Pros and Cons of Over-the-Counter Nasal Steroids


Nasacort Allergy 24 Hour (triamcinolone) was the first nasal spray with intranasal corticosteroids available without a prescription. Shortly thereafter, flonase (fluticasone) and rinocort (budesonide) also became available over the counter as effective corticosteroid sprays.

Deciding whether to use an over-the-counter oral corticosteroid or antihistamine nasal spray like Zyrtec or Allegra can be confusing. Which is more efficient? What lasts longer? What causes the least amount of symptoms? The choice depends a lot on the type and severity of your symptoms.

Antihistamine nasal sprays

The intranasal corticosteroids, Nazacort, Flonase, and Rinocort are probably the most effective over-the-counter medications for treating nasal allergy symptoms. The downside is that they won't work as needed.

Intranasal corticosteroids take time to work. They can begin to relieve allergy symptoms in about six to ten hours, but complete relief may not be achieved for three to six weeks with daily use.

On the other hand, antihistamines like Zyrtec (cetirizine) , Allegra (fexofenadine) , and Claritin (loratadine) tend to work fairly quickly, usually within a few hours (or less) after taking the drug. Therefore, these medications work well when taken as needed.

Antihistamines are better for itchy nose, itchy eyes, and sneezing, but are less effective for symptoms of a stuffy or runny nose. Of the three newer (and less sedating) oral antihistamines, Zyrtec and Allegra are particularly good at relieving nasal allergy symptoms, usually within an hour.

Claritin, on the other hand, does not work and its effect begins to take effect after about three hours. All three antihistamines are good options for spring allergy relief and are generally preferred over sedating antihistamines like Benadryl.

Another antihistamine option may include Astepro (azelastine hydrochloride), a nasal spray that has been approved for over-the-counter use in adults and children over the age of six.

The only medicated nasal sprays available without a prescription are non-steroidal decongestants such as Afrin (oxymetazoline) and NasalCrom (cromolyn) .

Controversies and considerations

Another aspect to consider is that many professional organizations of allergists, pediatricians and otolaryngologists opposed intranasal corticosteroids being available without a prescription. They previously opposed the antihistamine clarithin being available without a prescription.

However, during the 1990s, the FDA designated allergic rhinitis as a disease that can be recognized and treated without the involvement of a healthcare professional. This means that the FDA considers it safe for the general public to self-diagnose and treat allergic rhinitis with over-the-counter medications.

However, intranasal corticosteroids may not be as safe as antihistamines, so the risks and benefits must be considered. Over-the-counter nasal decongestants should not be used for more than two days at a time to avoid recurring nasal congestion and worsening nasal congestion.


Corticosteroid nasal sprays have been available on the prescription market for over 30 years, and a great deal of safety data has been collected during that time. The most common side effects include nasal irritation, sneezing, throat irritation, headaches, and nosebleeds, which are generally mild.

The most disturbing side effect of using nasal corticosteroids is septum perforation, although this is extremely rare given that most people stop using the spray after experiencing pain and nosebleeds.

The risk of septum perforation increases if you spray in the middle of the nose rather than on the outer wall of the nasal passage. Instead, spray one spray directly behind and parallel to the hard palate and the other spray upward and outward toward the ipsilateral eye / ear.

Aside from local symptoms, intranasal corticosteroids rarely cause whole-body side effects. Studies investigating the use of intranasal corticosteroids have yet to show any evidence for suppression of the hypothalamic-pituitary-adrenal (HPA) axis, in which overuse of corticosteroids affects the body's own cortisol production.

There are some concerns about the cost of intranasal corticosteroids since over-the-counter medications are not covered by health insurance. Generally speaking, the cost of visiting a healthcare provider almost alleviates this problem. After all, people are more likely to try an over-the-counter spray than to get a prescription with the same results.


Some health care organizations believe that over-the-counter intranasal corticosteroids are a bad idea. The reasons are mainly related to the safety of the product, especially in young children and the elderly.

Concerns about growth suppression have been raised in children using intranasal corticosteroids, although these effects are considered minor and inconsistent. Despite this, children using inhaled or intranasal corticosteroids should be monitored by a healthcare professional.

The use of intranasal corticosteroids in older adults who are already at risk for glaucoma is of great concern. The use of nasal and oral steroids is known to increase eye pressure, which contributes to the development of the disease.

There is currently no clinical evidence of an increased risk of cataracts in older adults taking corticosteroids. Although medications can increase the risk of osteoporosis when used excessively, there is no evidence that they increase the risk of fractures .

Opponents of over-the-counter intranasal corticosteroids also believe that consumers will not understand that this drug must be used regularly for it to work.

Unlike topical nasal decongestants, which provide relief in minutes, intranasal corticosteroids work for hours to days. Therefore, people can use higher doses than recommended, which can lead to more side effects.

Many of the side effects and misunderstandings about how intranasal corticosteroids work can be avoided by keeping these medications on prescription only, allowing them to be monitored frequently by a healthcare professional.

Get the word of drug information

Understanding the correct use of over-the-counter allergic rhinitis medications can help you avoid potential side effects. You can discuss your options with your doctor, especially if you plan to use them for children or the elderly.

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