Rhinitis Medicamentosa

Rhinitis Medicamentosa is the scientific term for the condition of rebound nasal congestion brought on by extended use of nasal sprays, most commonly with the active ingredients of oxymetazoline, phenylephrine or xylometazoline, that work by constricting blood vessels in the lining of the nose. This condition is also referred to as “nasal spray addiction”, “Afrin addiction”, rebound rhinitis, chemical rhinitis or rebound congestion.

Patients usually begin the usage of these over the counter (OTC) nasal sprays to relieve the symptoms of a blocked nose or congestion typically associated with a cold or flu. The nasal sprays are very effective in relieving the congestion and providing clear airway breathing for the user. The pharmacist or pharmacy staff normally warns the user to not exceed 5 days of continuing use.

Rebound Congestion typically occurs after 4 to 7 days of continued use of the nasal spray. Patients experience relief when using the nasal spray, however the congestion symptoms do not go away, even though all of their cold or flu symptoms have stopped. Patients often try increasing both the dose and the frequency of nasal sprays upon the onset of Rhinitis Medicamentosa thus worsening the condition. This sets in motion the cycle that leads to a physical dependency to the nasal spray.

Pathophysiology

In simple terms the nasal spray creates a vasconstrictive (shrinking) effect on the blood vessels in the nose causing the airway to open up allowing comfortable breathing, however after the 4 to 7 day usage period the body stops producing endogenous norepinephrine which leads to a vasodilation (filling) effect on the blood vessels of the nose which closes the airways. Once the body stops producing the endogenous norepinephrine the back and forth (rebound) cycle sets in.

Dangers

In most cases the long term negative medical effects are not dangerous and do not cause long term, life threatening or non reversible medical problems. The main problems are the dependency on the spray for comfortable breathing and the negative effect on lifestyle and comfort as well as an unnecessary cost. People have claimed to have a dependency to nasal sprays for 10, 20 and even 40 years.

In a small percentage of cases permanent turbinate hyperplasia (over-growth of cells in the nose) may occur, which may block nasal breathing until surgically removed. Other problems can be Chronic Sinusitis which is inflammation of the nasal cavity and in very rare incidences a patient may develop a deviated septum.

Treatments

The two most popular and effective treatments to rid a patient of the dependency on nasal sprays are:

Stop/Cessation-

-this is to stop “cold turkey” and suffer the discomfort for up to a week to two weeks where- by the symptoms of rebound congestion may cease afterwards. This sounds great in theory however few people can stand the struggle to breathe for an hour much less a day or a week.

Weaning-

-this is to progressively use less and less of the chemical or nasal spray over a period of time thus weaning off of the dependency. Because the dependency is a physical, not psychological, this method can be very effective if measured and controlled and adhered to over a period of 25 to 35 days allowing the body to re-adjust to the chemical changes. Benefit of this method is that there is usually little if any discomfort if done properly and the results are permanent.