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Can You Get Addicted to Nasal Spray?

Prolonged use of certain types can make a stuffy nose worse and kick-start a cycle

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AARP (Source: Shutterstock (2))

If you routinely reach for nasal spray to unclog your stuffy nose, you may start to wonder if the product you once relied on to deliver relief is actually doing the opposite.

Many nasal spray users have experienced this phenomenon, known as rebound congestion, which health experts say can occur with routine use of certain — not all — types of nasal sprays. It’s estimated that up to 9 percent of patients visiting ear, nose and throat specialists (ENTs) have rebound congestion, though research suggests the condition may actually be more common given the number of over-the-counter nasal sprays that are so readily available. 

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It typically occurs as a result of overuse or prolonged use of nasal decongestant sprays that contain the ingredients oxymetazoline or phenylephrine, says Nicholas Rowan, M.D., a rhinologist and associate professor at Johns Hopkins School of Medicine in the Department of Otolaryngology — Head and Neck Surgery.

“These medications work by constricting blood vessels in the nasal passages, providing immediate relief from nasal congestion and blockage,” Rowan says. “With prolonged use, however, the nasal passages can become tolerant to the medication’s effects. As the body becomes tolerant, it requires higher doses to achieve the same level of relief.”

This need for more is not an addiction by definition — that would imply the nasal sprays cause functional changes to the pleasure-reward circuits in the brain. But overusing certain sprays can create a physical dependence.

Here’s what you need to know.

Nasal decongestant sprays and rebound congestion

If the flu, a sinus infection or the common cold is to blame for your stuffed-up nose, a nasal decongestant spray can help unstuff it by shrinking blood vessels in the nasal passages, making it easier for you to breathe. However, if you use a decongestant spray for more than three days in a row, it’s no longer able to do its job.

Worse, when you stop using it, your nasal passages begin to swell again, which is like a calling card for your congestion to return, prompting you to reach for the nasal spray.

“Prolonged use of nasal decongestant sprays can cause the blood vessels in the nasal passages to become increasingly sensitive and reactive,” Rowan says. “When the medication wears off, the blood vessels dilate, leading to even more severe nasal congestion than before, perpetuating a cycle of dependency on the decongestant.”

To prevent rebound congestion, experts advise using these types of sprays no more than twice a day for three days:

  • Oxymetazoline (Afrin, Anefrin, Dristan, Vicks Sinex, Mucinex Sinus-Max)
  • Phenylephrine (Neo-Synephrine, 4-Way)

Worth noting: If you cleared your medicine cabinet of all decongestants that contain phenylephrine after the U.S. Food & Drug Administration concluded last fall that the ingredient is ineffective when taken by mouth, it’s important to note that the same isn’t true when it’s delivered directly to the nose as a spray. Although phenylephrine taken orally is rendered useless before it can enter your bloodstream, that’s not the case when used as a nasal spray or, for that matter, drops to dilate the eyes.


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Not all nasal sprays are the same

Allergy sufferers, know this: Just because nasal decongestant sprays aren’t meant to be used for more than three days doesn’t mean you have to white-knuckle your way through allergy season.

Nasal sprays that provide allergy relief are altogether different. Not only is it OK to use them every day, they should be used daily to control allergy symptoms. In fact, some should be used in advance of allergy season.

There are three types, and none is habit-forming:

  • Steroid sprays: fluticasone (Flonase); mometasone (Nasonex); budesonide (Rhinocort); triamcinolone (Nasacort)
  • Antihistamine sprays: azelastine (Astepro, available over the counter; Astelin, by prescription); olopatadine (Patanase, by prescription)
  • Saline nasal sprays

“Nasal decongestant sprays tend to work faster than these sprays, but these aren’t habit forming and there’s no risk of developing rebound congestion,” says Daniel Alicea, M.D., a sinus surgeon and assistant professor in the Department of Otolaryngology — Head and Neck Surgery at the Icahn School of Medicine at Mount Sinai. “Each of them works differently, but ultimately they all provide relief for nasal symptoms such as congestion, runny nose, postnasal drip, sneezing and nasal itching.”

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How to kick the habit

If you’ve used a nasal decongestant spray for a couple days longer than recommended and you’ve got all the symptoms of rebound congestion, you might be able to taper off on your own. If not, talk to your doctor about how to break the cycle — especially if you’ve been using one for weeks, months, even years.

“If you’re stuck in a cycle of rebound congestion from overusing nasal sprays, it’s best to see a board-certified otolaryngologist for help,” says Alicea, adding that they might recommend a short course of oral corticosteroids and switching to a nasal steroid spray.

Your doctor may also discover the root of the problem. “Individuals who become reliant on these sprays typically have some sort of underlying nasal or sinus problem, which is why they start using them in the first place,” Rowan says.

How to prevent rebound congestion

It’s one thing to swear off overusing the habit-forming nasal sprays if you suffer from the occasional sinus infection or cold. These usually resolve on their own. But it’s altogether different if you suffer from what’s known as chronic rhinitis (inflammation of the inner lining of the nose). For sinus sufferers who need ongoing relief, there are a number of options that won’t set them up for rebound congestion.

“Nasal saline sprays, steroid sprays, irrigations like a sinus rinse bottle or a neti pot, and over-the-counter antihistamines are all effective,” Rowan says. “They are best used on a daily basis while you’re sick or during allergy season.”

So-called natural decongestants can also play a role. A steamy shower or a hot towel wrapped around the face may relieve congestion. Drinking plenty of fluids, especially hot beverages, to keep mucus moist and flowing also helps.  

“If symptoms don’t improve, seek out care with your primary doctor or an ear, nose and throat surgeon,” Rowan says. “Sinus and nasal conditions are incredibly common and there are solutions available.”

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