8 Best Anti-COVID Nasal Sprays (2024)

Do nasal sprays actually work against COVID-19? There has been quite a lot of activities in the COVID nasal spray space. Below, we look at some of the best nasal sprays for COVID-19 and summaries of the rationale and evidence for each category. Do note that some of them are available as an over-the-counter medication but some are still under clinical trial stage.

Best Nasal Sprays for COVID-19 2024

There are lots of great nasal sprays out there, and this list is by no means complete. We’ve included nasal sprays with proven anti-COVID-19 ingredient, you can buy over the counter or online.

1. Povidone Iodine Nasal Spray and COVID-19

Povidone iodine (PVP-I) is an antiseptic that has been used for over 150 years. The antiseptic has immediate virucidal effects against COVID-19 virus. Do we have any evidence that povidone iodine is effective against COVID-19?

There are 20 published studies supporting povidone-iodine for COVID-19. You can check out the list at c19pvpi.com (constantly updated).

Povidone-iodine is ranked no. 3 in this COVID-19 early treatment death-rate league table below.


Povidone iodine nasal spray where to buy: Find iodine nasal spray on Amazon.

2. Xlear Natural Saline Nasal Spray with Xylitol (Available on Amazon)

Balmforth et al (Oct 2022), conducted a prospective Randomized double-blind, placebo-Controlled Trial (RCT) of a xylitol based nasal spray in the prevention of SARS-CoV-2 infection in exposed healthcare workers in two hospitals in Uttar Pradesh, India. Xylitol is known to have anti-infective and anti-inflammatory properties and is used in XLEAR nasal spray and anti-infective chewing gum to prevent dental caries. 

Balmforth found that SARS-CoV-2 infection confirmed by serology was 71% lower with xylitol compared to placebo [36 cases (13.1%) Vs 97 cases (34.5%); p < 0.0001]. Fewer clinical symptoms were also seen in the test group [57 cases (17.6%) vs 112 cases (34.6%), p < 0.0001]. No harmful effects were associated with xylitol. 

smaller clinical study (Jul 2022) of xylitol nasal spray in mild COVID-19 cases demonstrated that persistent loss of smell may be eliminated with xylitol nasal spray during the acute congestion phase.

Nasal sprays are proven safe, inexpensive, non-invasive, easy to use and you can get them off-the-shelf at your local store around the world. There is a growing body of data that sprays, in particular Xlear, can help combat the COVID-19 pandemic. It’s pure commonsense,” Nathan Jones, chief executive officer of Xlear said in a statement.

In March 2021, Xlear filed a Pre-Emergency Use Authorization request with the U.S. Food and Drug Administration in hopes of securing authorization of the spray as a new hygiene tool to help in combat the SARS-CoV-2 virus.

Xlear isn’t the only nasal spray that is showing promise in providing another level of protection against COVID-19, which has infected nearly 100 million people across the globe and led to the deaths more than 2 million people. 

Xlear Xylitol nasal spray where to buyXylitol is available as XLEAR in US pharmacies and on Amazon.

3. Saline Nasal Spray and Irrigation

According to research (Double blind randomized controlled trial of saline solution gargling and nasal rinsing in COVID infection) presented at the annual meeting of the American College of Allergy, Asthma and Immunology (ACAAI) in early November 2023, gargling and rinsing your nasal passages with a simple saline solution can ease the respiratory symptoms of COVID-19 and reduce your risk of hospitalization.

The results have not yet been published in a peer-reviewed medical journal. As reported in an ACAAI press release,1 both high- and low-dose saline regimens, consisting of gargling and nasal rinsing four times a day for 14 days, were associated with significantly lower hospitalization rates for COVID-19 infections compared to the reference population.

A study, published in the Ear, Nose & Throat journal in August 2022, showed that rinsing your nasal passages with a saline solution within 24 hours of a COVID-19 diagnosis could reduce your chances of being hospitalized by 8.5-fold. According to the researchers:

"Our results support that pressurized nasal irrigation reduces the likelihood of hospitalization in high-risk COVID-19 + outpatients, suggesting a safe and over the counter measure with potentially vital public health impact."

