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Nasal Spray: Are You Overdoing It?

Why overusing your nasal spray may backfire.
By Katrina Woznicki
WebMD Feature
Reviewed by Louise Chang, MD

Spring is here, which for millions of people means itchy noses, watery eyes, and nasal congestion. For many allergy sufferers, relief is often just a quick spritz away; prescription and over-the-counter (OTC) nasal sprays are one of the most common ways to treat nasal congestion caused by allergies or infection.

But for an estimated 7% of the United States population, relying too much on decongestant nasal sprays can actually cause more congestion -- a drug-induced condition called rhinitis medicamentosa.

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What Is Rhinitis Medicamentosa?

Rhinitis medicamentosa is most often seen among people who self-medicate with OTC decongestant sprays. Rhinitis medicamentosa may also occur in people with viral upper respiratory tract infections, such as colds, who sought relief for their symptoms. Up to 50% of respiratory infection patients may develop rhinitis medicamentosa.

Rhinitis medicamentosa is under-reported, under-diagnosed, and under-researched, according to a report published in the journal Clinical and Experimental Allergy.

"Despite many prescription warnings and manufacturer labels listing certain medications as causing rhinitis, drug-induced rhinitis still often goes undiagnosed," the researchers wrote. Increased awareness, they said, could help these patients get the proper treatment.

Rebound Effect

Rhinitis medicamentosa occurs when a decongestant nasal spray is used repeatedly for more than three to five consecutive days, leading to nasal passage damage and the inability to respond to the decongestant.

There are several types of nasal sprays, from over-the-counter (OTC) decongestants, steroids, and antihistamines to saline solutions and prescription drugs.

OTC decongestant nasal sprays work because they contain chemicals -- oxymetazoline, phenylephrine, xylometazoline, and naphazoline -- which quickly unclog the nose by constricting the blood vessels in the nasal lining. These sprays provide quick relief, but they also wear off "usually in 30 minutes or less," says Marilene B. Wang, MD, an otolaryngologist at UCLA. "The person will experience a rebound, where the nasal congestion is actually worse than before the spray was used."

Consequences of Overuse

Decongestant nasal spray overuse can also lead to a missed diagnosis of what's really causing the inflammation, as well as an increased risk for sinus infections, headaches, coughing, nasal passage swelling, and congestion, and -- rarely -- septal perforation, in which the membrane dividing the nostrils develops a tear.

The issue is overuse, not the products themselves.

"Many consumers turn to topical nasal sprays because they are safe and effective when used as directed," says Elizabeth A. Funderburk, a spokeswoman for the Consumer Healthcare Products Association. "We know that people demand a range of options and different delivery forms work for different people. As with all OTC medicines, it is important that consumers always read and follow the label. The labeled directions state that you should not use topical nasal decongestants (nasal sprays or gels) for more than three days, because frequent or prolonged use may cause nasal congestion to recur or worsen."

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