Published on Jun 14, 2011 with 0 comment
Decongestant nasal sprays or decongestant nose drops, like Afrin, Neosynephrine, Vicks, Sinex, Duration, and 4-Way, offer wonderful short term relief of nasal congestion. These brand names and their generic equivalent over-the-counter nasal sprays provide almost immediate relief of congested noses associated with colds, allergies, or other sinus conditions. Most are designed to provide 12 hour relief of nasal congestion, but they do nothing for the runny nose, sneezing, itching, or post nasal drip associated with these conditions.
Decongestant nose sprays and decongestant nose drops are generally very safe and effective if used as recommended, but the problem comes when they are taken too frequently or for longer than 5-7 days consecutively. Overuse results in a rebound phenomenon, whereby the medication lasts for shorter and shorter periods of time, resulting in the need to be taken more frequently to provide relief. The first sign of a problem may be the need to use a nasal spray several times in the middle of the night in order to breathe through the nose. Such patients become increasingly dependent and think they have a nasal spray addiction. This overuse leads to a condition called Rhinitis Medicamentosa.
During my career as a physician, I can recall two very memorable cases of Rhinitis Medicamentosa. The first occurred when I was consulted to see a newborn baby who was in respiratory distress. It was determined that the baby’s obstruction to airflow was occurring in the nose and not the lungs. Unfortunately for this baby, newborns can only breathe through their noses and they do not mouth breathe. Since this was a very unusual presentation, I spoke to the mother and a careful history revealed that she had a nasal spray addiction and was using decongestant nasal sprays frequently throughout her pregnancy, labor and delivery. It was presumed that the baby had Rhinitis Medicamentosa secondary to the mother’s overuse. Tubes were placed in the baby’s nostrils to create an airway and fortunately the swelling in the baby’s nose resolved over several days.
The other was a case of an elderly gentleman who had been using decongestant nose spray every 2-4 hours for over 25 years! He was indeed addicted to nose spray. Fortunately, he responded well to treatment and he was off of spray within two weeks.
Treatment of decongestant nose spray addiction is generally very successful. It commonly requires a short course of oral or injectable corticosteroids in order to break the cycle of overuse, and a short weaning period from the nasal spray. But, the best treatment is to avoid overuse. Long acting decongestant nose sprays and decongestant nose drops are recommended either once or twice a day, and for no longer than five to seven days consecutively.
The issue of nasal spray addiction applies only to decongestant nose sprays and not to nasal corticosteroid sprays. Because the steroid sprays do not give immediate relief, there is rarely a problem of overuse. Steroid nose sprays can be safely used over long periods of time, while under the supervision of a physician. Even if steroid nose sprays are taken more than prescribed, Rhinitis Medicamentosa will not result.
Becoming “hooked on” or addicted to decongestant nose spray or decongestant nose drops is preventable. The bottom line is that all medicines, both prescription and over-the-counter, should be taken only as prescribed or recommended!