Another study (2021) proposing a simple prevention/treatment method that can be made/applied in just about any country, regardless of how poor and remote it is. Namely, a simple solution of salt in water, such that the concentration of salt is about 1.5% (e.g. commonly known as “hypertonic”) in the solution, had a 100% effectiveness of stopping SARS-CoV-2 replication.  

This effectiveness actually exceeds the results (90% inhibition) demonstrated by the study on low-dose vitamin E mentioned above. As the study says, this simple hypertonic saline solution can be administered as a nasal spray as a prophylactic method, or for treating early stages of the infection. For already established or more severe cases affecting the lungs, a nebulizer may have to be used so that the salt vapors can reach the lower regions of the respiratory tract. 

The mechanism of action for the anti-viral effects of the saline is remarkably simple – i.e. the extra salt from the solution accumulates into the cells, which forces them to expend ATP in order to re-balance the electrolyte gradient, and this limits the amount of ATP available for viral replication. Since virtually all viruses, including SARS-CoV-2, depend for their survival on being able to hijack ATP for their own replication this study suggests hypertonic saline may be a universally applicable antiviral treatment.

Nozin Nasal Sanitizer - Available on Amazon

4. Nitric Oxide Nasal Spray (NONS)

Nitric oxide is a type of gas that’s found all throughout your body. It has many jobs, but one of its key roles is helping regulate your immune system. Because of this, researchers are curious if nitric oxide nasal sprays could help treat mild cases of COVID-19.

In particular, a few studies have looked to see if nitric oxide nasal sprays can help prevent severe illness from developing. One small study found that it can reduce viral load by about 95% after 24 hours. And large clinical trials for nitric oxide nasal sprays are still taking place.

A randomized controlled trial (Lancet, July 2022) involving mild-infection COVID-19 patients found that nitric oxide nasal spray can accelerate virus clearance. Patients receiving the nasal spray tested negative approximately four days sooner than those in the control group.

So far, this type of research has been influential in some countries. For instance, one nitric oxide nasal spray — called Enovid — is already available in Israel and on Amazon.com

The product is authorized as a medical device targeting COVID-19 in India, Israel, Bahrain, Indonesia and Thailand.
Canadian biotech SaNOtize’s nitric oxide nasal spray Enovid became available in pharmacies in Israel in July 2021 as a treatment for Covid-19.

The spray received emergency use authorisation in Israel in early July 2021 after Phase II trials showed it reduces SARS-CoV-2 viral load, and therefore decrease a person’s transmission of the virus.

Releasing a small dose of nitric oxide, a natural nanomolecule with anti-microbial properties including against SARS-CoV-2, Enovid provides a physical and chemical barrier in the nose.

In June 2021, SaNOtize announced it had received approval from Health Canada to proceed with enrolment of volunteers in Phase III trials, and submitted an application for a New Drug Submission under Health Canada’s Interim Order.

NONS is the only novel therapeutic treatment so far proven to reduce viral load in humans that is not a monoclonal antibody treatment. Monoclonal antibodies are highly specific, expensive and must be administered intravenously in a clinical setting.

I expect this to be a major advance in the global battle against the devastating human impacts of the COVID-19 pandemic,” said Dr. Stephen Winchester, Consultant Medical Virologist and Chief Investigator of this NHS Clinical Trial. 
This simple portable nasal spray could be highly effective in the treatment of COVID-19 and reducing onward transmission. Our trial included patients with a variant of concern and high viral loads yet still demonstrated significant reductions in the levels of SARS-CoV-2, which could be critical in supporting vaccines, preventing future outbreaks and safely reopening economies. Simply stated, I think this could be revolutionary.”

