The People's Perspective on Medicine

What Are the Downsides to Your Nasal Spray?

A steroid nasal spray like Flonase can combat congestion and other allergy symptoms, but it may also lead to cataracts or changes in the sense of smell.
Man uses a nasal spray for treatment

Allergy season makes millions miserable. They react to pollen and other allergens with nasal congestion, itchy watery eyes, sneezing and sniffling. No wonder so many people reach for a nasal spray.

Nasal Spray or Pills for Allergy Treatment?

A TV commercial for Flonase (fluticasone) is very appealing. A young couple and a beautiful dog are seen running through a forest. The announcer asks the question: “Are your allergies holding you back? Or is it your allergy pills?” The voice-over goes on to extol the benefits of Flonase Sensimist blocking “six key inflammatory substances.”

Does Flonase Have Side Effects?

There is no mention of side effects in this commercial. That’s because Flonase is now available over the counter. The FDA does not require a long list of adverse reactions in OTC drug ads.

Powerful steroid sprays have been used to treat allergies for years. Doctors prescribed medications like beclomethasone (Beconase AQ), budesonide (Rhinocort Aqua), fluticasone (Flonase), mometasone (Nasonex) and triamcinolone (Nasacort AQ).

Steroid Nasal Sprays Help Allergy Symptoms:

Such drugs are reasonably effective at calming allergy symptoms. That’s because these medications are corticosteroids and have substantial anti-inflammatory activity. Because they are sprays rather than pills, doctors worry less about the potential for systemic side effects.

That said, such drugs are not without drawbacks. The official prescribing information for Flonase before it went OTC included reactions such as headache, sore throat, nosebleeds and cough. Also included were: alteration or loss of sense of taste and/or smell, nasal septal perforation, glaucoma, increased intraocular pressure and cataracts, among other problems.

Nasal Spray and the Sense of Smell:

Readers of this column have reported complications of steroid nasal spray use. One reader shared this reaction:

“I used Flonase for about 10 days and then realized that my sense of smell and taste both had disappeared completely. My sense of smell had been very acute before that. I attribute the loss of my senses to the use of Flonase.

“Why doesn’t the manufacturer warn of the possibility of anosmia? Recently, I have the added annoyance of an ‘off’ taste with many foods. Why was it listed as a side effect on the prescription but left off the OTC medication?”

Nasal Spray and Vision Problems:

Anosmia (loss of the sense of smell) or changes in smell and taste are not the only problems people have experienced related to steroid nasal spray use. Several readers blame these sprays for causing cataracts. Here is one reader’s story:

“I am 55 and have been using fluticasone nasal spray year round since I was in my 40s. (In California, where I live, something is always blooming.)

“I was having vision problems. When I saw the ophthalmologist, she discovered I have a posterior subcapsular cataract. She kept asking if I’d taken steroids or had trauma to my eye. Finally I recalled that fluticasone is a corticosteroid.

“As I am generally healthy, I was shocked and could hardly believe that I have a cataract. My type of cataract is most commonly caused by corticosteroids or injury or irradiation to the eye for a tumor.”

Adverse Effects of OTC vs. Prescription Drugs:

Medications do not lose their potential to cause complications when they move from prescription to OTC, even if the commercials don’t mention scary side effects. To be a smart consumer, check with the pharmacist about possible adverse reactions to any drug before you use it.

You might also consider alternative ways to deal with your allergies. We have written about some of them here.

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    About the Author
    Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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    Having nasal congestion was miserable. I went to an acupuncturist and used eucalyptus essential oil inhalations instead. Effectof acupuncture was immediate and required a few treatments and the inhalations were wonderful before bedtime so I could sleep. These treatments take more time but no side effects.

    I’m another one with loss of taste and smell from having used steroidal nasal spray for about six months. Of course I stopped, but it’s been weeks now with no improvement.

    Well I suffered for years since I was a teenager in to 70s with seasonal allergies. Nose bleeds , constant sneezing and nose blowing. I found it difficult to work in my 20s and 30s (being in Sales) sneezing insensately. Until one doctor gave me Beconase spray. I have been using it for 35 years. Once a day, every morning from April to Nov. one puff per nostril. No sides effects to speak off , no issues with eyes, my sense of smell and taste is not been effected. Maybe I’m lucky.
    The key is not over using, and it can take a week or two before you see positive effects. Also if I stop using or forget for a couple of days my allergies flare up and I have start all over.

