Nasal Sprays & Drops

Frequently Asked Questions (FAQs)


Can you get HIV from sharing a nasal spray with a co-worker, even if you covered it with toilet paper before using it?

The quick answer is - No you cannot get infected with HIV this way.

Your next question is - why?

First let look at real world evidence - there is none. No surprise there. You really do not expect any medical center to run multi-center placebo controlled randomised double-blinded studies on whether sharing nasal sprays can spread HIV. As far as I know there are also no case reports, case series or any other scientific literature on the spread of HIV via nasal sprays.

Second let's look at proxy evidence. Is there anything similar to sharing a nasal spray that has been shown to spread HIV? Sharing nasal hair trimmers for example. Again not that I am aware of.

Last, let's look at scientific theory which, by the way, to me is the least reliable way to predict HIV risk. Scientific theory says there is no HIV virus in snot. So he might have had a nose bleed you say. OK so there is HIV virus on the nasal spray from the blood. Scientific theory also states HIV has found to retain it's enzymatic activity and be able to replicate in cell culture up to 7 days outside the body in certain climatic conditions! Note how I did NOT say HIV has been found to be infective after 7 days outside the body. Science also says HIV can infect a person via the mucous membranes which is exactly what lines the inside of the nose! OMG! Live HIV virus from blood on the nasal spray shot up into the nose lined with mucosal membranes!

OK time to calm down. You see how misleading scientific theory can be? Let's use some common sense instead. We have known about the existence of HIV for 30 years. In that time, it has become easily the most studied and recorded virus in the history of mankind. We know for a fact it is spread via penetrative sex, sharing needles for injection drug use, blood transfusion, organ transplants AND NO OTHER WAY. If HIV can be spread so easily by an action as benign as sharing a nasal spray do you not think there will be a whole lot more than just 35 million people in the whole world living with HIV right now?

But why oh why is there no risk you ask. Isn't the science reliable? Sure it is. But there is also a lot of other science just as reliable like how HIV is rendered non-infectious soon after contact with air. Like how the viral load on the nasal spray is too low to cause an infection. Like the mucous membrane contains antibodies and chemicals and cells that actively seek out and kill HIV and other viruses.

There is an extremely complex dance between the HIV virus and our immune system. A lot of this process we do not yet fully understand. But we know one thing - you cannot get HIV from casual contact and you certainly cannot, in my humble opinion, get it from sharing a nasal spray.


How does a nasal spray clear nasal congestion?

Most of the OTC nasal sprays contain drugs like Oxymetazoline, Xylometazoline, Naphazoline and Phenylephrine, all of which act by constricting the mucosal blood vessels. Narrowing of the blood vessels in turn increases the nasal airway space by reducing the fluid leakage from veins into the nasal mucosa, thus reducing the nasal secretion as well as the congestion. However, though the relief is quick, the action of nasal decongestants wears off in a span of about 30 minutes.

Nasal decongestants should not be used continuously for more than 3 consecutive days as this can worsen cold symptoms due to nasal passage damage and the inability of the blood vessels to respond to the decongestant which is called the "Rebound Effect".

There are other types of nasal sprays available which contain plain saline solution (Salt water). Such sprays loosen mucus and prevent crusting and can be used in cases of mild nasal congestion. They contain no medication and can be used as frequently as needed without causing additional problems.


Is the oxytocin nasal spray legit? If so, how does it work and is it worth buying?

Oxytocin is a powerful drug used to induce labor. As an Ob/Gyn, I used this thousands of times given IV - certainly more powerful than a nasal spray - to induce labor.

I never had one instance where any woman told me she was "euphoric" or relaxed while receiving the drug.


What is an alternate to Efcorlin nasal spray?

Never use any nasal sprays for long terms. Especially Efcorlin as it contains hydrocortisone which is a steroid. And prolonged use of steroids have some serious side effects. Switch to a non-steroid nasal spray in case of utmost necessity like Azelastine (generic name) sold under trade name Azeflo in India.


Ear, Nose and Throat (ENT Medical Specialty): When should I use a nasal spray as opposed to nasal drops?

Nasal drops will worsen the feeling of a blocked nose creating the feeling of more congestion. Hence, a nasal spray is usually advised. It all depends on your convenience as long as both have the same constituents.


Has anyone had success with capsaicin nasal sprays such as Ausanil, Sinol, or Sinus Buster for migraine headaches?

I tried Ausanil. It did seem to help some. The problem was taking it was soooo painful. I could have done that...but it made my eyes and tears burn so bad!


What is the mechanism behind the rebound congestion that comes after the usage of Otrivin (nasal drops) for 4-5 days?

Rebound congestion does not happen with in 4-5 days of use of drops like Otrivin/ Xylometazoline.

Rhinitis Medicamentosa is a broad term that has been loosely used for the congection or feeling of blocked nose while on medication. This may happen with even decongestant drops, or with Oral Contraceptives, antidepressants etc. Now, the "Rebound Congestion" / Rhinitis Medicamentosa is used to describe the former- congection even while using decongestant nose drops, and the rest is included under Drug induced Rhinitis.

Though the mechanism is not entirely clear, there are several hypotheses how this comes about. The decongestant drops/ sprays usually belong to a family of drugs called imidazolines that are sympathomimetics... acting on the same receptors as epinephrine as well as norepinephrine. Thus, the decongestants act on both the alpha and beta receptors, the alpha ones causing constriction of vessels resulting in decongestion while beta cause dilation with congestion. The beta action outlives alpha, and within about a week the "rebound" congestion becomes apparent.

Another proposed mechanism is that the sympathetic- parasympathetic tone dysregulation (vasoconstrictive/ decongestive v/s vasodilation/congestive action). The exogenous molecules tend to suppress the endogenous adrenergic compounds, through a negative feedback loop.

The way to deal with the rebound congestion is to go through the congestion without using the decongestants AT ALL. Or to taper the use.