Rebound Congestion & Rhinitis Medicamentosa

Rhinitis Medicamentosa (nasal spray addiction as a result of rebound congestion) is caused by the prolonged use of Afrin and other over-the-counter decongestant nasal sprays.  The active ingredient in these sprays is a topical vasoconstrictor that temporarily reduces the size of the nasal turbinates, opens the nasal airway and provides decongestant relief from the rebound congestion.

When the decongestants are used for more than 3 consecutive days, it provokes a condition known as rebound congestion

Rebound congestion is the result of abnormal swelling and enlargement (hypertrophy) of the nasal mucosa, which blocks the nasal airway completely and causes extreme discomfort.  This rebound congestion is temporarily relieved once again by the administration of another dose of Afrin or other nasal spray.

As soon as the temporary effect of the last dose of spray wears off, the swollen nasal mucosa again block the airway and another dose of spray is required to provide relief.  The commencement of this cycle represents the initiation of the addiction.

Afrin nasal spray addiction can (and often does) last a lifetime.  Rhinostat has documented many cases of individuals who reported that they have been addicted to Afrin and other nasal sprays for more than forty years.

Because the nasal spray itself is the root cause of the problem, the only effective way to eliminate it is to discontinue the use of the sprays.

As any person that has suffered with rhinitis medicamentosa will tell you, this is much easier said than done.  Breaking this addiction is not simply a matter of will power.  The ability to breathe comfortably is essential to normal human functionality.

Only a small percentage of these people (less than 4%, according to our research) are able to endure the misery associated with "cold turkey" withdrawal.  Unable to sleep, eat, work or socialize comfortably, the large majority of these people simply return to the use of the spray to end their misery.

Implications For Persons Addicted to Afrin & Nasal Sprays

It is not uncommon for these people to keep their problem a secret from their families, co-workers, friends and even their physicians.  They excuse themselves from social settings, wake up in the middle of the night and learn how to integrate the use of the sprays into their daily routines, in solitude.

They keep a bottle of Afrin in their pocket or purse, their nightstand, glove box, backpack, attaché case and anywhere else necessary to ensure that it is readily available when needed.

Addicted persons often stock up, plan ahead and buy in volume (when on sale.)  They know every retail store in their neighborhood that carries the product.  Some may even rotate the places they go to purchase it, so as not to reveal their addiction to sales clerks.  They often purchase other items along with the sprays to draw attention away from the item.

They may not be experts in chemistry, but they know the name of the active ingredient in their particular spray.  Oxymetazoline, Phenylepherine or Xylometazoline.  Regardless of the specific brand, they always select a spray with the correct compound.  Unless they have a very sympathetic and supportive spouse or partner, they buy their own sprays.

The prospect of things such as surgical anesthesia, a camping trip to an isolated location or an ocean cruise (where they have no easy and immediate access to the nasal sprays) is a nightmare.

Many of these people tell us that nasal spray addiction is the most miserable and frustrating problem they have ever dealt with.  This entire physiologic and psychological phenomenon is something that Rhinostat is intimately familiar with and it remains the subject of our focused research.

How Physicians Treat Rebound Congestion & Rhinitis Medicamentosa

In search of an answer, many of these patients turn to their physicians for help in ending nasal spray addiction. 

Rhinitis Medicamentosa is a very frustrating problem for physicians to effectively treat.  There are no FDA approved drugs nor therapies specifically for the treatment of RM patients.  Most commonly, these patients are given a course of intranasal and/or systemic steroids and are told to discontinue their use of the decongestants.  In some cases, surgery to reduce the turbinates or to correct a deviated septum is performed.

Regardless of what treatment is prescribed, the cornerstone of the therapy is always the same.  Patients must discontinue their use of the sprays.  It is this aspect of the treatment that presents the problem for these patients.

Medical Research On Rhinitis Medicamentosa

In spite of the large patient population (estimated to be more than 10 million in America alone) very little clinical research has been done on rhinitis medicamentosa.  The most extensive and comprehensive research that exists was done by Drs. Graf, Hallen, Enerdal and Juto at the renowned Karolinska Institute in Stockholm, Sweden.

The use of the steroid nasal sprays in treating rhinitis medicamentosa was studied by Drs. Graf, Hallen, Enerdal and Juto in 1997.  Their landmark study published in the Journal of Clinical and Experimental Allergy forms the basis of the use of steroid nasal sprays in treating rhinitis medicamentosa.  A copy of this study is available on our medical research page.

From the perspective of the rhinitis medicamentosa patient, the single most important aspect of treatment is the ability to continue to move air (breathe) during the withdrawal process.  The 1997 RM study (View It) concluded that the use of the steroid nasal sprays offered no improvement in air movement when compared to placebo.

In other words, substituting the nasal steroids for the decongestant offers no more relief than quitting cold turkey, in terms of your ability to breathe. 

The conclusions reached in the study are in full accordance with the research we have done at Rhinostat.

Impact of Allergies & Other Physiologic Conditions

Patients who have allergic rhinitis in addition to having rhinitis medicamentosa, should work with their health care providers to suppress the allergic symptoms and this treatment will often include steroids.  Rhinostat is frequently used in conjunction with nasal steroids as a combination therapy.

If you have any kind of medical or physiologic condition contributing to your congestion (in addition to rhinitis medicamentosa) it is necessary that it be treated effectively either before or during your attempt to withdraw from the decongestant sprays. Such conditions may include a deviated septum, among many other things.

If, however, you are not allergic, have no other medical or physiologic conditions and are simply addicted to the decongestants (78% of patients according to our research) there may be no harm in using the steroids along with Rhinostat, but no essential benefit, in terms of nasal airflow.

Improving The Treatment of Rebound Congestion & Rhinitis Medicamentosa

In our opinion, physicians would benefit greatly from two very important things which would help them in treating RM patients as well as understanding why it is so difficult for patients to simply exercise their will power and simply stop.

First, if you can find a doctor who has suffered from nasal spray addiction personally (we meet hundreds of them) it can make a big difference.  There are many unique and severe aspects of this problem that some physicians may not fully appreciate. Of course, this is not always necessary or practical.

Second (and more importantly) there is an instrument called a rhinomanometer, which can be used to accurately measure nasal inspiratory flow.  If your doctor had one of these instruments, he or she could quantify how well you are (or are not) breathing through your nose and evaluate the efficacy (or inefficacy) of the treatment they prescribe for you.


Although these instruments are essential for measuring nasal flow rates and pressures very few physician's offices are equipped with them.  RM patients already have their own physiologic internal rhinomanometers.  As soon as they sense the onset of rebound congestion, they reach for their bottle and suppress it.

Rhinostat relies exclusively on rhinomanometry to validate its method.  With rhinomanometry, we can see that patients who are weaning themselves gradually (using the Rhinostat System) maintain normal nasal inspiratory flow, compared to patients who are treated with other methods and are unable to move any air for the first 4-7 days. 

The 4-7 Day "Period Of Misery"