Long-Term Nasal Decongestant Use and Rhinitis Medicamentosa (RM)
In some cases, when your nose is very congested, you should not use nasal decongestant sprays for a long time, which you know will be very good for you and cause relaxation in the nasal air passage as soon as they are squeezed. Especially these sprays are suitable for regular use for only 3 and sometimes a maximum of 5 days. These sprays are easily available at pharmacies, and when you first use them, you might think "this is my medicine". Particularly in patients with turbinate hypertrophy or septal deviation, since the available air passage is already narrow, severe nasal congestion may occur in the case of a simple upper respiratory tract infection or mucosal inflammation due to allergic rhinitis. Unfortunately, these patients may start to use these sprays as the "fastest nasal medicine" as a medical treatment option. Nasal decongestant sprays reduce intranasal mucosal edema and increase air passage by affecting microcirculation. These effects can last for 8 hours or more, but in case of long-term use, the rebound effect may shorten the duration of the effect and patients may need to use it more frequently. An increase in nasal congestion complaints, which is called chemical rhinitis or Rhinitis Medicamentosa (RM) and vice versa, may occur. While there is very little use, such as once a week, at the beginning of the drug use; The frequency of use may increase over time and may need to be sprayed more than 10 times a day. The reason for this is that the longer the use, the shorter the effect of the drug.
What causes rhinitis medicamentosa?
The pathophysiology of RM has been attributed to two distinct classes of topical nasal decongestants, sympathomimetic amines and imidazoline derivatives. Sympathomimetic amines act on alpha-1 and beta receptors; this results in a period of vasoconstriction (decreased vessel diameter - decreased microcirculation) followed by vasodilation (increased vessel diameter - increased microcirculation) leading to nasal mucosal swelling. Imidazoline is an alpha-2 agonist that causes vasoconstriction of nasal vessels. This has a negative effect on endogenous norepinephrine. When imidazoline use is discontinued or withdrawn, it is believed that the vasomotor tone provided by the sympathetic system will not be maintained (resulting in re-widening of the vessel diameter), which increases parasympathetic activity and causes rebound congestion. Over time, chronic nasal decongestant use leads to microscopic changes in the nasal mucosa resulting in mucus-producing goblet cell hyperplasia, squamous cell metaplasia, and destruction of nasal cilia (Source >> Rhinitis medicamentosa: a nationwide survey of Canadian otolaryngologists). In old source books, a picture of an effort to clean the mucus that involuntarily drips from his nose with a napkin in his hand and bent forward is used in rhinitis medicamentaso.
Nasal decongestants that are frequently used in pharmacies include "xsilometazoline hydrochloride, oxymetazoline and tetrahydrazoline HCL".
Long-term nasal decongestant use and rhinitis medicamentosa are interconnected conditions that can arise from prolonged and excessive use of nasal decongestant medications. While nasal decongestants provide temporary relief from nasal congestion and sinus pressure, their overuse can lead to a rebound effect, causing chronic nasal congestion and worsening symptoms known as rhinitis medicamentosa.
Nasal decongestants, such as oxymetazoline or phenylephrine, work by constricting the blood vessels in the nasal passages, reducing swelling and opening up the airways. They are commonly used for short-term relief from nasal congestion due to allergies, colds, or sinusitis. However, when these medications are used for an extended period, usually more than three to five consecutive days, they can lead to a paradoxical effect.
Rhinitis medicamentosa is characterized by persistent nasal congestion, even when the original cause of congestion, such as allergies or a cold, has resolved. The condition occurs as a result of nasal tissue becoming dependent on the decongestant for normal functioning. Prolonged use of these medications can disrupt the natural nasal cycle and lead to increased nasal swelling, congestion, and an impaired ability to breathe through the nose.
The rebound congestion caused by rhinitis medicamentosa can be more severe than the original nasal congestion, making it challenging for individuals to discontinue the use of nasal decongestants. People may find themselves caught in a cycle of using decongestants to relieve congestion, only to experience worsening symptoms when the medication wears off.
To break the cycle of rhinitis medicamentosa, it is essential to discontinue the use of nasal decongestants gradually. Abrupt cessation can cause a temporary worsening of symptoms. Instead, individuals should consult a healthcare professional for guidance on tapering off the medication and managing the withdrawal period.
Other treatment options for rhinitis medicamentosa may include saline nasal sprays or rinses to moisturize the nasal passages, corticosteroid nasal sprays to reduce inflammation, and antihistamines to alleviate symptoms associated with allergies. In severe cases, when conservative measures are ineffective, a healthcare professional may recommend a short course of oral corticosteroids or other prescription medications.
Prevention is key when it comes to rhinitis medicamentosa. It is important to follow the recommended guidelines for using nasal decongestants, which typically advise limiting use to three to five consecutive days. Additionally, individuals with chronic nasal congestion should consult a healthcare professional to identify and address the underlying cause of their symptoms, rather than relying on long-term use of decongestant medications.
In conclusion, while nasal decongestants provide temporary relief from nasal congestion, their long-term and excessive use can lead to rhinitis medicamentosa, a condition characterized by chronic nasal congestion and rebound swelling. It is crucial to use these medications as directed and consult a healthcare professional for appropriate management and treatment of nasal congestion to avoid complications associated with rhinitis medicamentosa.
Rhinitis medicamentosa treatment
Treatment for rhinitis medicamentosa focuses on discontinuing the use of the offending nasal decongestant medication and managing the rebound congestion and symptoms associated with the condition. Here are some common approaches to treating rhinitis medicamentosa:
1. Gradual withdrawal: Abruptly stopping nasal decongestants can lead to a temporary worsening of symptoms. Instead, it is recommended to gradually reduce the frequency and dosage of the medication over time. Your healthcare professional can provide a tapering schedule tailored to your specific situation.
