Rebound Congestion (Rhinitis Medicamentosa): What to Do If You Overuse Nasal Spray

A stuffy nose can really ruin your day. It gets in the way of everything from sleeping to eating and all the things in between, like breathing! Decongestant nasal sprays can provide immediate relief and last for hours.

But when it comes to these nasal sprays, there's too much of a good thing. It even has a name - rhinitis medicamentosa or rebound congestion. Rebound congestion takes a stubborn stuffy nose to a whole new level.

But that doesn't mean you have to throw away your trusty nasal spray. Here's what you should know about rebound congestion and how to safely use decongestant nasal sprays.

What is rebound congestion (rhinitis medicamentosa)?

Rebound congestion, or rhinitis medicamentosa, is a condition that develops when you use decongestant nasal sprays for too long. It causes inflammation of the nasal passages. This inflammation causes swelling and blockage of the nasal passages, which in turn causes nasal congestion.

Rebound congestion usually happens when you use nasal decongestants made from ephedrine-based medications, like phenylephrine.

Over-the-counter (OTC) nasal decongestants can also contain a medication called oxymetazoline. Oxymetazoline isn't as likely to trigger rebound congestion. But cases related to oxymetazoline have been reported.

Why does rebound congestion happen?

Rebound congestion develops when your nose becomes dependent on decongestant nasal sprays.

When you have an upper respiratory tract infection or seasonal allergies, you get a stuffy nose because the tissues inside your nose swell. This inflammation makes it hard for you to breathe through your nose.

Decongestant nasal sprays, like Afrin and Mucinex, work by shrinking the blood vessels inside the nose - not by fighting off this inflammation. But this shrinking still helps relieve some of the swelling so you can breathe again.

After a couple of hours, the medication wears off and your blood vessels open back up. Your stuffiness comes back, prompting you to give yourself another spray.

Your blood vessels start to adapt to the nose spray. With each spray, they shrink less and less. As the medication wears off, they overcompensate by opening up more and more.

The result is a cycle where you stop feeling the benefits of the medication, so you use more medication. That causes your blood vessels to shrink less and dilate more, worsening your congestion. In the end, you're left with swollen blood vessels even after that virus or allergen is gone.

Which medications can cause rebound congestion?

Not all nasal sprays cause rebound congestion. Only nasal sprays that shrink your blood vessels can cause this problem. These include:

• Phenylephrine (Afrin, Neo-Synephrine and 4-Way Fast Acting, Afrin Children's)

• Oxymetazoline (12 Hour Decongestant, Afrin, Dristan, Mucinex, Vicks Decongestant)

Nasal sprays that are safe for long-term use

Nasal steroid sprays like fluticasone (Flonase) and mometasone (Nasonex) won't cause rebound congestion.

Saline nasal sprays will not cause rebound congestion either.

How long does rebound congestion last?

Rebound congestion won't go away until you stop using nasal decongestants. Once you've stopped using the medication, your body will adjust back to normal. But this can take a while.

Most people feel better within a few days. But it can take several weeks for congestion to go away. Studies suggest that nasal steroids may help speed up recovery.

How do you avoid rebound congestion?

You lower your risk of developing rebound congestion by not using OTC nasal sprays for too long.

It's not totally clear how long is "too long." In studies, people started developing signs of rebound congestion after 5 days of using nasal decongestants. But, in other studies people didn't develop rebound congestion even after taking oxymetazoline nasal sprays for 10 days.

Most experts recommend stopping nasal decongestants after 3 to 5 days. This is often enough time for your body to get over a cold or adjust to new allergy medication.

Talk with your healthcare team if your nasal congestion isn't better after 3 to 5 days. They may offer you another treatment option that can work just as well as an OTC nasal spray but won't give you rebound congestion. They might also recommend that you keep taking your OTC nasal spray but add on additional treatments that can lower your risk of developing rebound congestion.

How can you tell if your body is addicted to nasal spray?

If you've been using decongestant nasal sprays, here's how you can tell if you have rebound congestion:

• Your nasal spray isn't helping. If your nasal spray doesn't seem to work anymore or you need it more often, you've probably developed rebound congestion.

• You feel more stuffy as time goes on. Nasal congestion from colds and viruses gets better over time as you fight off the virus. You may have rebound congestion if you've been using nasal sprays and you feel worse as time goes on.

• Your nose aches. Swollen blood vessels take up a lot of space, and there's not much extra space in the nose. If the inside of your nose starts feeling achy or heavy, you might have rebound congestion.

How do you treat rebound congestion?

Rebound congestion takes time to go away. Treatment for rebound congestion includes:

• Stopping the nasal spray: The first step is to stop using your decongestant nasal spray. If you're using it often, you may need to cut back gradually.

• Trying nasal steroids: A healthcare professional might recommend a nasal steroid like fluticasone (Flonase) or mometasone (Nasonex). These medications can bring down swelling in the nose.

• Using saline spray or gel:Sodium chloride nasal spray or gel is a natural remedy that soothes irritated nasal passages. This can bring down overall inflammation and promote healing.

Most people start feeling better in a few days. But if you've been using nasal sprays for a long time, it can take longer for rebound congestion to go away.

Working with your healthcare team can help you recover faster. They can also make sure you don't develop complications from rebound congestion like infections and nasal polyps.