The Nasal Spray “Addiction”

The Nasal Spray “Addiction”


Many would agree that nasal congestion is one of the more bothersome symptoms of a common cold or allergies. Congestion can put a heavy burden on work, play, or sleep by making it harder to breath and causing pain and pressure in the sinus cavities.

Unfortunately, this time of year gives little reprieve to those suffering from nasal congestion. Fall allergies – whether it be due to ragweed or mold from the dampness – can wreak havoc on the respiratory system. The cold air also drives many people indoors, where close quarters can cause an easy spread of bacteria and viruses. Heating systems tend to dry out mucosa, a protective lining of the throat and sinuses, making it easier for viruses to grow. Lastly, newer research has found that immune systems tend to function in a lower capacity in colder temperatures. When considering these factors, it is no wonder that many people seem to be sniffling their way through the day.

A common product of use is a nasal spray decongestant called oxymetalozone (Afrin, Duramist Plus). The medication provides relief for congestion and is often recommended by doctors and pharmacists alike. However, it is important to be aware of the potential side effects and dangers of misuse.

The nasal decongestant works by constricting the blood vessels of the nose. The constricted vessels lead to less blood flow, and therefore less nasal discharge. A couple of sprays works almost immediately to open up inflamed nasal passageways, with the effect lasting up to 6 hours. Some versions can provide relief for almost 12 hours. Commonly purchased over-the-counter for less than $10 a bottle, it is an economical and easily procured way to ease congestion. But often times, the medication works so well that patients have a hard time stopping its use. The problem arises when Afrin is used for more than three or four consecutive days or longer. This type of dependence is actually more common than most healthcare professionals recognize and could eventually lead to more serious issues.

Why is it such a problem when the nasal spray is used for more than three or four days? The overuse of medication can cause rebound congestion, a phenomenon in which the vessels become tolerant to the drug and congestion returns – sometimes even worse than before. To the unknowing individual, this congestion may contribute to the feeling of having to use it again and again in order to obtain relief. A vicious cycle may occur in which overuse may lead to dependence. Unlike addictions to other drugs – such as heroin or cocaine – this “addiction” does not become physical, in which the body craves the medicine. However, it becomes more psychological, in which the patient feels they need to consistently use it to obtain relief.


Prolonged use can severely irritate the lining of the nose and cause damage to the mucosa. In rare cases, excessive dosing can lead to systemic absorption. This simply means that the drug starts to be absorbed into the blood stream, instead of just staying in the nose. Low blood pressure, decreased heart rate, dizziness, and fatigue have been reported in rare cases.

If prolonged use is causing rebound congestion, stopping the medication is first and foremost. It is important to note that the nasal spray will not fix the initial cause of congestion, whether it be due to allergies or a cold. If congestion is due to allergies, a more appropriate option would be to use a steroid nasal spray, such as fluticasone (Flonase) or triamcinolone (Nasacort). Sometimes even oral steroids are beneficial in short courses for allergic causes. For more acute issues, oral decongestants, like pseudoephedrine (Sudafed), can help without the fear of rebound congestion.

Other options are non-pharmacological, in that they do not contain a drug or active ingredient. These options are especially important for pregnant or breastfeeding women or those individuals who simply want to try a milder alternative. Saline nasal spray can be used to moisturize the nose and repair damaged tissues caused by overuse of the decongestant. Saline can loosen blocked nasal passageways and make it easier to blow out. Since it is also a spray, saline can help patients who feel the need to use Afrin by mimicking the use of the drug. If congestion occurs at bedtime, many patients report relief with nasal strips that physically open the nasal passageways. Also, the use of a facial steamer can help as well to loosen any thick mucus causing the congestion.

Afrin and other nasal decongestant sprays are generally safe and helpful options for relieving the burden of congestion. It is important to remember to use for a short term only and to consult a physician if congestion is persistent or severe.





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