2. Saline nasal irrigation: Using a saline nasal spray or rinse can help moisturize the nasal passages and alleviate congestion. This can be done multiple times a day to provide relief and promote healing of the nasal tissues.
3. Nasal corticosteroid sprays: These medications help reduce inflammation in the nasal passages and can be effective in managing the symptoms of rhinitis medicamentosa. Your healthcare provider may prescribe a corticosteroid spray to be used for a limited duration to help alleviate congestion and inflammation.
4. Oral antihistamines: Antihistamines are commonly used to manage allergies but can also provide some relief from the symptoms of rhinitis medicamentosa. They can help alleviate nasal congestion, sneezing, and itching associated with the condition.
5. Oral corticosteroids: In severe cases of rhinitis medicamentosa that do not respond to other treatments, short courses of oral corticosteroids may be prescribed by a healthcare professional. These medications help reduce inflammation and can provide temporary relief from rebound congestion. However, oral corticosteroids are typically used as a last resort due to the potential for side effects associated with long-term use.
6. Identifying and treating underlying causes: It is important to identify and address any underlying causes of chronic nasal congestion that may have led to the excessive use of nasal decongestants. Allergies, sinusitis, structural abnormalities, or other factors contributing to nasal congestion should be evaluated and treated accordingly.
It is crucial to work closely with a healthcare professional when managing rhinitis medicamentosa. They can provide personalized guidance, monitor your progress, and adjust the treatment plan as needed. Additionally, they can help address any underlying conditions and provide strategies for preventing future episodes of rebound congestion.
Remember, prevention is key. Avoiding excessive or prolonged use of nasal decongestants and seeking appropriate treatment for nasal congestion can help prevent the development of rhinitis medicamentosa. If you have concerns or questions about your symptoms or treatment options, it is best to consult a healthcare professional for proper evaluation and guidance.
Will you be able to discontinue the use of this drug?
A very big problem in patients who use nasal decongestant spray for a long time is "not being able to live without this drug" and the frequency of use has to be increased gradually. Our patients may be advised not to use these drugs if possible, and instead to use nasal saline irrigation and nasal cortisone sprays. However, this situation is a bit difficult and the common problem that is said in almost all of the patients who have become addicted for a long time is the sentence "I can't breathe without these sprays". Decongestant tablets can be used by mouth. While nasal saline irrigation, nasal cortisone sprays and oral decongestant drugs listed above may be beneficial for patients who want to get rid of this drug addiction in the early period; when it comes to chronic use, medical treatment option is quite difficult. It is necessary to inform our patients that "turbinate reducing procedures will be required if you continue to use it". So deliberately and slowly, the surgical treatment option seems to be the way to go.
Turbinate radiofrequency in the treatment of rhinitis medicamentosa
In patients who have used nasal decongestants for a long time, radiofrequency turbinate reduction can be performed to reduce the enlarged turbinates in order to treat the need for frequent use of the drug and the deterioration in quality of life, and after the procedure, the internal silicone splints placed in the nose are kept longer than normal (like 10 days). With the rebound effect, it can prevent the re-turbinates from contacting the septum by swelling. Generally, the turbinates start to shrink from the 10th day after the procedure. After the procedure, patients should not use nasal decongestants and should continue to breathe through the nose by cleaning the holes of the silicone splints with saline sprays.
Precautions for rhinitis medicamentosa
First of all, it is appropriate to accept nasal decongestant sprays as a "medicine" and to use this drug by reading the user manual. Please note the following recommendations regarding the use of nasal decongestant sprays:
- If your nose is blocked due to an upper respiratory tract infection or an allergic condition, nasal irrigation should be started by using sprays or waters containing natural salt water, and then appropriate medications should be arranged. If you are experiencing serious problems due to nasal congestion, it is appropriate to start with the lowest possible dose (for example, once in the evening).
- In regular use, adjust the dose to be no more than 3x1 for a maximum of 3 or 5 days.
- Do not use these sprays for every nasal congestion.
- In the minimally toxic treatment of allergic rhinitis, it may be appropriate to first use sprays containing ocean water into the nose and then use cortisone nasal sprays. Do not view nasal decongestants as first-line therapy in allergic conditions.
- Avoid continuous use of these drugs at bedtime, although it may result in an increase in your sleep quality at first; In long-term use, a shortening of the duration of action and an increase in the frequency of use are inevitable and you may need to spray these sprays after waking up from sleep.
Do not use decongestant products without consulting your doctor and reading the instructions for use.
Patients with nasal septum deviation, nasal polyp, nasal stenosis causing nasal obstruction should be careful in terms of nasal decongestant dependence. Patients may be more inclined to use these products because of the reduction in nasal congestion when they use these products. Patients with nasal septum deviation, nasal polyp, nasal stenosis causing nasal obstruction should be careful in terms of nasal decongestant dependence. Patients may be more inclined to use these products because of the reduction in nasal congestion when they use these products.
Rhinitis medicamentosa - are you addicted to nasal spray?
If you are using nasal decongestant sprays, you should try to end the medication by reducing the dose as much as possible. It is appropriate to reduce nasal decongestants by using nasal cortisone sprays and nasal salty sprays. In addition, if you have become addicted to this drug, if you cannot stop using it, you should consult an ENT specialist and be followed up. If you cannot stop using the decongestant spray, you are likely to make an appointment for an intranasal surgery in the future.
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon
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Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
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Appointment Phone: +90 212 561 00 52
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