What nasal decongestant steroids are available in patient hospitals in the United States of America (USA)?

From the Guidelines

Nasal decongestant steroids commonly available in U.S. hospitals include fluticasone (Flonase), mometasone (Nasonex), budesonide (Rhinocort), and triamcinolone (Nasacort). These intranasal corticosteroids work by reducing inflammation in the nasal passages, which helps decrease congestion, rhinorrhea, and other nasal symptoms 1. Unlike topical decongestants such as oxymetazoline, these medications don't cause rebound congestion with prolonged use.

The typical dosing is 1-2 sprays in each nostril once or twice daily, depending on the specific medication. Patients should be instructed to aim the spray toward the outer wall of the nostril rather than the septum to minimize side effects. These medications may take several days to reach full effectiveness, so patients should use them consistently. Common side effects include nasal irritation, mild bleeding, and headache. For optimal results, patients should clear their nasal passages before administration and avoid sniffing forcefully after spraying.

Some key points to consider when prescribing nasal decongestant steroids include:

• They are the most effective medication class for controlling sneezing, itching, rhinorrhea, and nasal congestion, the 4 major symptoms of allergic rhinitis 1
• They are particularly useful for treatment of more severe allergic rhinitis and may be useful in some forms of nonallergic rhinitis
• They have minimal systemic side effects when given in recommended doses
• Local side effects are minimal, but nasal irritation and bleeding may occur, and nasal septal perforation is rarely reported 1

It's essential to note that nasal decongestant steroids may be considered for initial treatment without a previous trial of antihistamines and/or oral decongestants, and they should always be considered before initiating treatment with systemic corticosteroids for the treatment of rhinitis 1.

From the FDA Drug Label

CLINICAL TRIALS A total of 13 randomized, double-blind, parallel-group, multicenter, vehicle placebo-controlled clinical trials were conducted in the United States in adults and pediatric patients (4 years of age and older) to investigate regular use of Fluticasone Propionate Nasal Spray, USP, in patients with seasonal or perennial allergic rhinitis The answer to whether a nasal decongestant steroid is available in an inpatient hospital in the USA is:

• Yes, Fluticasone Propionate Nasal Spray, USP is available in the USA, as evidenced by the clinical trials conducted in the United States 2.
• The drug label does not provide information on the availability of the drug in inpatient hospitals specifically, but it does indicate that the drug is available in the USA.
• Key points:
  • Fluticasone Propionate Nasal Spray, USP is used to treat seasonal or perennial allergic rhinitis.
  • The drug has been studied in clinical trials in the United States.
  • The drug is available in the USA, but the label does not provide information on its availability in inpatient hospitals.

From the Research

Nasal Decongestant Steroids Available in Patient Hospital in USA

• The following nasal decongestant steroids are available:
  • Beclomethasone dipropionate
  • Budesonide
  • Flunisolide
  • Fluticasone propionate
  • Mometasone furoate
  • Triamcinolone acetonide 3
• These intranasal corticosteroids are accepted as safe and effective first-line therapy for allergic rhinitis 3
• They relieve nasal congestion and itching, rhinorrhea, and sneezing that occur in the early and late phases of allergic response 3

Efficacy of Nasal Decongestant Steroids

• Double blind, randomized clinical trials have demonstrated greater efficacy of intranasal corticosteroids versus placebo, antihistamines, or montelukast for relief of all nasal symptoms, especially congestion 4
• Budesonide and fluticasone propionate treatments were effective and well-tolerated in the treatment of seasonal allergic rhinitis 5
• Once daily budesonide aqueous nasal spray, 256 microgram, was significantly better in controlling the symptoms of perennial allergic rhinitis than once daily fluticasone propionate, 200 microgram, especially nasal blockage 6

Usage and Recommendations

• Nasal decongestants are recommended for the management of acute rhinosinusitis to reduce the consequences of often disabling nasal congestion 7
• They are also recommended during rhinoscopic examination and for preparation of the nasal mucosa prior to endonasal surgery 7
• The task force explained the rebound congestion observed after stopping nasal decongestant treatment by return of the nasal congestion induced by rhinosinusitis and rejected the concept of rhinitis medicamentosa in the absence of scientific evidence from patients with rhinosinusitis 7