Causes and Treatment of Rebound Nasal Congestion
My Afrin Nightmare: How I Developed an Addiction to Nasal Decongestants
I am addicted to the nasal spray Afrin. I hate to admit this, but I feel that I must be honest. I don't think there are any meetings for this. I think this is something we suffer from quietly, away from the public eye. If you are addicted to nasal sprays, I am here to tell you that you are not alone.
For the record, I don't drink, smoke, or have an addictive personality. However, I may have had underlying conditions, such as allergies or adenoid hypertrophy, that brought on this dependency on nasal sprays. For most of my life, I felt that it was normal to have that stuffy-nose feeling. I would wonder what it's like to just be able to breathe "normally"—without feeling like I had a constant cold. I remember my mom would give nose drops to my brother and myself every night, and it was just part of our bedtime ritual. Nose drops, some Vicks Vapor Rub, a prayer, and good night. Little did I know, those daily nose drops would come back and haunt me.
As an adult, I found a different version of nose drops in the form of Afrin. Using it was so relieving—and so liberating. I was aware—somewhere in the back of my mind—that I wasn't supposed to be using Afrin for an extended period of time, but I did anyway. I couldn't leave home without it; I always had to have some in my purse. I remember leaving on a trip to the beach and going into a panic mode when I realized I forgot my Afrin at home. My husband had to stop at a gas station just so I could buy an overpriced bottle. When I tried not using Afrin for a day, I almost cried. I couldn't breathe well at all! I couldn't talk right, and I felt as if some monster was sitting on my face, ruining my life. What was wrong with me? Why was it so hard to quit?
Oxymetazoline: The Main Ingredient in Afrin
The main ingredient in Afrin, oxymetazoline, can be categorized into two types of drugs: sympathomimetics and vasoconstrictors.
Sympathomimetics imitate natural molecules in the body, like adrenaline and dopamine, that activate the sympathetic nervous system, part of our fight-or-flight response. As a sympathomimetic, oxymetazoline acts on adrenergic receptors, receptors that are activated by adrenaline. Adrenergic receptors can be found on the smooth muscle of blood vessels. Therefore, their activation leads to muscle contractions that constrict the blood vessels.
Vasoconstrictors cause blood vessels to constrict, narrowing their diameter. Their purpose, in this case, is to provide relief from nasal congestion. The oxymetazoline works by activating alpha-2 adrenergic receptors after binding to them. Upon administration of Afrin within the nose, the oxymetazoline constricts the blood vessels in the nasal passage, resulting in congestion relief. Oxymetazoline works almost immediately, and the full effect of the medication is reached in 5-10 minutes. Even though the box advertises 12 hours of relief, the effects of oxymetazoline only up to about seven hours.
The Worst Side Effect of Oxymetazoline
Afrin is a potent decongestant, but its power is hindered by the fact that oxymetazoline can cause rhinitis medicamentosa, more commonly known as rebound nasal congestion. Through continuous, extended use of nasal decongestants, especially after your symptoms have already cleared, your nose may start to feel stuffy again. Other topical decongestants can also cause rhinitis medicamentosa are naphazoline, xylometazoline, and phenylephrine.
At some point, the medicine will stop working for you and will begin working against you. This may have contributed to my dependency on Afrin.
The Physical Dangers of Afrin Addiction
Afrin is considered a "chemical tourniquet." The longer that the nose is forced to constrict the vessels, the more it will be deprived of nutrients and oxygen that it needs to thrive. The constant reduction in blood flow can manifest itself through physical damage to the nasal passage.
- Your ears may feel stuffed or clogged.
- The nasal regions may become engorged with blood after the Afrin wears off.
- There may be structural damage, such as saddle nose deformity, and septal perforation.
- Septal perforation is when the cartilage membrane that divides the nostrils develops small holes.
- Saddle nose deformity is when the nose bridge collapses due to thinning of the bone or cartilage in the septum.
How Long Does Rhinitis Medicamentosa Last?