The SaNOtize treatment is designed to kill the virus in the upper airways, preventing it from incubating and spreading to the lungs. It is based on nitric oxide (NO), a natural nanomolecule produced by the human body with proven anti-microbial properties shown to have a direct effect on SARS-CoV-2, the virus that causes COVID-19. The pharmacology, toxicity, and safety data for NO use in humans has been well-established for decades. The NO molecule released from NONS is identical to the one delivered in its gaseous form to treat persistent pulmonary hypertension, or Blue Baby Syndrome, in newborn babies.

SaNOtize Seeking Emergency Use Authorization in UK and Canada

SaNOtize is applying to regulatory authorities in the UK and Canada for Emergency Use authorization. Swift approval and ramp-up of manufacturing could facilitate an almost immediate safe return to work, school and society, and spur an economic recovery that is months – if not years – ahead of full global vaccination.

Wide-scale equitable global availability of NONS could form a bridge during the global production and distribution of vaccines to help keep people safe and healthy. The ease of NONS manufacture, storage and use makes NONS a treatment candidate that could soon be widely available at low-cost for long-term care facilities, healthcare and frontline workers, and the general population.

In addition to providing antiviral treatment in the early stages of infection and for those who have yet to be vaccinated, NONS has also demonstrated that it could also reduce infectivity – the frequency of transmission from an infected person to a non-infected person.

The results of the UK trial corroborate the information gathered from SaNOtize’s earlier Phase 2 trials in Canada and independent lab tests at Utah State University’s Antiviral Research Institute.

Now that NONS has been demonstrated to be safe and effective in clinical trials, we must move with urgency to get it into the hands of the public where it can help bring an end to the pandemic, accelerate a return to normality, and prevent future outbreaks of COVID-19 and its variants,” said Dr. Gilly Regev, CEO and co-founder of SaNOtize. “The human toll of this disease cannot be expressed simply in numbers, and each day compounds the frustration, fear and loss suffered by millions around the world. Combined with the roll-out of vaccines, NONS can help get the world back on its feet.

Positive Phase 3 Study Results

In February 2022, the company reported a Phase 3 trial achieve its primary endpoint while demonstrating a reduction in SARS-CoV-2 log viral load in COVID-19 patients by over 94% within 24 hours of treatment. Within 48 hours the viral load was wiped out by 99%.

Moreover, a greater proportion of people in the high risk group, numbering 218, achieved a combination of clinical and virological cure, based on the WHO Progression Scale. They report a stunning medical time to virological cure at 4 days in the treatment group and eight days in the placebo group (p<0.05). Moreover, Glenmark Pharmaceuticals received manufacturing and marketing approval for the Nitric Oxide Nasal Spray (NONS) as part of an accelerated approval process.

Co-Founder and CEO Gilly Regev shared with TrialSite’s Founder Daniel O’Connor, “SaNOtize is excited to have Glenmark as our partner for manufacturing and distribution in India. We share the vision for this product and hoping it will become the first line of treatment and defence against respiratory viral infections.”

In late August 2022, it was also reported that Enovid’s manufacturer raised $24M to fund an ongoing phase 3 prevention trial.
Sanotize Nasal Spray Where to Buy | Enovid Nasal Spray Amazon

Canadian biotech SaNOtize’s nitric oxide nasal spray Enovid became available in pharmacies in Israel in July 2021 as a treatment for Covid-19. You can purchase it online on Amazon.com

Glenmark Pharmaceuticals has signed a partnership with Canadian company SaNOtize Research & Development Corp., to manufacture, market and distribute Nitric Oxide Nasal Spray (NONS) for COVID-19 treatment in India and Asian markets including Malaysia, Singapore, Hong Kong, Taiwan, Brunei, Nepal, Cambodia, Laos, Myanmar, Sri Lanka, Timor-Leste and Vietnam.

5. Iota-Carrageenan Nasal Spray for COVID-19

Iota-carrageenan nasal spray is also being studied as a way to prevent COVID-19. Iota-carrageenan is a sugar that comes from algae.

