Afrin is OK for about 3 days or so but then you start to "rebound" and end up more congested than when you started. There is evidence that if you use Flonase or other nasal steroids daily, there is some degree of protection from that rebound. The dosage of Flonase systemically absorbed is nearly negligible, particularly if used properly. A researcher once did the math on it and it ended up that daily use of Flonase for 7 years was about the same amount of systemic absorption as a Medrol dose pack. Only if you have glaucoma should you really worry about it, IMHO, but all steroids contain that same class warning.
The systemic uptake of Flonase and other nasal steroids is significantly increased if proper technique isn't followed - look down at your toes, gently breathe in (sniffing hard just means you swallow the product instead of getting it to where it needs to go), and aim slightly to the outside (about as much angulation as your fingers would create if you made a "peace" sign over your nose). I particularly like Flonase Sensimist because it has low systemic uptake and a "stickier" formulation without alcohol and the nasty fragrant taste that the prescription Flonase has.
Azelastine is great, but it tastes nasty. I use it a ton, and it is apparently going OTC very soon. Although it tastes nasty, but you can add Splenda to it, and it takes the bitter taste away (Kid Doc, how did you know that???). Another alternative is to use Astepro instead of Astelin (50% higher concentration, dosed only at night, and contains Sucralose and sorbitol to take the nasty taste out). Astelin plus Splenda (added to taste) is the poor man's Astepro.
Oral decongestants work, but if you have hypertension or any cardiac issues as well, be careful with them vs. just avoid them. Also, you have to sign them out from behind the counter if you want the good stuff because people make meth from them. One of my colleagues was doing this years ago, and doing it very well. He ended up going to the Big House. I had a patient who was DEA who was working the case, he told me he was making a lot of it and making it quite well. Perhaps he was the original Heisenberg from Breaking Bad???
From doctor to jail beyotchOral steroids are the final arrow in the proverbial quiver, but they have lots of risks and so you need to weigh that against the potential benefits.
Cheers
