How-to guide
How to Use a Steroid Nasal Spray
Quick answer: Steroid nasal sprays such as fluticasone (Flonase), triamcinolone (Nasacort), budesonide (Rhinocort) and mometasone (Nasonex) calm the swelling inside your nose. They work best when you use them every day, and the full effect builds over about 2 weeks. Keep your head upright, hold the bottle in the opposite hand, aim toward the outer corner of your eye, away from the middle of your nose, and breathe in gently as you spray. Aiming away from the middle of the nose is the best way to avoid nosebleeds.
What do I need?
- A steroid nasal spray. Four are sold without a prescription in the allergy aisle: fluticasone (Flonase), triamcinolone (Nasacort), budesonide (Rhinocort) and mometasone (Nasonex). Store brands with the same ingredient work the same way. We may prescribe a different one.
- Tissues, to blow your nose first and wipe the tip after.
- Your saline rinse, if you use one. Rinse first, then spray. See how to do a nasal saline rinse.
This Is Not a Decongestant Spray
Decongestant sprays such as oxymetazoline (Afrin) open your nose within minutes, but using them for more than 3 days can cause rebound congestion. Steroid sprays work slowly by calming swelling, and they are meant to be used every day.
Why use it every day?
Steroid nasal sprays are the most effective daily medicine for a stuffy, runny, itchy or sneezy nose from allergies (AAO-HNS guideline, 2015; Dykewicz et al., 2020). We also use them for chronic sinusitis and nasal polyps.
- They build up over time. Some people feel better within hours to a day, but the full effect takes about 2 weeks of daily use.
- Every day works better than now and then. In a review of the research, people who used their spray every day did better than people who used it only when they had symptoms (Hoang et al., 2022). Keep using it on good days too.
- Seasonal allergies? Start a week or two before your season usually begins.
How do I use it?
Opposite hand, aim outward. Left hand for the right nostril. Point the tip toward the outer corner of your eye.
Head upright. Look straight ahead. Tilting your head back sends the medicine down your throat.
New bottle? Prime it first: shake it, point it away from your face, and pump it into the air until a fine mist comes out. Prime it again if you have not used it for a while; the label says how many pumps.
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Blow your nose gently
Clear out mucus so the medicine reaches the lining. If you rinse with saline, rinse now instead. If you have had nasal or sinus surgery in the past week, do not blow your nose.
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Shake the bottle
Take off the cap and shake it gently.
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Keep your head upright
Look straight ahead or slightly down. Do not tilt your head back.
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Switch hands
Hold the bottle in your left hand to spray your right nostril, and in your right hand to spray your left nostril. You can press the other nostril closed with your free hand.
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Aim toward the outer corner of your eye
Place the tip just inside your nostril and point it toward the outer corner of the eye on the same side, away from the middle wall of your nose (the septum).
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Spray while breathing in gently
Press the pump once as you breathe in slowly through your nose. Do not sniff hard: that pulls the medicine down your throat instead of keeping it in your nose. Breathe out through your mouth.
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Repeat on the other side
Switch hands and do the other nostril. Use the number of sprays on the label, or the number we prescribed.
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Wipe the tip and replace the cap
Wipe the tip with a clean tissue. Follow the label for cleaning the tip, and do not share your spray.
A little medicine running down the back of your throat, or a slight taste, is normal. Keeping your head upright and breathing in gently helps.
Do and don’t
Do
- Use it every day, even on days you feel fine
- Give it about 2 weeks to work fully
- Rinse first, then spray
- Use the opposite hand and aim toward the outer corner of your eye
- Breathe in gently as you spray
Don’t
The most common mistakes:
- Stopping after a few days because it is not working yet
- Using it only on bad days
- Tilting your head back
- Sniffing hard after you spray
- Aiming at the middle of your nose
- Forgetting to prime a new bottle
What side effects should I watch for?
Most side effects are mild: dryness, stinging, crusting, a bad taste, or a little blood in your mucus. Nosebleeds are the most common one, and spraying toward the middle of the nose makes them more likely (Rollema et al., 2022).
- Nosebleeds, dryness or crusting: stop the spray for a few days to let your nose heal, then start again, aiming toward the outer corner of your eye. A saline spray or gel can help with dryness.
- If your nose bleeds: sit up, lean slightly forward, and pinch the soft part of your nose for 10 to 15 minutes. A spray or two of oxymetazoline (Afrin), if you have it, can help. See how to stop a nosebleed.
- A hole in the septum is an extremely rare side effect. Aiming away from the middle of your nose helps prevent it. Tell us if you notice a whistling sound when you breathe, or crusting or sores that do not heal.
