Addiction to Nasal Spray: Can It Happen?

Constant administration of nasal decongestants may cause progressive loss of their effectiveness. In fact, in some cases it produces the opposite of the desired effect. What should you know about it? In this article, we'll explain addiction to nasal spray in detail.
Addiction to Nasal Spray: Can It Happen?

Last update: 03 August, 2021

Is addiction to nasal spray possible?

In general, this type of medication contains decongestants that help to reduce inflammation and congestion in the nasal passages. These are often affected by dilation of the blood vessels present in the area.

The problem is that the sprays are easy to use and produce a soothing effect that leads many people to abuse their use. In turn, this leads to a syndrome called rhinitis medicamentosa (RM) or chemical rhinitis, in which an individual needs more and more frequent and abundant doses to obtain the desired effects.

It’s common to confuse it with addiction, although they’re different terms. Do you want to know a little more about it?

We’ve prepared the following article to clarify the main questions.

Types of nasal decongestants

There are many medications capable of reducing nasal secretions. They can be administered topically (i.e. on the affected area) or orally. Drops and sprays are the most common formulations.

When we speak of nasal decongestants, we’re referring to drugs capable of causing vasoconstriction in the nasal mucosa. This decreases the release of fluid and mucus production.

Other drugs are steroids and antihistamines, which are also highly effective. Below, we’ll explain some of the most common nasal decongestants on the market.

A woman administering a nasal spray.
Nasal spray usually has medications to relieve congestion and irritation of the nasal passage.

Naphazoline

This is generally a safe drug to use with few adverse effects, as long as you administer it in the proper doses. Doctors recommend it for allergic rhinitis or any situation that causes nasal congestion, such as trauma or inflammation.

It’s available both in drops and spray, and you can apply it directly or by preparing nebulizations, especially for children. As it promotes the activation of receptors in the cardiovascular system, it’s important to exercise caution in conditions such as heart failure, arrhythmias, high blood pressure, and a history of heart attacks.

However, these complications usually only exist when systemic absorption is large. As long as you respect the administration indications, these are events that rarely occur.

Phenylephrine

According to the Spanish Association of Pediatrics, this drug also has other uses for more serious conditions. One of these is severe hypotension, in which phenylephrine has favorable effects on the cardiovascular system.

But its most commercial and widespread use remains as a nasal decongestant, either in drops or as a spray. In addition, there are ophthalmic drops that allow pupillary dilation, something that may be required by a physician for certain evaluations or clinical interventions.

It’s contraindicated in cases of hypersensitivity, severe asthma, pancreatitis, or hepatitis. Of course, this relates more to intravenous administration than to nasal preparations, which are usually quite safe.

Oxymetazoline

Although this medication has the same mechanism of action as the previous drugs, its effect is longer-lasting, reaching 8 to 12 hours of continuous activity. The others, such as phenylephrine or naphazoline, usually don’t reach more than 6 hours.

The duration of the effects not only makes dosage easier, but also prevents the rebound effect and addiction to the nasal spray, as we’ll mention in the following sections.

Both children and adults can use this medication, although they should practice the same precautions as with the drugs we mentioned above. On rare occasions, it can contribute to the onset of insomnia, which is why it’s best to avoid nighttime doses.

Rhinitis medicamentosa and drug tolerance

Acute rhinitis can have many causes. Upper respiratory infections and allergies are the most common in most countries. In fact, cold weather – typical of the winter season – tends to increase the risk of developing moderate to severe forms of rhinitis.

Because of the almost immediate relief that the nasal decongestants we mentioned above provide, and because they’re available over the counter, there tends to be an abuse of these substances among the general population.

Over time, experts have seen that these medications cease to have the same effect, which implies patients taking higher doses to achieve the same relief. This phenomenon tends to be confused with addiction, but it’s a very different condition.

What is an addiction?

According to the World Health Organization (WHO), addiction is a condition or disease whose anatomical substrate is in the brain, and causes the compulsive need and search for a drug, regardless of the adverse effects it may generate.

We know that the development of dependence on a certain drug requires prolonged exposure and a set of important neurochemical changes for the brain to develop this pathological need. It often greatly compromises the quality of life, since the lack of the drug can lead to a withdrawal syndrome, with worse consequences.

