Do the effects of nasal spray remain localized?

From the Guidelines

Nasal sprays primarily work locally in the nasal passages, but some can have systemic effects depending on the type. Decongestant nasal sprays containing oxymetazoline or phenylephrine generally work locally by constricting blood vessels in the nasal tissues to reduce swelling and congestion. However, with prolonged use beyond 3-5 days, they can cause rebound congestion (rhinitis medicamentosa) [ 1 ]. Steroid nasal sprays like fluticasone or mometasone primarily work locally to reduce inflammation in the nasal passages, though minimal amounts may be absorbed systemically [ 1 ].

Key Points to Consider

• The effects of nasal sprays can be localized or systemic, depending on the type of medication and individual factors.
• Decongestant nasal sprays can cause rebound congestion with prolonged use [ 1 ].
• Steroid nasal sprays have a local effect on reducing inflammation in the nasal passages [ 1 ].
• The nasal mucosa is highly vascularized, allowing some medications to enter the bloodstream, especially if used in higher than recommended doses.

Recommendations for Use

• Use decongestant nasal sprays for no more than 3-5 consecutive days to avoid rebound congestion [ 1 ].
• Steroid nasal sprays can be used for extended periods under medical supervision, as they are generally not associated with clinically significant systemic side effects [ 1 ].
• Always follow the recommended dosage and usage guidelines for any nasal spray medication to minimize the risk of systemic effects.

From the FDA Drug Label

Serious side effects are rare with Fluticasone Propionate Nasal Spray, USP because Fluticasone Propionate Nasal Spray, USP works in your nose, and barely any of it travels through your body.

The effects of the nasal spray remain largely localized to the nose, as barely any of it travels through the body 2.

From the Research

Effects of Nasal Spray

• The effects of nasal spray on nasal congestion and other symptoms of allergic rhinitis have been studied in several research papers 3, 4, 5, 6, 7.
• A study on the fixed-dose combination of fluticasone furoate and oxymetazoline hydrochloride nasal spray found that it was effective in relieving nasal congestion and reducing total nasal symptom score (TNSS), total ocular symptom score (TOSS), and total symptom score (TSS) in patients with allergic rhinitis 3.
• Another study on oxymetazoline nasal spray found that it provided relief of nasal symptoms for up to 12 hours 4.
• A study on the effect of nasal steroid sprays in perennial allergic rhinitis patients with rhinitis medicamentosa found that concomitant nasal steroid spray usage reduced rebound congestion 5.

Localization of Effects

• The studies suggest that the effects of nasal spray are primarily localized to the nasal passages and do not have significant systemic effects 3, 4, 5, 6, 7.
• However, the use of nasal sprays can lead to rebound congestion and nasal hyperreactivity, which can be reduced by concomitant use of nasal steroid sprays 5, 7.
• The localization of effects is also supported by the fact that azelastine nasal spray, which is a fast-acting H1-receptor antagonist, has a rapid onset of action and improves nasal symptoms associated with rhinitis, such as nasal congestion and post-nasal drip, without significant systemic effects 6.

Safety and Tolerability

• The studies also suggest that nasal sprays are generally safe and well-tolerated, with few adverse events reported 3, 4, 5, 6, 7.
• However, the use of nasal sprays can lead to rebound congestion and nasal hyperreactivity, which can be reduced by concomitant use of nasal steroid sprays 5, 7.
• The safety and tolerability of nasal sprays are also supported by the fact that azelastine nasal spray has a faster onset of action and a better safety profile compared to intranasal corticosteroids, and is well-tolerated in both adults and children with allergic rhinitis 6.