Over the Counter Nasacort, Flonase and Rhinocort

Over the Counter Intranasal Corticosteroid Sprays

Woman looking at medication
Many nasal steroid sprays are now available over-the-counter without a prescription. BSIP/UIG/Universal Images Group/Getty Images

In July 2013, the U.S. Food and Drug Administration’s (FDA) Committee on Non-Prescription Drugs voted to allow Nasacort (triamcinolone) to be sold over-the-counter (OTC) without a prescription. Nasacort became the first intranasal corticosteroid nasal spray to be sold OTC without being prescribed by a healthcare professional in March 2014. Flonase became available OTC in February 2015, and Rhinocort became available OTC in February of 2016.

While most low sedating antihistamines have been available OTC for many years, including Zyrtec (cetirizine), Allegra (fexofenadine) and Claritin (loratadine), the only other medicated nasal sprays available OTC include topical nasal decongestants (such as Afrin) and NasalCrom (cromolyn).

The decision by the FDA is not without controversy. As was the case many years ago when Claritin became available OTC, many professional organizations of allergists, pediatricians and otolaryngologists are against Nasacort AQ being available OTC. However, during the 1990s, the FDA labeled allergic rhinitis as a disease that could be recognized and treated without a healthcare professional. This means that the FDA felt that it was safe to have the public self-diagnose and treat allergic rhinitis using OTC products. Intranasal corticosteroids may not be as safe as antihistamines, however, and therefore the risks and benefits should be considered to determine if having these medications being available OTC is a good idea.

Nasal Steroids OTC: A Good Idea

The availability of intranasal corticosteroids OTC without a prescription is a good idea based on the safety of this type of medication. Nasal corticosteroid sprays have been available on the market by prescription for more than 30 years, with large amounts of safety data being collected during that time.

The most common side effects include localized nasal irritation and nosebleeds, which are usually mild. The most concerning side effect is the possibility of nasal septal perforation, although this is rare. Most people should be able to follow package instructions that would include information about stopping the use of Intranasal corticosteroids if nosebleeds or irritation occur.

Outside of localized side effects, intranasal corticosteroids rarely cause whole-body side effects. Studies on intranasal corticosteroids over a 2-year period showed no significant increase in glaucoma or cataract formation. Other studies failed to show any evidence of hypothalamic-pituitary-adrenal (HPA) axis suppression, which is indicative of the amount of steroid absorbed into the body, affecting the bodies own cortisol formation. There have been concerns about vertical growth suppression in children by intranasal corticosteroids, although these effects are small and inconsistent. Measurement of growth by a qualified healthcare professional is recommended for children using intranasal or inhaled corticosteroids.

There is also an economic concern for the availability of intranasal corticosteroids OTC. Medical insurance will no longer cover prescription Intranasal corticosteroids, and it is likely that other prescription intranasal corticosteroids will no longer be covered once there is an OTC equivalent option. However, this may be an advantage to some people, as the cost of going to a doctor appointment (taking off of work/school, traveling time and travel costs) far exceeds that of an OTC product. People may be more likely to try an OTC product for their allergic rhinitis symptoms, as opposed to going to the effort of obtaining a prescription. This may lead to better control of symptoms and improved quality of life.

Nasal Steroids OTC: A Bad Idea

There are numerous professional medical organizations that believe that having Intranasal corticosteroids available OTC is a bad idea. The reasons for this for mostly related to safety, as various studies have shown that certain types of side effects may occur as a result of using intranasal corticosteroids. First, intranasal corticosteroids have an effect on vertical growth in children (although other studies have failed to show any significant effect), experts believe that children who use these medications should have their growth monitored closely. Second, in people with a family history of glaucoma, there was an increased risk of developing glaucoma with the use of intranasal corticosteroids. Third, elderly people appear to be at increased risk of developing cataracts from the prolonged use of intranasal corticosteroids. Lastly, there seems to be some effect on bone mineral density from the prolonged use of intranasal corticosteroids, which could lead to osteoporosis.

Opponents to Intranasal corticosteroids OTC also believe that consumers won’t understand that this medication needs to be used routinely in order for it to work. Unlike topical nasal decongestants, which bring relief in a matter of minutes, Intranasal corticosteroids takes hours to days to work. Therefore, people might use much higher doses than recommended, which may lead to more side effects. Many of the side effects, and misunderstandings of how intranasal corticosteroids work, could be avoided by having these medications remain by prescription only, which allows for frequent monitoring by a healthcare professional.

Learn more about OTC medications for the treatment of allergic rhinitis.

Source:

Blaiss MS. Over-the-Counter Intranasal Corticosteroids: Why the Time is Now. Ann Allergy Asthma Immunol. 2013;111:316-8.

Friedlander SL, et al. Risk of Adverse Effects, Misdiagnosis, and Suboptimal Patient Care With the Use of Over-the-Counter Triamcinolone. Ann Allergy Asthma Immunol. 2013;111:319-22.

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