Rhinitis Medicamentosa (aka Afrin Addiction)

Rhinitis Medicamentosa (aka Afrin Addiction) – by Dr. Bryant T. Conger

Afrin (oxymetazoline), Neo-Synephrine (phenylephrine), and other over-the-counter nasal decongestant sprays are popular short-term remedies for nasal obstruction due to colds, sinus infections, and allergies. However, their overuse can lead to a serious medical problem called “rhinitis medicamentosa.”

These sprays contain a chemical that causes the blood vessels in the nose to shrink, thus reducing the swelling in the nose and the stuffy sensation. When the medicine starts to wear off, those blood vessels go back to their normal/enlarged size. After 3-4 days of consistent nasal spray use, the blood vessels don’t only return to their former size when the medicine wears off – they actually get larger, creating more stuffiness, and prompting more nasal spray use. Eventually, the duration of action of the nasal spray decreases, so it must be used more and more frequently for the same effect. If the medicine is used long-term (months to years), permanent damage to the nose may occur.

Once a nasal decongestant spray addiction has taken hold, it is tough to break on one’s own. Just like any addiction, there are withdrawal symptoms when abruptly stopping the medicine. In this case, withdrawal consists of severe nasal congestion and stuffiness lasting from a week to a few months, depending on how long the nasal spray was used and the patient’s anatomy.

But hope is not lost! There are good treatment options for rhinitis medicamentosa that an ENT doctor can help you with. Before your ENT visit, consider using an over-the-counter nasal steroid spray, such as Flonase or Nasonex. These medicines can begin to process of returning the nose back to normal, but sometimes prescription medications are necessary to complete the process. 

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