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How to Beat Nose Spray Dependence One Nostril at a Time

Decongestant nasal sprays such as Afrin can lead to rebound congestion if they are overused. How can you overcome such nose spray dependence?

Decongestant nose spray is fabulous when your nasal passages are so congested you can’t breathe. Just a spritz can open clogged sinuses. However, such nasal sprays have a big downside: nose spray addiction. If a decongestant spray is used for more than a few days, the tissues of the nose become dependent on it. Stopping it suddenly results in rebound congestion, and suddenly you can’t breathe again! Sometimes people get stuck in this vicious cycle for years. How can you overcome it and break your nose spray dependence?

The Medical Name for Rebound Nasal Congestion:

Doctors call this problem rhinitis medicamentosa. It translates as drug-induced inflammation of nasal tissues. What’s really happening?

The ingredients in nasal decongestants are vasoconstrictors. That means they cause the small blood vessels in the nose to constrict. These are medications such as oxymetazoline (Afrin, Duramist Plus, Dristan 12 Hr, Sinarest, Vicks Sinex Severe 12 Hr, etc), phenylephrine (Neo-Synephrine, Nostril, etc) and xylometazoline (Balminil Decongest, Otrivin, etc.)

The Warning on the Label To Prevent Nose Spray Dependence:

The FDA actually requires a warning on the label of many nasal decongestants. For example, here is what you will find on the Afrin Original Nasal Spray packaging:

When using this product

  • do not use more than directed
  • Do not use for more than 3 days. Use only as directed. Frequent or prolonged use may cause nasal congestion to recur or worsen.

How To Resist The Temptation To Breathe?

People love the effect of nasal decongestants. Within seconds of a spritz to the nose, you can breathe again. It’s almost like magic and very seductive. When your nose gets stuffy again, another spritz and voila! Your stuffy nose goes away…until the medicine wears off. Why not spritz again…and again…and again?

It’s easy to understand how people would keep using a nasal decongestant for more than three days. Allergies and colds usually last longer than that. And the FDA does not require drug manufacturers to provide strategies for dealing with a nose spray dependence.

Medical Management of Rhinitis Medicamentosa (Nasal Spray Dependence):

Here is what some experts wrote in the journal Otolaryngology–Head and Neck Surgery (March, 2019):

Objective: Rhinitis medicamentosa (RM) is a common condition resulting from overuse of topical nasal decongestants. Despite the prevalence in otolaryngologic practice, a clear treatment protocol has not been established. Our objective was to review the current published literature pertaining to the treatment of RM with the possibility of finding data that support one treatment over another.”

The authors of this article identified 350 articles and settled on 9 for useful information.

And the envelope please:

“There is not adequate evidence to develop a standardized treatment protocol for RM…Prospective randomized controlled studies are warranted to determine the optimal treatment regimen following diagnosis of RM.”

In other words, the specialists (otolaryngologists) have no “standardized treatment protocol” for dealing with rebound nasal congestion, aka rhinitis medicamentosa or RM for short. Patients are on their own.

Kicking Nose Spray Dependence One Nostril at a Time:

Readers of our syndicated newspaper column have been sharing their experiences with us for decades. Here are some examples:

Q. I became dependent on decongestant nose drops some years back. My doctor’s solution was to use the drops in a single nostril until the dependency passed and then totally discontinue nose drops. It’s not a perfect solution but it worked for me.

A. This is a sensible approach to overcoming nose spray dependence.

A pharmacist agreed with you:

“I have been a pharmacist for 55 years and discovered this treatment years ago. After the need to use decongestant nasal sprays for congestion associated with colds or allergies has passed, overcome rebound congestion by continuing to spray only one nostril. This allows the other nostril to adjust back to normal. When the un-sprayed nostril opens, discontinue the decongestant spray.”

Marilyn agrees that this approach can be helpful:

“I had a full blown addiction to nasal spray before it was commonly known that it could happen. I sprayed one nostril only until the other cleared, and then stopped. As others have mentioned here, one nostril free breathing is tolerable. It took 5-7 days for each to clear.”

Green Chile to Overcome Nose Spray Addiction:

Q. I got addicted to Afrin nasal spray. I couldn’t go any longer than 15 minutes without it.

It was a painful process to break the habit, but this worked for me. I would apply a hot compress to my sinuses (and cry because it hurt so much.) Then I would eat really hot green chile salsa, which would open up my sinuses. (I found this would also work if I was just starting to get a sinus infection.)

It helped to go for a run to get the sinuses open after eating the salsa. If I get a little stuffed up now, out comes the green chile. I have read that green chile has medicinal properties. Maybe this will help someone else break an Afrin addiction.

Overcoming Your Nasal Spray Addiction:

A. When people use strong vasoconstricting nasal decongestants for more than a few days, the nose adapts. Stopping the spray can trigger rebound nasal congestion, which may lead to a vicious cycle of nasal spray overuse.

Your strategy is intriguing. Others have found that gradually diluting the spray with saline solution can help.

Steroid Nasal Spray to the Rescue:

Some people also use steroid nasal sprays (Flonase, Nasacort, Rhinocort) to overcome nose spray dependency. Here is what another reader did.

Q. I have been using Afrin Nasal Decongestant Spray for two decades. My mom started me on it when I was a kid with bad allergies and then I couldn’t stop. I hated that nose spray dependence.

I finally got off Afrin by using Flonase and diluting the last bottle of Afrin with saline. It took about a week, and though I am still a little stuffy, I am so glad to be off the decongestant. I just thought others might benefit from my experience.

A. Thank you for sharing your success. Flonase is a corticosteroid nasal spray (fluticasone) that has recently become available over the counter. It can be helpful during the process of weaning off a nose spray addiction. It is also useful in controlling nasal allergy symptoms.

Side Effects of Steroid Sprays:

Side effects of Flonase may include headache, nosebleeds, nausea, cough and oral yeast infections. With long-term use, some people become more susceptible to cataracts or glaucoma.

To avoid getting into trouble with nasal spray, some people with allergies might want to try natural approaches:

Cindy has a natural alternative for allergies:

“Some years ago I started taking one capsule of stinging nettle leaf a day to combat allergies. I have since recommended it to others. One of my friends has reported back that it has helped greatly in control of allergy symptoms. It is inexpensive.”

Marie shared another way to avoid an Afrin addiction:

“Afrin is great when used only for occasional stuffiness. I never spray it in both nostrils; I alternate. Even with the worst cold, breathing through one clear nostril is fine. If you alternate nostrils you don’t have to worry about rebound congestion.”

Ed noted that finding another way to treat allergies can help:

“I used Afrin for a few days and got completely stopped up. Took some cortisone pills that cleared it. Now I use daily sinus rinse and Flonase. A prescription, Montelukast, seems to help control allergies. This combo works for me.”

Kent reports:

XLEAR works extremely well for a lot of people, including me.”

Xlear is not a decongestant nasal spray and should not trigger nose spray dependence. It contains saline solution and the sweetener xylitol. Xylitol in nasal spray effectively eases congestion as well as decongestant nasal sprays (Cingi et al, International Forum of Allergy & Rhinology, June 2014).

Please share your own nasal spray dependence story in the comment section below. If you came up with a successful strategy for overcoming your dependence, please pass it along.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies..
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