Marinomed Biotech AG (VSE:MARI), an Austrian science-based biotech company with globally marketed therapeutics derived from innovative proprietary technology platforms, announced today that Carragelose inactivates the new, rapidly spreading variants and SARS-CoV-2 wildtype with similar efficacy in vitro. The Company tested the three variants that currently mostly drive the COVID-19 pandemic, namely the so-called British or B.1.1.7, the South-African or B.1.351, and the Brazilian or P1 variant.[*] The data demonstrate that also with increasing prevalence of virus variants, the marketed OTC Carragelose-based lozenges, nasal and throat sprays will continue to effectively contribute to combatting the COVID-19 pandemic.

The COVID-19 pandemic continues to be a major health, social, and economic burden, and we now see variants of SARS-CoV-2 taking over the dynamics of the pandemic. We are very confident in these results that show Carragelose inactivates SARS-CoV-2, independent of the mutations we tested,” said Dr. Eva Prieschl-Grassauer, Chief Scientific Officer at Marinomed. “Given the broad antiviral efficacy and the physical mode of action, we were convinced that SARS‑CoV‑2 variants are unlikely to evade the antiviral efficacy of Carragelose. With these new results we confirmed the hypothesis that our Carragelose-based products continue to be effective also against the mutations of concern currently emerging strongly. We believe that this will hold true for any future variants.

In recent in vitro tests, Marinomed included four lentiviruses differently pseudotyped with the spike protein of wild-type SARS-CoV-2 or one of the three variants B.1.1.7, B1.351 and P1, respectively. Carragelose was able to inactivate all four virus forms at concentrations below 5 µg/ml. This is clinically relevant for the use of Carragelose-containing products: The marketed nasal sprays have a Carragelose concentration of 1.2 mg / ml, a more than 200-fold higher dose as shown to be effective in vitro. The non-sulfated polymers HPMC and CMC were ineffective even at the highest concentrations tested.

In addition, two of the three SARS-CoV-2 variants (B1.1.7 and B1.351) were independently tested in Vero cell tissue culture in cooperation with the virological institute of the University Hospital Erlangen, Germany. Carragelose showed similar effectiveness against the SARS-CoV-2 wild type and the tested variants.

Marinomed’s lentivirus data show the ability of Carragelose to prevent the virus from attaching to the host cell. The infectious virus particles used in the cooperation with the virological institute of the University Hospital Erlangen mimic the effect of an actual infection, where the virus replicates in the host cells and then reinfects further cells, thereby spreading the infection in the body. Both are established and scientifically widely accepted models. Taken together, the data show how Carragelose can effectively inhibit SARS-CoV-2 variants in tissue culture. The cooperation partners plan to publish the data in a peer reviewed journal.

So far, one study of about 400 healthcare workers suggested that iota-carrageenan may potentially lower the risk of getting COVID-19 by up to 80%. Another study is looking to analyze iota-carrageenan’s ability to prevent COVID-19, but it's still recruiting participants. This study is expected to wrap up by February 2023.

About Carragelose®:

Carragelose® is a sulfated polymer from red seaweed and is a unique, broadly active anti-viral compound. It is known as a gentle yet effective and safe prevention and treatment against respiratory infections. Several clinical and preclinical studies have shown that Carragelose® forms a layer on the mucosa wrapping entering viruses, thereby inactivating them, and preventing them from infecting cells. Increasing clinical evidence indicates that Carragelose® can also inactivate SARS-CoV-2.[1],[2] 

Marinomed is holder of the IP rights and has licensed Carragelose® for marketing in Europe, parts of Asia, Canada, and Australia. For a full list of Marinomed’s portfolio of Carragelose® containing nasal sprays and oral products, please visit https://www.carragelose.com/en/portfolio/launched-products, for a list of scientific publications on Carragelose®, https://www.carragelose.com/en/publications.


6. Nasal spray vaccines

A number of COVID-19 nasal spray vaccines are also being researched and developed. It’s thought that they could help build up protective antibodies in your nose that fight SARS-CoV-2.

