Can cortisone nasal spray have serious side effects?

Young girl applies nasal spray

An over-the-counter cortisone nasal spray can have side effects just like prescription preparations and is not intended for use by people under 18. (Source: Valeriy_G/Getty Images)

Some people refuse cortisone nasal spray because they fear side effects. Here you can find out whether and to what extent such concerns are justified.

If you have a severe allergic rhinitis , against which the usual allergy medications (antihistamines) are not effective enough, a nasal spray containing cortisone from the pharmacy can help. Even if you have a chronic sinus infection , the symptoms can be alleviated with a cortisone nasal spray. The risk of side effects is manageable. So where does cortisone’s bad reputation come from?

“Cortisone” can mean many things

What you need to know is that when you talk about cortisone, you often mean one of the artificially produced drugs from the group of glucocorticoids. There are over 30 of them, some of which vary greatly in potency – such as hydrocortisone, prednisolone, betamethasone and mometasone. Cortisone nasal spray is also available with various active ingredients.

It depends on the quantity

But no matter what active ingredient is in cortisone nasal spray: the side effects are comparable. The dosage and duration of treatment are crucial for the tolerability of medications containing cortisone. This applies not only to nasal sprays, but to every dosage form – such as tablets or ointments.

In the initial period after cortisone was introduced as a medicinal substance, little was known about its possible side effects. That’s why doctors often prescribed it for too long and in too high a dose – sometimes with serious consequences. The possible undesirable effects of cortisone include:

  • Weight gain due to cravings
  • high blood pressure
  • increased bleeding tendency
  • too high blood sugar levels
  • depressions
  • cataracts or glaucoma
  • thinning skin
  • increased susceptibility to infections
  • Bone loss
  • Inflammation of the gastric mucosa
  • Muscle weakness
  • insomnia
  • Hypofunction of the adrenal cortex
  • (in women) missed menstrual period
  • (in men) erectile dysfunction
  • (in children) growth disorders

It is therefore important to only use as much cortisone as necessary for as short a time as possible in order to keep the risk of side effects low. This also applies to cortisone nasal spray – including over-the-counter preparations. These are therefore only intended for short-term treatment of adults following a medical diagnosis.

There are many possible uses for cortisone

Doctors now know more about cortisone and its possible side effects – and about how the risks of treatment can be reduced. The active ingredients are therefore used not only against acute but also against chronic diseases.

Cortisone primarily serves to inhibit inflammatory reactions or suppress the immune system. Used as a nasal spray (e.g. for hay fever , house dust allergy or chronic sinusitis ) it reduces the swelling of the inflamed nasal mucosa, making breathing through the nose easier again. In other dosage forms, cortisone can be used for treatment for many other reasons. These include, for example:

  • other allergic reactions including anaphylactic shock
  • Eye diseases (such as the inflammation of the eye socket in Graves’ disease)
  • inflammatory bowel disease (such as Crohn’s disease or ulcerative colitis )
  • Joint diseases (e.g. rheumatoid arthritis or frozen shoulder)
  • inflammatory skin diseases (such as neurodermatitis or psoriasis)
  • Hormone replacement (e.g. if the adrenal cortex is underactive)
  • Cancer diseases (accompanying chemotherapy )
  • Lung diseases (e.g. asthma or COPD )
  • inflammatory nerve diseases (such as multiple sclerosis)
  • Organ transplants

In principle, before using cortisone nasal sprays, ointments, injections or tablets, the benefits must be carefully weighed against possible risks and side effects: if used correctly, the treatment can often greatly improve the quality of life of those affected. In some cases it is even life-saving.

Topical application is less risky

The risk of cortisone nasal spray is comparatively low. Side effects occur here especially when overused or used under 18 years of age. Otherwise, nasal spray with cortisone rarely has side effects, which are also rather mild. The reason for this is the local application of the active ingredient.

The dosage form also has a major influence on the risks of treatment with cortisone. Tablets are more likely to have more severe side effects – especially if taken for a longer period of time. The active ingredient then enters the bloodstream and has an effect throughout the body (systemically).

On the other hand, cortisone from topical or externally applied medicines (such as asthma or nasal sprays, ointments or creams) enters the bloodstream in at most small quantities. The effect is therefore largely localized (local) – as are possible side effects.

Cortisone nasal spray can have these side effects

When used correctly, cortisone nasal spray usually causes at most mild side effects that are only temporary. These include, for example:

  • dry nasal mucosa
  • slight nosebleeds
  • Sensations in the nose and throat (such as tingling or burning)
  • unpleasant, metallic taste
  • impaired sense of taste and smell

    In addition, cortisone nasal spray sometimes weakens the nose’s defenses, which makes it easier for infections to occur. Side effects can also affect the eyes: for example in the form of visual disturbances such as blurred vision, an increase in pressure in the eye (glaucoma) or a clouding of the eye lens (cataract).

    Beware of overuse

    If overused, cortisone nasal spray can occasionally cause serious damage to the nasal septum. In addition, the risk of side effects that affect the entire body increases – such as increased blood sugar levels, weight gain or increased infections (especially fungal infections of the mucous membranes).

    Children in particular have an increased risk that long-term and high-dose cortisone nasal sprays will trigger internal side effects – including (temporary) growth disorders.

    However, based on previous experience, such side effects are unlikely if cortisone nasal spray is used briefly and correctly. To be on the safe side, it is still advisable for children, as well as during pregnancy and breastfeeding, to only use cortisone on medical advice. This also applies to over-the-counter preparations.

    Conclusion: It is difficult to imagine the treatment of countless diseases without cortisone. When cortisone is applied topically – such as in nasal spray – side effects are rarer and tend to be less pronounced than with tablets. But even with the latter, the risk is lower than many people fear.


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