In August of 2013, the FDA gave the okay for Nasacort AQ to be marketed as an over the counter medication. This nasal spray is used mostly for the treatment of nasal allergies and is effective for symptoms of nasal congestion, itching, drainage, and sneezing. It is significantly more effective than any other over the counter medication on the market. However, if not used properly, it can have serious side effects. Concern over misuse and serious side effects led 6 out of the 18 member FDA panel to vote not to allow over the counter marketing of the drug.
What are some key ways that this medication can be accidentally misused?
Patients who should avoid using a nasal steroid at all include those with
- nose ulcers, recent unhealed nose injury, nose surgery, or severe or frequent nosebleeds (especially those on blood thinners) because the medication interferes with nasal healing.
- history of or current glaucoma or cataracts because the medication can worsen these conditions.
- an active infection or recent exposure to tuberculosis, chickenpox, or measles, because the medication can cause these infections to be more severe.
Patients who should only use a nasal steroid under a doctor’s supervision include:
- children under the age of 2.
- an active infection in the head or neck area, especially if you have a fever.
- pregnant and nursing women. There are nasal steroids which are safer to use in pregnant women, so ask your doctor for a prescription.
- those currently using prescription nasal sprays. Nasacort OTC is the same as Nasacort AQ. However, it is a less potent spray than most other prescription nasal sprays on the market.
You should not use this for a cold or a bacterial sinus infection. It will not help and it may make things a lot worse.
Nasacort is a steroid and it can be absorbed into the bloodstream. Too much medication can lead to major problems in every system of the body, such as high blood sugars, cataracts/glaucoma, low blood sodium (and sometimes seizures), osteoporosis, suppressed immune system, and more. If the steroids are at a high enough dose and then suddenly stopped, the person could go into shock and die. One accidental overspray is not going to be a problem, but persistent overuse may lead to unintended health consequences. There are a few ways to get the wrong dose.
- Some people think that if a medication works well, then more medication should work even better. A better answer is to see your doctor for either a stronger steroid, adjunctive medication, other maybe even surgery (not fun, but usually not life threatening either).
- Some people don’t check the dosing carefully enough to realize that the dosing is different for children.
- Some people take other steroid medications by different routes, either by mouth (pills), inhaled (for asthma or COPD), as creams/lotions/ointments (for eczema, psoriasis, and other skin problems), and as drops (for ears or eyes). These people can still take Nasacort, but they should let their doctor(s) know and never stop their medication suddenly without the guidance of a physician.
Wrong technique can lead to a few problems, but the most serious are severe nosebleeds and putting a hole in the inside of your nose. Proper technique is easy to learn and the Nasacort website has good resources. The main thing to remember is to aim the nozzle straight up and down or slightly toward the ear on the same side as the nostril, not toward the center of the nose.
Unlike antihistamines and prescription nose sprays, Nasacort 24HR has a time limit on its use without the supervision of a doctor. The time limits (after which a doctor should be consulted) are:
- one week in all users if there is no relief of symptoms.
- two weeks in children under the age of 12, because the medicine may start to affect growth.
If it is respected, Nasacort 24H can be a boon to an allergy sufferer. Use the guidelines above, and happy nose breathing!
Chattem, Inc. (2014). Nasacort 24H [Product Label]. Chattanooga, Tennessee.