Nasal Steroids

  • Administered as a spray or drops

  • Bind to glucocorticoid receptors and exert an anti-inflammatory effect. 

- decrease activation of macrophages and T cells increase synthesis of annexin-1

- inhibit release of inflammatory mediators such as histamine, prostaglandins, leukotrienes and cytokines

  • Reduce swelling, oedema and cause vasoconstriction

  • 2nd generation steroids (mometasone, fluticasone) are more lipophilic so greater deposition (30%) in respiratory tract tissue. 70% is absorbed systemically and rapidly passes through first pass metabolism. 

  • Betamethasone (1st generation steroid) administered as drops and has most systemic bioavailability and highest probability of systemic side effects.

  • Similar response and effectiveness of all steroids via nasal route

Side effects 

 

  • Nasal dryness, epistaxis, irritation in nose & mouth

  • Unpleasant taste/smell

  • Caution in glaucoma - theoretic risk of raised intraocular pressure, headache. Seek advice of ophthalmology

 

* pregnancy: risk of systemic effects increase with prolonged use. Use for a short a time as necessary

* children: monitor growth with prolonged use due to increased risk of systemic absorption