When your nose is stopped up because of a cold or allergies, you feel awful. Breathing through your mouth when you are trying to sleep can be especially challenging. It’s hardly surprising that people frequently turn to nose sprays to open up congested sinuses. Few people bother to read the warning about the three-day limit. After that, decongestant spray addiction can be challenging. No one is getting high here. They just have a hard time quitting their nasal spray. This reader shares what it can be like.
Hooked on Afrin:
Q. Several years ago, I was hooked on Afrin. I could not breathe through my nose unless I used it.
My doctor prescribed a tapering dose of prednisone and I could breathe freely within one day. I didn’t like the prednisone because it made me very agitated and prevented sleep. On the other hand, it did take care of the addiction.
I don’t plan on using Afrin for more than three days again. I don’t want to have to deal with prednisone any more, as there are problems with that, too.
The 3-Day Limit:
A. Nasal decongestant sprays like Afrin (oxymetazoline) have a clear warning:
“Do not use for more than 3 days. Use only as directed. Frequent or prolonged use may cause nasal congestion to recur or worsen.”
The official name for rebound nasal congestion is “rhinitis medicamentosa.” That means a stuffy nose triggered by medication overuse. Believe it or not, there is a surprising paucity of good research on how to treat this condition (Otolaryngology–Head and Neck Surgery, March, 2019).
When people use topical decongestants such as naphazoline, oxymetazoline, phenylephrine or xylometazoline for more than few days, their noses adapt to the vasoconstriction. When the medicine is stopped, blood vessels dilate and create congestion that can be challenging. Another way to describe this is rebound nasal congestion.
Michelle in Alabama describes her challenge:
“I had an Afrin addiction for 15 years (needing it every 2-4 hours). I wanted to share my process so that others may kick it – I finally did it!
“1. I began using a saline mist to flush out my nose once in the morning and once at night. At first, the saline mist wouldn’t even go all the way through my sinuses. After about four days, it would.
“2. I began extending the time I would wait before I would use the Afrin by 30 minutes. It didn’t matter how miserable I was, how stuffed up, how bad my headache was getting, I was going to wait! If I used it every four hours one day, I would make myself wait four and a half hours the next day – no matter what. Sometimes I felt a sense of desperation waiting those last thirty minutes, but I did it.
“3. At some point, when I was going to wait eight hours, I left my Afrin bottle at home. That was the first time in 15 years I was able to be separated from that little bottle. At work, I sat and thought about that little bottle. I was tempted to run home and get it ‘just in case.’ Willpower alone kept my butt in my seat.
“4. Using it only once a day was the most difficult. Times when I should have been sleeping were actually spent looking at the clock waiting for that final little bit of time to run out. The rebound would get so bad I would get out of bed and sleep in a recliner. Having my head elevated would relieve the swelling and allow me to get some sleep.
“At the time that I was going to wait 26 hours (at one point that would have been impossible), I actually slept through the night. When I woke up, I was a little stuffy, but the saline mist cleared it up. I will never use nasal spray again! No more ridiculous amounts of sneezing, no more making sure I have that bottle with me, no more trying to surreptitiously use it or making excuses.”
“If I can get over a decongestant spray addiction, anyone can!”
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Other Ways to Deal with Decongestant Spray Addiction:
The Alternate Nostril Approach:
Marilyn shares her strategy for overcoming decongestant spray addiction:
“I had a full-blown addiction to nasal sprays before it was commonly known that it could happen. I sprayed one nostril only until the other cleared, and then stopped. One nostril free breathing is tolerable. It took 5-7 days for each nostril to clear.”
Bonnie used the same strategy to deal with decongestant spray addiction:
“I have been addicted to Afrin twice in my lifetime. I can’t remember how I got off of it the first time; maybe cold turkey. I vowed not to get hooked on it a second time, but alas, I began using it again with a head cold and sinus congestion.
“This was the worst time of all, and it lasted several years. I was using it every hour during this time. I read a suggestion of stopping in one nostril at a time, and this worked for me. It took less than a week, and I was free! I do still use a nasal spray occasionally when I have a cold, but never more than once every 12 hours. I will not go down that road again.”
Kirk dilutes his bottle to overcome decongestant spray addiction:
“I rarely use 12-hour nasal decongestants because of the rebound associated with them. Phenylephrine 1% sprays (Neo-Synephrine) is not 12 hour; however prolonged use at that concentration can also cause some rebound congestion, though nowhere near as severe.
“I dilute it down by adding water, generally between 10 and 12 ounces total including the 1 oz of generic phenylephrine spray. You could also use saline to dilute it, although that could get expensive. It takes a little longer for relief during a cold, but doesn’t cause severe rebound like the 12 hour sprays do.”
We would advise using sterile saline to dilute the nose spray decongestant. We would not want someone to develop an infection by using tap water.
Using a Topical Corticosteroid Spray to Overcome Decongestant Spray Addiction:
Some years ago we heard from readers who used topical steroid sprays such as Nasonex:
Mike in Alabama used Nasacort to overcome his decongestant spray addiction:
“The solution to nasal spray addiction is simple. I discovered it by accident. Here’s how to do it:
“1. STOP using your decongestant nasal sprays.
“2. Buy a bottle of Nasacort (over-the-counter). It costs between $15 and $20. Nasacort is a steroid nasal spray. It works differently than Afrin and similar sprays. Use two sprays in each nostril daily for 20 days.
“3. It will take 2-4 days before you notice any improvement. KEEP USING IT even though your symptoms are improving. After about 7 days your nose will open. Once your nose has opened, you can stop using Nasacort without any side effects.
“I used Afrin daily for four years and tried everything imaginable to get off of it. Then I discovered Nasacort and cured the addiction. It is the answer to nasal spray addiction!”
What to Do for Allergies?
Because allergies last longer than three or four days, decongestant nose sprays are inappropriate for treat the resulting congestion and runny noses.
Another reader found a different solution:
“I have always been plagued with nighttime congestion, but I’ve had great success with NasalCrom. If I forget to use it, the congestion comes right back. When I start to use it again, my congestion is gone!”
Cromolyn sodium (NasalCrom) stabilizes mast cells in the nasal passages. These cells discharge histamine and other inflammatory compounds, but this spray prevents their release. It does not lead to rebound congestion.
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” Read Joe's Full Bio.
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Zucker, S.M., et al, "Management of Rhinitis Medicamentosa: A Systematic Review," Otolaryngology--Head and Neck Surgery, March, 2019, doi: 10.1177/0194599818807891
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