It’s sometimes said that too much of a good thing can become a bad thing. Carrots are healthy in moderation but should you start crunching through pounds of them a day, it’s probably time to reevaluate your life choices. Medications can be the same, including some of those seemingly harmless nose sprays.

Rhinitis Medicamentosa

Rhinitis medicamentosa is also known as rebound rhinitis. It involves congestion due to inflammation of the mucosal lining of the nasal passages from overenthusiastic use of nasal decongestant sprays.

Topical nasal decongestants are often obtained as an off-the-shelf or over-the-counter medication to relieve nasal congestion from allergy, an upper respiratory infection (cold or flu), nasal polyps, or sinusitis. These sprays help to relieve a blocked nose because they contain an active ingredient that acts as a vasoconstrictor. Vasoconstrictors work by narrowing the blood vessels, which effectively reduces swelling of the surrounding tissue. If you take a peek at your decongestant nasal spray ingredients for a bit of light reading, you may see words like phenylephrine, neosynephrine, oxymetazoline, or xylometazoline.

The problem with some of these vasoconstrictors, however, is that your nasal mucosa can like them a little too much. So, when allergy season is finally over or you’ve finally kicked that cold and stop using the nasal spray, your nose basically goes into withdrawal. Ironically, this presents as chronic nasal congestion.

Rhinitis medicamentosa tends to be most common in young and middle-aged adults. The risk typically begins after using a nasal decongestant for more than 7 to 10 days, though early generation vasoconstrictors were known to induce the condition after as soon as 3 days.

What’s Happening in the Nose During Rebound Congestion?

The exactly underlying mechanisms of rhinitis medicamentosa are still not fully understood, though a few explanations have been proposed.

One hypothesis is that the long-term vasoconstriction of the nasal lining’s blood vessels leads to a state of reduced oxygen supply known as ischemia. Ischemia itself can cause swelling and subsequent congestion.

Another hypothesis is that the cells of the nasal lining become desensitized to the effects of the vasoconstrictor with overuse. This means that the tissues reactively become congested. People with rhinitis medicamentosa also tend to find they need to use the nasal spray more often throughout the day to get the decongestant effect.

During rhinitis medicamentosa/rebound congestion, the nose has essentially developed an addiction or dependency on the decongestant medication in order to stay decongested, even long after the original congesting-event has passed.

Always Read the Label!

The best method to avoid falling into the trap of rebound congestion is to just follow the instructions on the medication. You will find that the directions for use on a nasal decongestant spray are typically something along the lines of “Do not use for longer than 3 to 5 days” and “Use once only every 12 hours”. Doctors also tend to recommend you give yourself (and your nasal mucosa) a break for at least three consecutive weeks before you use that spritz again.

However, should you already find yourself in the throes of rhinitis medicamentosa, how do you escape from its clutches? Step number one is to stop using the nasal decongestant spray.

Once you stop using the spray, expect your nasal passages to go into withdrawal and your congestion to possibly become even worse. This cold turkey approach can take two to eight weeks for your nose to go back to normal, depending on the severity of your prior decongestant spray habits. However, there have been reports of recovery taking about a year in really long-term overuse.

Some doctors may prescribe some other medications to minimize the symptoms of rebound congestion while your nose recovers. These can include a steroid and/or an antihistamine nasal spray (which fortunately aren’t associated with rebound congestion), and sometimes also a steroid tablet. However, as always, prevention is the best cure so it’s best to not let your nasal passages get into the downward spiral of decongestant addiction in the first place. And always read the label!