Addiction to decongestant nasal sprays: side effects and solutions

Decongestant nasal sprays provide relief from a blocked nose. However, avoidable problems can and do occur with overuse. Mr Prince Modayil is one of London’s leading ENT (ear, nose and throat) specialists. Within this article, he provides the must-know facts regarding decongestant sprays, such as why they can be addictive and the resulting side effects from long-term use. He also provides insight into how he treats these side effects.

Are nasal sprays addictive?

Addictions are physiological cravings and while over-the-counter nasal sprays can be addictive, they aren’t true physiological cravings. Therefore, they are not truly an addictive substance. However, they can be addictive due to the ongoing cycle of decongestion and congestion that they create.

Some common brands of nasal spray are

• Vicks Sinex (oxymetazoline)
• Otrivine (xylometazoline)
• Sudafed (xylometazoline)

Why do people get addicted?

With the use of nasal sprays, the nose becomes decongested but at the same time, more nasal congestion is created as a result. Once a person stops using the spray, the nasal congestion worsens. As a consequence, they believe they need to use the spray more often and for a longer period of time than recommended.

What happens after long-term use?

After continuous and frequent use of nasal sprays, people can develop rebound nasal congestion (clinically referred to as rhinitis medicamentosa). Symptoms of rebound nasal congestion and dependency on nasal spray may include:

• becoming congested again soon after using the spray
• having the sensation that the spray doesn’t work anymore
• wanting to use the spray more often than the spray’s guidelines recommend
• relying on the decongesting spray on a daily basis to breath normally

Can prolonged use damage nose structures?

Yes, it can.

• The nose contains air conditioning cushions with the overuse of decongesting sprays, the cushions become thickened. This is clinically called “turbinate hypertrophy” and it can increase the blockages in the nasal passages.
• The cilia are your nose hairs and these are important in clearing nasal and sinus secretions. Prolonged use of nasal sprays can cause the cilia to function abnormally.
• Overuse can also result in increased blood flow to the nose, therefore causing even more nasal congestion.

Do nasal sprays affect blood pressure?

A specific nasal decongestant, Sudafed (pseudoephedrine) can increase blood pressure.

What is your professional advice for people who are overusing decongesting nasal sprays?

Key points I advise are:

• Be aware of the hidden hazards (that are explained above).
• Do not use the spray for more than three to five days.
• Do not use the spray more frequently than the product instructions recommend.

The first week of stopping decongestion sprays is often the most difficult. However, it is possible to overcome it with determination and medical assistance.

How do you help people who have overused decongesting sprays?

Firstly, I look for the initial reason of congestion that caused my patient to seek out the nasal spray. To do this, I perform a nasal endoscopy exam. If the endoscopy identifies any of the following causes, I then place my patient on a course of treatment to relieve the blockage.

• Sinusitis
• Nasal polyps
• A deviated nasal septum
• Allergy related conditions

If none of the listed conditions are at fault, I will provide my patient with a steroid nasal spray and this does not cause rebound congestion nor is it addictive. I instruct patients to gradually (over three weeks) lessen its use from twice a day to once a day and then to only use it at night. Ultimately, they won’t be using the nasal spray at all.

I may also recommend the use of saline nasal spray and if patients experience a headache during withdrawal from the decongesting spray, I may recommend paracetamol.

Visit Mr Prince Modayil’s profile to learn how he can provide you with care of the highest quality for a wide range of ear, nose and throat conditions.