Watch Out for Nasal Spray Addiction

Rhinitis Medicamentosum (RM) is a fancy name for being addicted to nose drops.

by Murray Grossan, M.D.

What happens is that your nose is stuffy and you can’t sleep. So you spray with the nose spray and open the nose beautifully. Now you can breathe and sleep.

But later, the nose clogs again and you use the drops again, maybe more that the first time. At first you only use them every 12 hours. Then every 8, then 6. Now every four. You KNOW the bottle says only use for a few days, but the nose is really plugged unless you use the drops. Meanwhile you feel nervous and irritable. This is the “adrenergic” effect of the drops, whether you take them orally or by nasal spray.

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These are the common nasal sprays that can cause RM.

Oxymetazoline (Afrin)
Phenyleherine (Neosynephrine)
Xylometazoline (Otrivin or Inspire)

Any constrictor nose drop can do this. There is evidence that it is the preservative, usually benzalkonium (BZK) that is the culprit. So that the afrin – oxymetrazoline - shrinks the nasal tissue but the BZK irritates it so that you need more afrin. These products without BZK may not cause RM.

Strangely, in my practice, it is the medical people that have the high incidence of RM. Probably it is because these medications are so readily available.

It is easy to tell the patient to stop using the product, but the extreme misery is quite severe and often will power doesn’t work, even in the most strong willed persons.

One solution is a course of prednisone with antibiotic. This will shrink the nose and reduce inflammation. Sometimes I add Benadryl at night to help the patients get his sleep. This is a fairly severe course of therapy.

Another gentler solution is to gradually dilute the drops you are using. You can get a program of gradual reduction of the nasal drops through a company called Rhinostat Systems. Here they make a solution for you so that you gradually reduce the dose. Since you are no longer getting the rebound effect, this is a preferred method, and you avoid “more drugs”.

In some cases where the medication has been used a long time, the cilia fail to resume good movement right away and the nose may still feel as though it is stuffy. Hot tea, chicken soup, compresses to the sinus area all may help. Or pulsatile irrigation with Hydro Pulse® Nasal Sinus irrigator is a rapid way to refresh the nose. The Hydro Pulse nasal / sinus irrigator pulses at a rate to best restore normal cilia speed. This is important because the condition that caused the patient to overuse nose drops may still be present and it is best to get the cilia back moving properly.

Prevention? Persons today are constantly exposed to advertisements: take this pill and use this spray. If you do get a stuffy nose, on the first day, take it easy. Don’t rush to the medicine cabinet. Plenty of tea and rest may be all you need. But once you start overusing the nasal sprays, you can wind up addicted. Not because you are “weak”, but because of the rebound effect of these medications.

I must emphasize that “willpower” is not the issue here. RM is no different than one person getting a large bump from an insect bite. The RM is a “chemical” condition caused by the rebound of the medication. Patients with RM do need assistance to quit the nose spray habit. Best of course is not to get started.

Cortisone sprays, saline sprays without benzalkonium, Breathe.ease XL spray – these do not cause Rhinitis Medicamentosum. Some persons find they need to continue using certain cortisone sprays, but that is not the rebound phenomenon but rather that they are helped by it.

If only getting cured of my addiction to chocolate candy were this easy!

Hydromedonline.com

First Published: Early October 2003
Updated: February 2007

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