How To Use Nasal Medications

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**Written by Tulsa Doctor and Tulsa Natural Medicine Expert, Doctor Chad Edwards

There are a number of medical conditions that benefit from topical nasal medications. This means that the medication is sprayed directly into the nose. Spraying the medicine into the nose has the benefit of largely avoiding any systemic effects but is very effective in the tissues with which it makes contact.

Here are some of the medical conditions:

  1. Allergic rhinitis (allergies, hay fever)
  2. Common cold, flu, other respiratory viral conditions
  3. Sinusitis (sinus infections) – acute & chronic
  4. Eustachian tube dysfunction (“stopped up ears”)
  5. Upper Airway Cough Syndrome (UACS)
  6. Post-nasal drip
  7. Nasal polyps

I’m sure there are others but these are the ones that come to mind. Nasal medications are often first-line therapy for these conditions but they must be used correctly in order to get maximum effect and avoid common & unpleasant adverse effects.

There are some general guidelines for how to use all of these medications. There are exceptions to these guidelines but, if you stick to these guidelines you’ll probably do well most of the time.

General Guidelines for Nasal Medications

Because of the anatomy of the nose, you want to get the medication to the lateral (outside) wall of your nose. The best way to do this is to ensure that you spray the medication at a 45o angle up and 45o angle out – you don’t want to spray the medicine toward the middle of your nose. I generally recommend using your right hand to spray the left nostril and vice versa – this helps to achieve the proper angle.

Lean slightly forward and take a very small sniff as you spray the medicine. If you can taste the medicine, you sniffed too hard or sprayed too flat.


This is a topical decongestant that you can purchase over-the-counter (OTC). The generic is as effective as the brand name and is often 1/2 the price. In my experience, Neo-Synephrine, Afrin, and Oxymetazoline are all equally effective though you may find one that you prefer.

  • Follow the “General Instructions” above for the proper procedure
  • Use one spray in each nostril, wait about 5 minutes and then repeat. The purpose is that the nasal respiratory tissue is congested and the medication can’t get to all of the surfaces. Using 1 spray starts the decongestion so that when you spray the 2nd, after several minutes, the tissues have started to open up and the medication can then get to more of the tissues and you have a better effect. This is not always necessary but may, at least theoretically, be beneficial.
  • This medicine is extremely effective and starts to work immediately. You may use it up to twice daily for a maximum of 3 days!! It may not last a full twelve hours but don’t use it more than twice daily. I haven’t noticed a need to follow a strict 12 hour schedule and you can use it at the times when you’ll benefit from the decongestion the most, such as just before going to bed.
  • Take at least 3 days off before you start to use it again if needed.
  • Use of this medication for more than 3 days can lead to worsening congestion that requires more and more decongestants – a condition called Rhinitis Medicamentosa. This is a difficult condition to get over – it is best to prevent it all together.
  • You may take oral decongestants in addition to this medication without interactions.

Neilmed Sinus RinseSinus Rinse Package:

This is one of my favorites. It is available OTC at most pharmacies. It is merely a saline solution and is a “bath for your nose.” It has some good research that validates its effectiveness and I have never had a patient tell me that they didn’t benefit from it. It may feel a little weird but is not painful. I generally recommend using the Afrin, if you are congested, and then waiting for about 30 minutes to help open things up before rinsing. I recommend using the rinse 2-3 times per day but may be used as often as you wish.

There are no drug interactions, adverse effects, or allergic reactions of which I have heard. There are other versions available. You may have heard of the ” Neti Pot” which has been around for decades. It works in the same way. I just prefer the Sinus Rinse kit.

The kit will tell you that you should use distilled water. Do not use cold, or even room temperature, water. It is extremely uncomfortable – yes, that is experience talking.

  1. Inhaled topical steroid
  • Follow “General Instructions” above – this will help prevent one of the adverse effects of chronic use, nasal septal perforation.
  • This medication is for chronic use and should not be used on an “as needed” basis. It takes 4-6 weeks to get full effect. You may notice a difference in less time but it generally takes several weeks for the maximum effect.
  • You should either wait about 30 minutes after using a steroid to rinse your nose with the Sinus Rinse or use this after rinsing your nose.
  • Follow the instructions for your particular nasal steroid regarding how often to use it.

These medications are extremely effective but must be used correctly. Hopefully this information will help!