Health & Wellness

5 Myths About Nasal Sprays

An allergist shares why not all nasal sprays are the same.
Nasal Spray

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Amy Schlinger

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Amy Schlinger,   

Aug 6, 2020 • 4 min read

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If you’re an allergy sufferer, there’s nothing you want more than relief. Generally, you’ll take that relief in any form, but chances are that you’ve tried some pills or natural remedies that just haven’t worked for you. So what about nasal sprays? You’ve seen some at your local pharmacy that are available over the counter (OTC), and advertisements on television for prescription sprays. Is one option better than the other? And aren’t all nasal sprays addictive? 

There are a lot of misconceptions when it comes to nasal sprays, so we spoke with an allergist to learn what is and isn’t true about both OTC and prescription options. Read on to learn more.

Myth #1: All nasal sprays are the same

While they all may be called “nasal spray,” that doesn’t necessarily mean that all the options are equal. There are two categories of sprays available: over-the-counter (OTC) and prescription nasal sprays. But the real difference lies in the types of ingredients in the medication, explains Sara Axelrod, MD, MPH, board-certified allergist at ENT and Allergy Associates in East Brunswick, NJ.

“There are various classes of nasal sprays on the market,” she says. “Prescription nasal sprays like beclomethasone (Beconase, Qnasl), mometasone (Nasonex), ciclesonide (Omnaris), fluticasone furoate (Veramyst), and similar prescription medicines contain corticosteroids as their active ingredient.” These nasal sprays help prevent and relieve sneezing and a runny, stuffy, or itchy nose, and post-nasal drip caused by allergies, she goes on to explain. 

“Then there are nasal antihistamines or anticholinergics, which are terrific at drying up mucus,” says Dr. Axelrod. An example of these would be olopatadine (Patanase) or ipratropium bromide (Atrovent), and they are only available with a prescription. 

“Next, you have nasal decongestants, which are largely available over the counter but should not be used without consulting your physician first,” says Dr. Axelrod. “Using them for longer than three to five days can cause rebound nasal congestion as well as dependence on this medication, which leaves room for misuse.”

Here’s a quick breakdown of the various types and whether or not you need a prescription for them:

Nasal corticosteroids (OTC and prescription). Reduce inflammation caused by allergies; found in beclomethasone (Beconase, Qnasl), ciclesonide (Zetonna, Omnaris), fluticasone furoate (Veramyst), mometasone (Nasonex), and fluticasone propionate (Xhance). Three medications can be purchased over the counter: budesonide (Rhinocort Allergy), fluticasone (Flonase Allergy Relief), and triamcinolone (Nasacort Allergy 24HR).

Nasal antihistamines (Prescription only). Help to reduce mucus production and prevent allergic symptoms; azelastine (Astelin, Astepro), olopatadine (Patanase).

Nasal decongestants (OTC). Main purpose is to decrease congestion; oxymetazoline hydrochloride (Afrin, Dristan, Sinex) and phenylephrine hydrochloride (Neo-Synephrine).

Nasal anticholinergics (Prescription only). Help to dry up mucus; ipratropium bromide (Atrovent).

Nasal mast cell stabilizer (OTC). Inhibit mast cell degranulation to prevent allergic symptoms from flaring; cromolyn sodium (Nasalcrom).

Myth #2: Nasal sprays and pills treat symptoms the same way.

It’s not about one form being better than the other, but more about the mode in which they’re administered that can help determine why you might want to use one medication versus the other. “Nasal sprays are beneficial because they directly target the area where most symptoms of allergies originate,” says Axelrod. “Our treatment algorithm for seasonal allergies lists nasal sprays as first-line therapy. This is not only because they work well, but because you get less systemic absorption than you would see with a pill.”

Myth #3: OTC nasal sprays don’t work as well as prescription nasal sprays.

A prescription nasal spray won’t necessarily work better than an OTC option. “OTC allergy nasal sprays do work and have the same efficacy as their prescription counterparts,” says Dr. Axelrod. What will work best for a patient is a medication that targets the symptoms the patient is experiencing, not necessarily prescription versus non-prescription. 

Myth #4: All nasal sprays are addictive.

It’s not true to say that all nasal sprays are addictive. However, nasal decongestants can cause rebound congestion when they are stopped. “While they can relieve nasal congestion, if used longer than three to five days, the patient may then feel like they need to use it all the time to breath through their nose,” says Dr. Axelrod. “This is where the danger lies.” The rebound congestion can cause individuals to use a nasal decongestant multiple times throughout the day or more. “It’s called rhinitis medicamentosa, and once recognized it is a challenge to treat,” says Dr. Axelrod.

Sprays that are nasal corticosteroids are meant to be taken more long term and have a relatively good safety profile. “While it may not be desirable to be on these medications every day year after year, the side effects are mild,” says Dr. Axelrod.

In order to be safe on whatever medication you’re taking, always stick to the directions, and don’t use any medication longer than or in excess of the recommendations. If you have any questions or concerns, speak with your doctor or a medical professional.

Myth #5: Because a nasal spray is OTC, it’s completely safe.

Yes, over the counter medications can be bought by anyone without a prescription. But if you end up using a medicine that isn’t made to treat your symptoms, it’s not going to help you feel better and it’s not necessarily a good thing. And if you don’t follow the dosage directions, you could end up doing more harm than good. “I think the most important thing to note is that even though many medications are over the counter, patients still should consult with their allergist or physician to discuss which nasal spray might be appropriate for them, as well as discussing duration and direction of therapy,” says Dr. Axelrod. “And, stay away from long-term Afrin therapy!”

If you’ve recently been prescribed a nasal spray, check to see if you can get medication for less with Blink Health.

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This article is not medical advice. It is intended for general informational purposes and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, immediately call your physician or dial 911.

Blink Health is not insurance. The discount prescription drug provider is Blink Health Administration, LLC, 1407 Broadway, Suite 2100, New York, NY 10018, 1 (844) 265-6444, www.blinkhealth.com.

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