The rebound effect will last for as long as you are using nasal decongestants. Once you stop, it should resolve itself in 1-2 weeks. The main issue is how you decide to stop using nasal sprays.
When I tried to quit Afrin cold turkey, it was a terrible experience. I could not sleep well at all. Now, I only use one spray in each nostril at night around 9 PM. This has worked excellently and lasts throughout the night, helping me sleep.
Can Intranasal Steroids Treat Rhinitis Medicamentosa?
According to a 2017 study in China, yes, it can. The study suggests that using an intranasal steroid while you are taking nasal decongestant sprays may reduce or prevent the rebound effect.
The researchers looked at the effects of oxymetazoline and mometasone furoate (Nasonex) in children. Nasonex is an intranasal steroid that reduces swelling and mucus in the nasal passageways. It's usually used to treat allergic rhinitis and associated congestion. Intranasal steroids do not work immediately like oxymetazoline does; it can take up to two weeks to notice the effects.
The study compared any changes in symptoms when taking mometasone furoate, oxymetazoline, or both concurrently. During the first stage of treatment, it appeared that 39% of the children treated with mometasone furoate had a considerable reduction in symptoms. During the second stage, the scores of nasal congestion in the group using both mometasone furoate and oxymetazoline went down. This suggests that the combination can be a safe and effective treatment option for children who have allergic rhinitis or adenoid hypertrophy.
In another study published in 2010, fluticasone (Flonase)—another intranasal steroid—was shown to also have a potential to reverse rebound congestion caused by oxymetazoline.
As mentioned above, it may take up to two weeks to feel the effects. Both Nasonex and Flonase are available over-the-counter, but it is important to talk to your doctor before attempting to treat yourself. You can easily overmedicate in an attempt to get rid of your symptoms. Know the side effects and precautions, and always follow the directions on the label or your doctor's instructions.
Nasal Irrigation Can Help Relieve Congestion
The purpose of nasal irrigation is to rinse out mucus and any debris from the nasal passageways. There are many ways to do this, but the simplest way is by using a Neti Pot; they can be found in most drug stores and are typically used for sinus congestion, allergies, and colds. The Neti Pot works by flushing a saline solution through the nasal passageways, thinning the mucus so that it can be removed with the solution. This speeds up the process of mucus removal normally done by cilia, or small “hairs,” in the passageways. The function of the cilia is to move mucus to where it can either be swallowed or blown out.
I first heard about this method from both my father and my father-in-law, who have successfully used the Neti Pot to relieve their congestion. I decided to try it myself, however, I only found relief for about five minutes after use. On top of that, there is a slight burning sensation from the saline solution that I was not comfortable with. Overall, I did not find enough congestion relief from using a Neti Pot. However, it is a proven natural alternative to nasal decongestants that has worked for others. You can also try saline nasal sprays that are a little gentler and keep your nose hydrated.
How I Got Over My Nasal Spray Addiction
By taking Zyrtec-D and diluting my Afrin nasal spray solution with saline, I was able to taper off Afrin. Zyrtec-D is an oral medication that uses a combination of cetirizine, an antihistamine, and pseudoephedrine, a decongestant. You can get Zyrtec-D by asking your pharmacist; you don’t need a prescription, but it cannot be found in the regular aisles. I found that the combination of antihistamine and decongestant worked well to relieve my nasal congestion. This allowed me to decrease my dose of Afrin by pouring out half the bottle and replacing it with a saline solution. I was no longer getting a full dose of oxymetazoline with each spray, and over time, the rebound effect went away.
Although this method worked very well for me, it may not be the best or safest option for you. It is also important to note that decongestants like pseudoephedrine are not recommended for people with high blood pressure or other heart conditions. Discuss this and other options with your doctor so that you can find the best solution for your specific situation.
My final piece of advice is to find out what is causing your nasal congestion and treat that cause rather than just treating the symptoms. You can avoid getting stuck using nasal sprays by treating your problem correctly the first time around.
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© 2018 Charlotte Doyle