Nasal Spray Addiction

by Andrew R. Gould, MD

One of the most common patient complaints in my office is chronic nasal obstruction. The inability to breath through your nose can truly make you miserable. There are multiple potential causes for this problem; however, overuse of the over-the-counter nasal sprays is one of the most frequent. If our physicians see that little white bottle poking out of a patient’s shirt pocket, and they also admit having a bottle of spray on their night stand, as well as in their glove box, then we are in trouble. People typically start using them when they get a cold or have an allergy flare-up, and then gradually become addicted to them. It is not uncommon to find people who have been using nasal sprays for years and years. There are multiple different trade names such as Neo-Synephrine, Afrin, and 4Way; however, the chemical names are phenylephrine, oxymetazoline, or xylometazoline.

Unfortunately, these nasal sprays cause problems if they are used for longer than three to four days. They typically cause a phenomenon called rebound congestion. The medication basically causes the tiny blood vessels in the mucous membranes to constrict, causing temporary shrinkage in the lining of the nose and therefore better breathing. After a few days however, the blood vessels become severely congested when the medication wears off. This results in the need for nasal spray every few hours.

Quitting is easier said than done. “Cold turkey” is obviously the quickest and simplest method; however, this may be ineffective for some people. Some may benefit from adding an over-the-counter or prescription oral decongestant, but you must be careful of the potential side effects from these medications. The decongestants need to be taken one week beyond your last dose of nasal spray. Tapering the nasal spray also may be effective. We recommend decreasing your daily dose by one dose at three day increments until you have gradually stopped using those sprays all together. For those that are severely addicted, tapering one side of the nose at a time may be the best option. This will at least allow you to breathe well through one side of the nose. Also, adding a saltwater nasal spray, three to four puffs, six to eight times a day, will help moisten the swollen membranes and loosen crust which is associated with the chronic use of addictive nasal spray.

If you are unsuccessful, a trip to your Ear, Nose and Throat doctor may be necessary. We are usually able to facilitate discontinuation of nasal sprays with prescription strength medication. Our physicians will also carefully search for the underlying cause of the nasal stuffiness which created the need for nasal sprays in the first place. Problems such as anatomic obstruction, nasal allergies, chemical sensitivities or chronic sinusitis, are often to blame and can be treated effectively. So the next time you are thinking about reaching for that over-the-counter nasal spray, be careful because you may wind up with more than you bargained for.