    I used Flonase for a number of years when it was a prescription medication. My doctor’s orders were to use it once daily from Nov. 1st. to April 1st. I did well until I was bothered more than usual with upper respiratory allergies. I used the spray during Nov., Dec., and Jan. Unexpectedly, I had a horrible nosebleed which was treated two different times in the E.R. The first time, the bleed was cauterized. Within a day, another, heavier nosebleed occurred. I returned to the E.R. and my nose was packed until I could get in to see an ENT specialist, who had to cauterize both sides of my nose. The nosebleeds were attributed to my use of Flonase and I had to discontinue using it. I was advised to start using a Neti Pot, Fall and Winter and I haven’t had a nosebleed since then.
    I also take one ginger root capsule daily and my upper respiratory allergies, sinus pain and infections have disappeared. I have also been able to discontinue the allergy shots I took for many years. These things were done with the approval of my PCP, who was amazed at my success.

    I used a steroid nasal spray for more than ten years for year-round allergies and suddenly started to have frequent nosebleeds. I was diagnosed with an ulcerated nasal septum that was close to perforating. It took several months to heal and, needless to say, I haven’t used nasal steroids since and use other methods to control allergy symptoms. I once worked with someone who developed cataracts in both eyes in her twenties after years of using inhaled corticosteroids for asthma. Patients need to be aware of these risks, keeping in mind that prescribed corticosteroids should never be abruptly stopped without permission from the prescriber.

    I lost my sense of taste about 18 months ago. I realize now from reading this that these steroid nasal sprays may have caused the problem. I was a fairly heavy user of different brands during mountain cedar season.

    My ENT doctor thought it might be caused by one of my cranial nerves but an MRI on my brain revealed all cranial nerves were fine. I just wish my sense of taste would come back.

    I used Flonase for about a year. Cooking breakfast one mornin my son in-law came flying down the stairs raced to the stove and turned off the burner I was using. He could smell gas upstairs and I couldn’t smell it standing at the stove! That was my wake-up call and have never used Flonase again!

    What are the effects of wrinkle creams, as L’Oreal’s which contain “soy seed proteins” in promoting skin cancer, since soy is known to be estrogenic, promoting tumor growth?

    As a cataract surgeon myself, I have seen several patients over the years with posterior subcapular cataracts that I thought were attributable to steroid nasal sprays. It is quite common to see them in asthma or COPD patients that need inhaled steroids in order to breathe freely. The nasal sprays are not so likely to cause cataracts as the inhalers, but some of the drug is getting into the bloodstream and circulating throughout the body from either route of administration.

    I took Flonase for awhile, and got some very large blood clots in my nose. When I saw my ENT, he told me that some allergy meds dry your nasal passages, and can result in this.

    Now isn’t that special. I had mentioned this to my Eye Dr. Since, I have asthma; just reading the pamphlets that comes with the medicines. My eye dr said that the medicines do not cause cataracts. Well guess what?

    Next month, I have an appointment to see a specialist for my cataracts. I feel that the meds do cause cataracts. Or that I have just gotten old.

    I couldn’t agree with you more! I am living proof too….I am 68 and started using Flonase again about a year ago. Prior to that I used it in the 90s along with Allegra D which were both on prescription. Well guess what?? When I was 50 I got cataracts in both eyes and my doctor told me I was her youngest patient. Thanks Flonase; the positive side was I no longer needed glasses which I wore since I was 8. I can drive and go to the movies without wearing glasses!!! and I can see my computer and read without glasses. I have had mono-vision for 18 years now so there is a crazy upside to the use of Flonase!

    Thank you for the information regarding nasal medications. I had cataract eye surgery in January, and my vision was great. I suffer from allergies and when the weather changes I start having problems with nasal congestion, so I use Neo-Synephrine which works great for me. When I returned to the eye doctor for after-surgery check-up, I didn’t pass the eye tests, so the eye doctor who couldn’t figure out the problem, sent me to a retinal specialist. I went today and after a few tests, he concluded that I had inflammation of the retina and prescribed Durezol 0.05 Ophth Emulsion eye drops. I am to see him again in two weeks. Now I will share your information with both doctors. I added two and two and think probably that is my problem. Again, thanks.

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