Suffering from nasal spray addiction?

Step 1: Put down the Afrin

If you suffer from seasonal allergies or an upper respiratory infection, your friends may warn you about the dangers of Afrin addiction. “If you use it once, your body will become dependent on it,” they say. Doctors call this phenomenon “rebound congestion,” or rhinitis medicamentosa, and it is a very real problem. In fact, it could be responsible for up to 9% of visits to allergists and ENT doctors.

Afrin (oxymetazoline) is a nasal decongestant spray sometimes used to relieve a stuffy nose and sinus pressure. As cold and flu season begins, you’re more likely to use this OTC remedy. But you should beware of the side effects of using it too often.

Rebound congestion 101

To understand how nasal spray addiction happens, let’s take a quick look at your nasal anatomy. According to Dr. Duane Gels, MD, an allergist with Annapolis Allergy and Asthma in Maryland, your upper airway expands and shrinks all the time. 

“The nose is packed with blood vessels, as anyone who’s had a nosebleed that resembles a crime scene can attest,” Dr. Gels says. “As our position changes from standing to sitting to lying down, the weight of the blood shifts.” This keeps your nose from clogging up when you change positions. 

Adrenaline can change blood flow to your nose as well. “Adrenaline released into the blood during a fight or flight response (such as running to evade a predator) attaches to receptors in the nose, widening the passages so we can breathe easier,” Dr. Gels explains.

He explains that oxymetazoline (the active Afrin ingredient) actually works by mimicking adrenaline in your nose. It forces your nostrils open by squeezing the blood out of your nasal tissues. When you spray a shot of Afrin nasal spray into your nose, you will feel immediate relief from that awful congestion. Unfortunately, the relief is temporary. The Afrin side effects—like rebound congestion—are not.

When the blood drains from your nose, so do the oxygen and nutrients that blood brings with it. Your nasal tissues need these things, so once the Afrin wears off, your body overcompensates by drawing more blood to your nose, and you feel even more congested than you did before.

What is rebound congestion?

“Rebound congestion is increasing nasal congestion as the decongestant nasal spray wears off, causing the patient to use more spray to combat the continued congestion,” says Dr. Susan Besser, MD, a primary care provider specializing in family medicine at Mercy Personal Physicians in Baltimore. “So, the patient continually feels a need to use the spray to combat the continued congestion. In effect, this leads to dependency on the medication to control the symptoms.”

In other words, it becomes a vicious cycle. After a few days of use, the nasal spray will relieve your congestion for shorter and shorter periods of time, causing a rebound effect. The rebound congestion can get so bad that eventually, the Afrin doesn’t clear your airway at all. The problem can go on for years.

Rebound congestion treatment

The best way to break the cycle of Afrin addiction, Dr. Besser advises, is to stop taking the medication cold turkey. “Expect to be miserable for a few days while the body recovers,” she says. “One can use a nasal steroid (such as Flonase) to help limit the symptoms while the body recovers. In severe cases, an oral steroid can be prescribed, which may help.”

Dr. Gels adds that saline spray might help to reduce the inflammation. In addition, “Oral decongestants like pseudoephedrine or phenylephrine tablets can decongest without the threat of rebound congestion,” he says.

If you feel only Afrin spray will work, Dr. Besser says it’s okay for a day or two. “I have even seen ENT doctors recommend it for very limited use,” she says. “But I wouldn’t suggest reaching for it first; use all other measures before Afrin.”

There are several other treatment options for nasal congestion that won’t trigger a dependence.

“If the problem is allergies, topical nasal steroids (Flonase and Nasacort) reduce allergic inflammation over a couple days,” Dr. Gels says. “These are available over the counter. Prescription Singulair can also improve nasal congestion.”

Rebound congestion is a surprisingly common problem that can cause you years of agonized breathing. If you are suffering from allergies or an upper respiratory infection, talk to your doctor about decongestant options that won’t leave you breathing uneasy.