nasal spray
{{Short description|Spray that delivers medications locally in the nasal cavities or systemically}}
{{medref|date=November 2017}}
{{Use dmy dates|date=June 2024}}
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{{Infobox medical intervention
| name = Nasal spray
| synonym = nasal drops
| image = Action photo of nasal spray on a black background.jpg
| caption = Actuation of a nasal spray bottle, used to deliver medication via the nostrils
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Nasal sprays are used to deliver medications locally in the nasal cavities or systemically. They are used locally for conditions such as nasal congestion and allergic rhinitis. In some situations, the nasal delivery route is preferred for systemic therapy because it provides an agreeable alternative to injection or pills. Substances can be assimilated extremely quickly and directly through the nose.{{Cite news|title=Breakthrough: Nasal Spray May Soon Replace Pills for Delivering Drugs to the Brain|url=https://www.sciencedaily.com/releases/2014/05/140521133603.htm|work=Science Daily|publisher=Science Daily|date=21 May 2014|access-date=30 March 2015}}{{ums|date=November 2017}} Many pharmaceutical drugs exist as nasal sprays for systemic administration (e.g. sedative-analgesics, treatments for migraine, osteoporosis and nausea). Other applications include hormone replacement therapy, treatment of Alzheimer's disease and Parkinson's disease. Nasal sprays are seen as a more efficient way of transporting drugs with potential use in crossing the blood–brain barrier.
Antihistamines
Antihistamines work by competing for receptor sites to block the function of histamine, thereby reducing the inflammatory effect. Antihistamine nasal sprays include:
- Azelastine hydrochloride
- Levocabastine hydrochloride
- Olopatadine hydrochloride
Corticosteroids
Corticosteroid nasal sprays can be used to relieve the symptoms of sinusitis, hay fever, allergic rhinitis and non-allergic (perennial) rhinitis. They can reduce inflammation and histamine production in the nasal passages, and have been shown to relieve nasal congestion, runny nose, itchy nose and sneezing.{{cite journal |vauthors=Rizzo MC, Solé D, Naspitz CK |title=Corticosteroids (inhaled and/or intranasal) in the treatment of respiratory allergy in children: safety vs. efficacy |journal= Allergologia et Immunopathologia|volume=35 |issue=5 |pages=197–208 |year=2007 |pmid=17923074 |doi=10.1157/13110315 |s2cid=13622570 |url=http://www.elsevier.es/en-revista-allergologia-et-immunopathologia-105-articulo-corticosteroids-inhaled-and-or-intranasal-in-13110315|url-access=subscription }} Side effects may include headaches, nausea and nose bleeds.{{citation needed|date=October 2015}} Corticosteroid nasal sprays include:
Saline
Saline sprays are typically non-medicated. A mist of saline solution containing sodium chloride is delivered to help moisturize dry or irritated nostrils. This is a form of nasal irrigation. They can also relieve nasal congestion and remove airborne irritants such as pollen and dust thereby providing sinus allergy relief.
Three types of nasal sprays preparations of sodium chloride are available including hypertonic (3% sodium chloride or sea water), isotonic (0.9% sodium chloride) and hypotonic (0.65% sodium chloride). Isotonic solutions have the same salt concentration as the human body, whereas hypertonic solutions have a higher salt content and hypotonic solutions have a lower salt content. Isotonic saline nasal sprays are commonly used in infants and children to wash out the thick mucus from the nose in case of allergic rhinitis. Hypertonic solutions may be more useful at drawing moisture from the mucous membrane and relieving nasal congestion.
Natural nasal sprays that include chemical complexes derived from plant sources such as ginger, capsaicin and tea-tree oil are also available. There is however no trial-verified evidence that they have a measurable effect on symptoms.
Topical decongestants
Decongestant nasal sprays are available over-the-counter in many countries. They work to very quickly open up nasal passages by constricting blood vessels in the lining of the nose. Prolonged use of these types of sprays can damage the delicate mucous membranes in the nose. This causes increased inflammation, an effect known as rhinitis medicamentosa or the rebound effect. Decongestant nasal sprays are advised for short-term use only, preferably 5 to 7 days at maximum. Some doctors advise to use them 3 days at maximum. A recent clinical trial has shown that a corticosteroid nasal spray may be useful in reversing this condition.{{cite journal | title = Fluticasone reverses oxymetazoline-induced tachyphylaxis of response and rebound congestion |journal=American Journal of Respiratory and Critical Care Medicine |vauthors=Vaidyanathan S, Williamson P, Clearie K, Kahn F, Lipworth B | pmid= 20203244 | doi=10.1164/rccm.200911-1701OC | volume=182 | issue=1 |date=July 2010 | pages=19–24}} Topical nasal decongestants include:
Allergy combinations
{{Infobox drug
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| type = combo
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| component1 = Azelastine hydrochloride
| class1 = Antihistamine
| component2 = Fluticasone propionate
| class2 = Corticosteroid
| tradename = Dymista
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| DailyMedID = Azelastine hydrochloride and fluticasone propionate
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| routes_of_administration = Nasal
| ATC_prefix = None
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| legal_AU = S4
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| legal_CA = Rx-only
| legal_CA_comment = {{cite web | title=Dymista Product information | website=Health Canada | date=31 July 2018 | url=https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=91729 | access-date=17 February 2025}}
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| legal_US = Rx-only
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| CAS_number = 1417803-89-4
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| KEGG = D11656
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Combination use of two medications are available as nasal sprays.
List of some combination nasal sprays:
- {{anchor|Azela/Flutica}} Azelastine together with fluticasone propionate (brand names including Dymista){{cite web | title=Dymista/Dylastine (Viatris Pty Ltd) | website=Therapeutic Goods Administration (TGA) | date=1 July 2024 | url=https://www.tga.gov.au/resources/prescription-medicines-registrations/dymista-dylastine-viatris-pty-ltd | access-date=8 July 2024}}
- Xylometazoline together with cromoglicic acid
In some countries, Dymista is marketed by Viatris after Upjohn merged with Mylan to create Viatris.{{cite web | title=Pfizer Completes Transaction to Combine Its Upjohn Business with Mylan | publisher=Pfizer | via=Business Wire | date=16 November 2020 | url=https://www.businesswire.com/news/home/20201116005378/en/ | access-date=17 June 2024}}{{cite web | title=Brands | website=Viatris | date=16 November 2020 | url=https://www.viatris.com/en/products/brands | access-date=17 June 2024}}
In 2022, the combination azelastine/fluticasone was the 299th most commonly prescribed medication in the United States, with more than 300,000 prescriptions.{{cite web | title=The Top 300 of 2022 | url=https://clincalc.com/DrugStats/Top300Drugs.aspx | website=ClinCalc | access-date=30 August 2024 | archive-date=30 August 2024 | archive-url=https://web.archive.org/web/20240830202410/https://clincalc.com/DrugStats/Top300Drugs.aspx | url-status=live }}{{cite web | title = Azelastine; Fluticasone Drug Usage Statistics, United States, 2013 - 2022 | website = ClinCalc | url = https://clincalc.com/DrugStats/Drugs/AzelastineFluticasone | access-date = 30 August 2024 }}
References
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External links
- {{Commonscat-inline|Nasal sprays}}
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