Nasal steroid drops are used for more the control of more severe nose and sinus problems caused by inflammation (rhinitis and rhinosinusitis). Different nasal drops are used for short-term and long-term control of nasal conditions, but they all act by decreasing the amount of inflammation in your nasal cavity and sinuses. To get the most out of your nasal drops, consistency is key. Learning the best technique with which to administer your spray, and taking them regularly as prescribed, will give you the best results.
What kinds of nasal drops are there?
There are two main kinds of nasal drops:
Fluticasone 400 mcg drops (formerly known as Flixonase Nasules)
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These nasal drops come in individual plastic vials. One vial is generally one dose, and is shared between the nostrils after opening.
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Fluticasone drops are generally used for long-term control of inflammatory nasal conditions: either severe rhinitis or chronic rhinosinusitis.
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Fluticasone drops deliver a higher dose of steroid than equivalent nasal sprays, but are still felt to be very safe as only a tiny proportion is absorbed into the bloodstream.
Betamethasone drops (Betnesol/Vistamethasone)
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These nasal drops come in a bottle.
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Betamethasone drops are highly effective, but are generally used for short-term control of nasal symptoms (for example when they are particularly severe). This because the absorption of the steroid into the bloodstream is quite high. However, they are very safe when taken for two weeks or less.
Nasal steroid drops should not be confused with nasal decongestant drops (e.g. Otrivine). These work via a different mechanism, and while they are useful for short term problems such as infections and colds, if used long-term they make symptoms worse, leading to an addictive cycle of congestion and spray use. This does not occur with nasal steroid drops.
Are nasal steroid drops safe?
Nasal steroid drops based on fluticasone have an excellent safety profile. It is natural to be concerned about the long term use of steroid medication. However in the case of nasal drops, fluticasone has been shown to have very low absorption into the bloodstream. Because of this, there is no evidence that it can cause steroid-related side effects.
Nasal steroid drops do not "thin the skin" inside the nose. The only significant safety caution is the interaction between fluticasone and some HIV treatments (e.g. ritonavir).
What should I expect from my nasal steroid drops?
You won't feel any immediate benefit from nasal steroid drops. Over a few weeks of regular use however, you will gradually experience an improvement in your nasal congestion and other symptoms. Some patients find their nose feels a little dry, but this is not normally a significant problem.
Nasal drops administration
There are two positions in which you can administer nasal drops: the head-back position, and the Kaiteki manoeuvre. Unless you have been advised to use a specific technique, use whichever position you find works and is comfortable for you. The aim is for the drops to flow into your nasal cavities, but not straight down your throat. If you use a nasal irrigation, do this about 20 minutes before taking your drops.
Head-back position
Lie on your back, with your head hanging backwards off the edge of a bed. Alternatively place two pillows under your shoulders.
Administer the drops (with Flixonase Nasules, one Nasule usually provides 3-4 drops per nostril).
Breathe gently through your nose but do not sniff. Lie in the same position for 1-2 minutes.
Kaiteki manoeuvre
This position is useful for patients who have a particular problem with their sense of smell, as it helps to guide drops into the olfactory region at the top of the nasal cavity. It can also be helpful for patients who find it difficult or uncomfortable to administer drops in the head-back position (“Kaiteki” means “comfortable” in Japanese).
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Lie on your side on a bed or couch. Your neck should be slightly bent downwards, towards your lower shoulder. Your head should be rotated slightly upwards so that you can just see the ceiling.
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Carefully introduce the prescribed number of drops into the upper nostril only. If you are using a “Nasule”, this usually equates to about 5 drops per nostril.
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Breathe gently through your nose but do not sniff.
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Lie still for 30-60 seconds to allow the drops to flow upwards inside your nasal cavity.
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Turn onto the other shoulder and again tilt your neck down and your head slightly up.
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Repeat the drop administration into the upper nostril only and wait for 30-60 seconds before getting up.
Reference
The administration of nasal drops in the ‘‘Kaiteki’’ position allows for delivery of the drug to the olfactory cleft: a pilot study in healthy subjects. Mori E, Merkonidis C, Cuevas M, Gudziol V, Matsuwaki Y, Hummel T. Eur Arch Otorhinolaryngol. 2016 Apr;273(4):939-43.