FFinalistSouthampton · 2027
The drug atlas
ENT/Intranasal corticosteroid

Intranasal corticosteroids

also: mometasone · fluticasone · beclometasone · nasal steroid

Overview

The single most effective treatment for moderate–severe and persistent allergic rhinitis — more effective than antihistamines for nasal blockage.

Mechanism

Topical glucocorticoid action on the nasal mucosa → suppresses the late-phase allergic inflammatory response (↓cytokines, eosinophils, mucosal oedema). Minimal systemic absorption with modern molecules (mometasone, fluticasone furoate).

Indications

  • Allergic rhinitis (persistent/moderate–severe)
  • Nasal polyps
  • Non-allergic rhinitis

The agents

Mometasone / fluticasonelow bioavailability

OD

Preferred — negligible systemic absorption; safe long-term.

Beclometasoneolder

BD

Slightly higher systemic absorption.

Adverse effects

Nasal dryness / irritation / epistaxiscommon

Correct spray technique (aim away from the septum) reduces it.

Sore throat, headachecommon
Septal perforation (rare, long-term poor technique)serious

Cautions & contraindications

Untreated nasal infectionall
Recent nasal surgery / traumaall

Interactions

  • Potent CYP3A4 inhibitors (ritonavir/ketoconazole) → systemic steroid effects (rare)

Monitoring & kinetics

Symptom control; spray technique; growth in children on long-term high-dose

Topical nasal spray; full benefit takes days–2 weeks of regular use (not PRN).

Source: NICE CKS — Allergic rhinitis · BNF — Nasal corticosteroids