s OTC.

There have not been specific studies on using OTC nasal spray products such as Afrin in people who are pregnant or breastfeeding. However, the product labels usually include warnings for people in these groups just to be safe.

Overuse and Rebound Congestion

Do not use a decongestant nasal spray for more than three days. Overusing nasal sprays makes them less effective and may even make your symptoms worse. This is called rhinitis medicamentosa or rebound congestion.

The narrowing of blood vessels in the nasal tissues (vasoconstriction) helps decrease congestion and fluid in the nose. This is why certain nasal sprays (like Afrin and Neo-Synephrine) make these symptoms better.

However, if you use nasal sprays too often or for a long time, they will stop working and you will need to use more to get relief. If you overuse nasal sprays, you might need a metered-dose device called a Rhinostat to wean you off the medication.

Summary

Nasal sprays can relieve congestion and other symptoms of allergies and colds. You can get nasal sprays over-the-counter (OTC) or as a prescription from your provider. Some medications that come in nasal spray form, like vaccines, must be given to you by a provider.

While using a nasal spray for congestion or other symptoms can be OK in the short term, if you use nasal sprays too much or for you too long, they can stop working. Overusing nasal sprays can also lead to rebound congestion.

If you have been using a nasal spray for three days and your symptoms aren’t any better, they’re getting worse, or you have serious side effects like trouble with your vision or dizziness, stop using the nasal spray and call your provider.

By Michael Bihari, MD
Michael Bihari, MD, is a board-certified pediatrician, health educator, and medical writer, and president emeritus of the Community Health Center of Cape Cod.