Is it safe to use for months or years?
Yes, for most people, when used as directed. Very little of the medicine reaches the rest of your body, so these sprays are very different from steroid pills. Long-term use has not been shown to thin the lining of the nose (Dykewicz et al., 2020).
Studies have not found that these sprays raise eye pressure or cause cataracts in most people. If you have glaucoma or cataracts, let your eye doctor know you use one.
Can children use a steroid nasal spray?
Yes, and they are often the best treatment for a child’s nasal allergies. Some studies have found a small, temporary slowing of growth in children, but a review of the research found no lasting effects on growth hormones or eye pressure (Donaldson et al., 2020). To be safe, children should use the lowest dose that works, with their height checked at regular visits.
- Age limits on over-the-counter sprays differ by product. Check the box, and ask us or your pharmacist before giving one to a child.
- An adult should help with each dose.
- If your child needs a spray for more than 2 months a year, talk with us or your child’s doctor.
What about after nasal or sinus surgery?
Your surgeon will tell you whether and when to use a steroid spray or steroid rinse after surgery. Follow your own post-op instructions; they take priority over this page. Our recovery guides cover sinus surgery, balloon sinuplasty and septoplasty.
When should I call?
Call our office if
- Your symptoms are not better after a few weeks of daily use
- You keep getting nosebleeds, even after a break and better aim
- You notice a whistling sound when you breathe, or crusting or sores in your nose that do not heal
- Your child needs a spray for more than 2 months a year
Get care right away
Go to the ER or call 911 for a nosebleed that does not stop after 20 minutes of steady pressure, heavy bleeding, or bleeding with dizziness, lightheadedness or fainting.
Austin 512-339-4040 · Lakeway 512-682-4798 · Marble Falls 830-992-2830
Questions patients ask
Some people feel better within hours to a day, but the full effect builds over about 2 weeks of daily use. Keep using it every day, even on days you feel fine, and give it at least 2 weeks before deciding whether it helps.
Yes, for most people, when used as directed. Very little of the medicine reaches the rest of the body, and long-term use has not been shown to thin the lining of the nose. If you get nosebleeds, dryness or crusting, take a few days off and restart with better aim.
No. Decongestant sprays such as oxymetazoline (Afrin) work within minutes, but using them for more than 3 days can cause rebound congestion. Steroid sprays work slowly by calming swelling and are meant to be used every day.
Rinse first, then use your steroid spray. The rinse clears out mucus so the medicine reaches a clean lining instead of being washed away.
Hold the bottle in the opposite hand, keep your head upright, and point the tip toward the outer corner of the eye on the same side, away from the middle of your nose. If nosebleeds start, stop the spray for a few days to let your nose heal, then start again.
For most people they work about equally well, and store brands with the same ingredient work the same way. If one bothers you because of its smell, taste or drip, another may suit you better. Ask us if you are not sure which to choose.
This guide is for educational purposes only and does not replace an in-person evaluation. If your provider gave you different instructions, follow theirs.
Full guide and sources: capitalent.com/nasal-steroid-spray.html
Sources
- Seidman MD, Gurgel RK, Lin SY, et al. Clinical practice guideline: allergic rhinitis. Otolaryngology–Head and Neck Surgery. 2015;152(1 Suppl):S1-S43. doi:10.1177/0194599814561600. PMID: 25644617
- Dykewicz MS, Wallace DV, Amrol DJ, et al. Rhinitis 2020: a practice parameter update. Journal of Allergy and Clinical Immunology. 2020;146(4):721-767. doi:10.1016/j.jaci.2020.07.007. PMID: 32707227
- Hoang MP, Chitsuthipakorn W, Seresirikachorn K, Snidvongs K. As-needed intranasal corticosteroid spray for allergic rhinitis: a systematic review and meta-analysis. Rhinology. 2022;60(4):242-251. doi:10.4193/Rhin21.355. PMID: 35379997
- Rollema C, van Roon EN, van Boven JFM, et al. Pharmacology, particle deposition and drug administration techniques of intranasal corticosteroids for treating allergic rhinitis. Clinical and Experimental Allergy. 2022;52(11):1247-1263. doi:10.1111/cea.14212. PMID: 35947495
- Donaldson AM, Choby G, Kim DH, Marks LA, Lal D. Intranasal corticosteroid therapy: systematic review and meta-analysis of reported safety and adverse effects in children. Otolaryngology–Head and Neck Surgery. 2020;163(6):1087-1096. doi:10.1177/0194599820931454. PMID: 32660332