As the Mayo Clinic explains, addiction to nasal spray is very rare. What does happen in most cases is the development of tolerance or tachyphylaxis to these medications.

Tachyphylaxis from nasal decongestants

The loss of the response to a given drug, following repeat administration of the drug, is known as “tachyphylaxis”. We can also consider the term tolerance as an equivalent for practical purposes, although both have more complex molecular explanations.

Drugs are nothing more than substances that interact with various sites in the body. These sites of interaction are called receptors, which are usually proteins. When contact occurs, it triggers a set of biochemical reactions that lead to the desired effect.

If the body receives too many drugs, thus saturating the receptors, the body will produce more over time. This implies the need to administer a higher dose to elicit the same effects that less substance produced previously.

Nasal decongestants tend to produce this phenomenon more frequently, which is due to the following factors:

  • Low cost
  • They’re marketed without prescription
  • Few adverse effects
  • Ease of administration

What happens with other medications?

A little further back we mentioned that steroids are part of the therapeutic arsenal for rhinitis, in any of its forms. They have the ability to reduce local inflammation in the same way that skin creams do.

Their capacity to produce tolerance or addiction is low. They’re usually reserved for chronic cases of rhinitis, especially where vasomotor phenomena predominate in the arteries of the nose. In fact, since rhinitis medicamentosa has a chronic presentation, they can be useful in treating this condition.

Some of the most common drugs in this group are triamcinolone, fluticasone, and budesonide. The main side effects include a burning or itching sensation in the nose, as well as frequent sneezing.

Symptoms of rhinitis medicamentosa

Like other forms of rhinitis, this condition involves moderate to heavy hyaline nasal discharge. This usually produces obstructions capable of causing breathing problems, but which you can solve by ventilating through the mouth.

Itching and a feeling of tightness are also common symptoms. In some cases, if the area isn’t decongested, viral or bacterial infections may occur, leading to rhinosinusitis. It’s a chronic form of the disease, also called “chemical rhinitis”.

How does it differ from other forms of rhinitis?

Although they have the same characteristics, rhinitis medicamentosa involves a medical history of abundant use of nasal decongestants. These can be any of those we’ve mentioned above. The rebound effect, in addition, causes the following alterations:

  • Decreased effectiveness of the medications.
  • Exaggerated mucus production after a few hours of administering the drugs.
  • Increase of adverse reactions in those cases where the patient exceeds the recommended dose.
A woman blowing her nose into a tissue.
The excessive use of nasal decongestants may reduce their effectiveness. At the same time, it causes contrary reactions, such as excessive mucus production.

Treatments and recommendations

The development of tachyphylaxis or drug tolerance is potentially reversible, especially if diagnoses and treatment take place early on. While there are no specific drugs to cause this, combining behavioral changes with the use of new drugs can have excellent results.

More complicated cases require the evaluation of an ENT physician. Other patients may see a family physician, general practitioner, or even a pediatrician, as many children may suffer from the condition.

The first measures usually include a progressive decrease of the dose. Experts don’t recommend the abrupt withdrawal of the drug because of the consequences that the rebound effect may produce.

In addition, the concomitant use of drugs with less addictive effects or that are less capable of developing tolerance is important. This allows symptom relief while progressive de-escalation of topical decongestants occurs.

Steroids and saline are excellent alternatives to initiate treatment. Depending on the severity of the clinical picture, the specialist may indicate oral medications.

Correct use of nasal spray

To avoid the development of tolerance or possible addiction in the future, it’s best to follow the instructions that come with the drops or sprays. As they’re over-the-counter, many have specific dosages for those patients who don’t feel the need to go to the doctor.

In any case, it’s important not to prolong its use more than 2 or 3 times a day for 3 continuous days. If symptomatic relief doesn’t occur, then you should see a doctor as soon as possible.

What to remember about nasal spray addiction?

Addiction to nasal spray is rare but can occur. Although many drugs seem harmless, their overuse can lead to significant and difficult-to-manage medical conditions.

To prevent this, it’s important to follow the instructions that come with over-the-counter medications. Seeing a doctor is the best option.

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