Are nasal steroids safe?
“Steroids.” For many people, even the word is enough to make them recoil. They’ve heard stories from friends and family members about the side effects and want to avoid them if possible.
This is something I hear every day from my patients. But there’s no need to be afraid of nasal steroids. When used properly, nasal steroids are extremely safe and don’t have the same side effects as oral steroids. In fact, they’re one of the safest medications available for patients.
How do nasal steroids work?
Nasal steroids relieve inflammation in the nasal airway caused by allergies and other irritants. Inflammation can cause the nasal passages to swell. Nasal steroids, like other forms of steroids, have the following benefits:
- Decrease inflammation
- Reduce swelling
- Reduce the upper respiratory system’s production of inflammation-causing chemicals
Doctors prescribe nasal steroid sprays to help patients breathe through the nose. These nasal steroid sprays are different than saline or other nasal sprays available at the drugstore. Saline sprays rinse and moisturize the interior of the nose, but they don’t treat swelling or inflammation like nasal steroids do.
We also use nasal steroid sprays to reduce swelling caused by benign, or noncancerous, polyps inside the nose or sinuses. Though we don’t know the exact cause of nasal polyps, they appear to be more likely to develop in people who have long-term swelling from allergies, asthma or infections.
How are nasal steroids different from oral steroids?
I have patients who are afraid to take nasal steroids when I prescribe them. They tell me they have family members or friends who have taken steroids and had problems with them. These patients don’t want that to happen, so they don’t take their prescribed medication, and their allergies continue to bother them.
Nasal steroids are much safer than oral steroids because they work differently. Oral steroids, or steroids taken by mouth, are what we call systemically active medications. That means they work throughout the whole body, not just where you have a particular condition.
For example, a doctor may prescribe an oral steroid for a patient with rheumatoid arthritis. The medication works by reducing inflammation and swelling in the patient’s arthritic joints. But oral steroids’ effects work everywhere in the body, not just the problem areas. This can lead to some of the side effects many people associate with steroids, including:
- Decreased healing after injuries
- Easy bruising of the skin
- Increased chances of infections
- Weight gain
But nasal steroids aren’t systemically active drugs. They’re what we call topical medications. Topical medications are those applied directly to the area being treated. They don’t affect the whole body, like systemically active medications do. Topical medications like nasal steroid sprays work where you put them and nowhere else.
opical medications like nasal steroid sprays work where you put them and nowhere else. via @MedStarWHC
Topical nasal steroids have been on the market for more than 30 years. In that time, researchers have studied the medications extensively to verify their safety.
I like to compare nasal steroids to hydrocortisone cream. Hydrocortisone cream is sold under many brand names, including Cortizone, and it’s a common remedy during the summer months for mosquito bites. The hydrocortisone is a topical steroid that relieves the swelling and itching of the insect bite. People aren’t worried about gaining weight or bruising more easily because they put cream on a mosquito bite, even if they get bitten and put the cream on every day.
Sadly, even other doctors aren’t immune to this sort of well-intentioned misinformation when it comes to nasal steroids. A patient may get a prescription for fluticasone, a common nasal steroid better known as Flonase. Their doctor may tell them, “Just take it for two weeks, and then stop,” to alleviate the patient’s fears about the medication. But for some people, fluticasone has barely started working within that two-week span. It can take time for the effects to be noticeable. And some people need to take fluticasone every day, all year round, and they do fine.
Open, honest communication with your doctor
Open, honest communication with your doctor
This is not to say that people should just take whatever the doctor prescribes without asking any questions. It’s good to be mindful of the medications you take. You should ask your doctor regularly about your medications you take and why they’re important. Ask questions like:
- What does this medication do?
- Why is this medication the best option?
- Is there another medication I could be taking instead?
- Is there a lower dose I could be taking instead?
- Should I still be taking this medication?
I value these sorts of questions from my patients. My job as a doctor is to give my patients honest advice about their medical conditions. I work with my patients to find the best treatments to address their unique symptoms.
Unfortunately, not everyone asks their doctors these questions. And so people don’t learn about what they’re taking and how it can help or harm them. That’s how myths about the harm of nasal steroids come about: a lack of real information. But having a good, honest, open relationship with your doctor can go a long way toward clearing up these misunderstandings and helping everyone get the most effective treatments possible.
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