Nasal sprays for blocked nose: Help or Hindrance?
(sudafed, otrivine, vicks sinex,…)
Can these sprays be addictive and why? What does the ingredient do?
It is not a true addiction. This is because over-the-counter nasal sprays don't cause the physiological cravings that mark an addiction. It produces what is called a rebound congestion. After using the spray for a few days, its decongestant effect is reduced and instead, it produces more nasal congestion. This nasal congestion gets worse when this medication is stopped. This means the person will have to use the spray more frequently and for long term. The latter is what makes us think it is an addiction, but it isn’t.
What is the effect of long term use? Can it damage the structures of the nose? Does it raise blood pressure?
A condition called Rhinitis medicamentosa (rebound nasal congestion) which is characterised by nasal congestion. This is produced by prolonged and frequent use of nasal decongestant sprays (oxymetazoline, phenylephrine, xylometazoline) and certain oral decongestants (peudoephedrine).
Symptoms of rebound congestion or dependency on nasal spray may include:
- Feeling congested again shortly after using a decongestant spray
- Using a decongestant spray regularly but feeling that it doesn't work anymore
- Feeling a strong urge to use the spray more often than directed
Using the spray just to be able to breathe normally on a daily basis
Yes it can cause changes to the structures of the nose. It can cause thickening of air conditioning cushions in the nose (turbinate hypertrophy) which can further block the nasal passages.
Abnormal function of cilia in the nose (hair like structures that help in the clearance of nasal and sinus secretions)
Increase in blood flow to nose which also results in nasal congestion
Yes it can raise blood pressure. Pseudoephedrine (Sudafed) is a specific decongestant that can increase blood pressure.
Do I see these cases in my practice - Yes
In a survey of 119 allergists, 6.7% had rhinitis medicamentosa. In a study conducted over 10 years in an otolaryngology (ENT) office, the incidence of rhinitis medicamentosa was 1%. In another study, an ENT practitioner diagnosed rhinitis medicamentosa in 52 out of 100 consecutive noninfectious patients who presented with nasal obstruction.
Is this something of concern? Yes
What would I say to someone who came into see me who was addicted to spraying this every day?
Make them aware of the hidden hazards. Do not use over the counter nasal decongestant sprays continuously for more than 3-5 days or very frequently.
It is difficult for them to stop it at once. No one will stop if you tell them to do so. The first week is often the most difficult for weaning.
I perform a nasal endoscopy examination to look for a cause as to why they had started using the spray at the first instance - like sinusitis, nasal polyps, deviated nasal septum and allergy related conditions. If any of the above are present, then that has to be treated and it will help relieve the nasal blockage.
If this has been ruled out then I start them on steroid nasal sprays, ask them to taper decongestant spray to twice daily, once daily, and then to use it at night only when required and then to stop once and for all (over a span of 3 weeks). Steroid nasal sprays do not cause rebound congestion or addiction.
Regular use of saline nasal sprays
Some patients experience headache during withdrawal from nasal decongestants. They should be asked to take paracetamol.
Some common brands
- Vicks Sinex (oxymetazoline)
- Otrivine (xylometazoline)
- Sudafed (xylometazoline)