Several COVID-19 nasal spray vaccines are being researched in studies — 16 intranasal and 2 inhaled to be exact. They aim to build up protective antibodies in your nose that fight SARS-CoV-2, the virus that causes COVID-19. A few are authorized in Asia, but none are available in the U.S. yet.

China has become the first country to approve an inhaled Covid vaccine. Made by CanSino (“CanSinoBIO”) (SSE: 688185, HKEX: 06185), Convidecia Air has similar ingredients to its injected vaccine, using a harmless adenovirus as a carrier for the genetic code that teaches the body how to fight Covid.

Inhaled as a fine mist, Convidecia Air can provide good protection after just one breath, the company says.

Other researchers, including teams in the UK and the US, have been investigating nasal spray vaccines.

Scientists say these may give added immunity in the lining of the nose and upper airways, where Covid typically enters the body.

The National Medical Products Administration of China granted CanSino approval for its inhaled vaccine to be used as a booster dose.

It can top up protection in those who have previously had a jab, trials suggest.

In July 2023, the Icahn School of Medicine at Mount Sinai in New York announced that CastleVax has completed phase 1 trials for its nasal vaccine. The study is expected to be completed in the spring of 2024.

7. Steroid nasal sprays

Corticosteroid (steroid) nasal sprays are available widely in the U.S., and they’re often used for treating conditions like allergies and nasal polyps. But some researchers are exploring their potential as a treatment option for COVID-19. It’s thought that these sprays can help control inflammation while also stopping the coronavirus from entering your respiratory system.

In one Cleveland Clinic study, registry data from over 70,000 people with mild-to-moderate COVID-19 was collected. Results suggested that corticosteroid nasal sprays may help prevent hospitalizations, ICU admissions, or death from COVID-19. But to see if they’re truly safe and effective for COVID-19, clinical trials would need to be performed.

Related: Inhaled Budesonide and COVID-19

8. Antibody Nasal Spray

A January 2024 study finds that administering IgA antibodies via nasal spray can fend off multiple omicron variants within the respiratory tract. The immune system generates different types of antibodies, each serving distinct functions. IgA antibodies in the respiratory mucosa play a protective role at the entry point of viruses in the respiratory tract, preventing their replication or entry into the lungs. The COVID-19 vaccines primarily stimulate an IgG antibody response within the body, with limited impact on the induction of mucosal IgA antibodies. The preventive capability of IgG antibodies generated via vaccination with the original strain is also less effective against the omicron variant.

In January 2024, a study from Sweden’s Karolinska Institutet was published in the Proceedings of the National Academy of Sciences (PNAS). In it, researchers used genetic engineering to convert IgG antibodies into IgA antibodies, and the results revealed that these exhibited a more robust neutralizing activity against the omicron variant. For the omicron subvariants BA.1, BA.2, BA.4, and BA.5, the potency of IgA antibodies increased by 25 to 75 times compared to the parental IgG antibodies.

An earlier study found that IgA antibodies produced in the respiratory mucosa, whether through infection with the original COVID-19 virus or vaccination targeting it, can effectively prevent omicron variant infection. The higher the levels of IgA antibodies in saliva, the less susceptible individuals are to the omicron variant. Conversely, even after a person receives the COVID-19 vaccine, a lack of IgA antibodies still poses a higher risk of contracting COVID-19.

The research team indicated that the IgA antibodies in the nasal spray are expected to provide at least 24 hours of protection, and they aim to develop nasal sprays with even longer-lasting protection in the future. The researchers believe this IgA antibody nasal spray can be used for both preventive measures and post-infection treatment. Direct supplementation of IgA antibodies via nasal spray is particularly beneficial for people with compromised immune systems, such as those with HIV/AIDS, who may not generate sufficient immunity through vaccination. 

What medications can I take to treat or prevent COVID-19?

Nasal sprays aside, many medications are already authorized to treat and prevent COVID-19. Your healthcare provider can tell you if you’re eligible to access any of these treatments.

    Note: Treatment of COVID-19 is a highly dynamic topic. Please refer to the latest FLCCC protocols.


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