The active ingredient in most over-the-counter, or OTC, nasal sprays is either phenylephrine or oxymetazoline. These drugs decrease mucus production and shrink swollen blood vessels in the nasal passages and are best for short-term use, such as for colds. Prescription nasal sprays primarily use corticosteroids as the active ingredient and can be used for long-term relief.
Sinusitis Complications
Sinusitis is most commonly caused by a bacterial infection of the sinus cavities, or air pockets, in the skull around the nose. Nasal decongestants are known to aggravate, but not cause, sinusitis. The Food and Drug Administration mandated in 2007 that OTC nasal decongestants cannot carry references regarding sinusitis on labels.
The Rebound Effect
Use of a nasal spray beyond three days can cause increased and ongoing congestion, known as rebound congestion. The nose becomes less responsive to the spray and congestion may be worse if use is stopped. This may result in more frequent use to control congestion. This effect is not present with prescription nasal sprays.
Burning Sensation
Prescription nasal steroids have long-lasting and cumulative effects. For best results, they need to be taken on a regular basis over a period of time. Some people experience a burning sensation from the propellant used with the steroid. This can be relieved by using an OTC saline inhaler prior to the steroid spray.
Pediatric Concerns
NYU Langone Medical Center cites the FDA's recommendation against the use of OTC cough and cold remedies for children, including oral and nasal spray decongestants. Langone goes on to add that rare but serious side effects in children under the age of 2 may include rapid heart rates, convulsions, decreased levels of consciousness and death.
References
- University of Maryland Medicine: Over-the-Counter Drugs for Cold, Flu, Allergy, and Sinus Infection
- NYU Langone Medical Center: Common Cold: Treatment
- University of California, San Diego: Nasal Disease Handbook
- Food and Drug Administration: Cold, Cough, Allergy, Bronchodilator, and Antiasthmatic Drug
