Can nasal decongestants cause an addiction?

Nasal congestion is an often-occurring symptom that usually develops due to the common cold, allergic rhinitis, and respiratory system infections. It is especially prevalent in colder months. Nasal decongestants, in the form of pills, drops, or sprays, are then used as symptomatic therapy. Moreover, the trend of nasal decongestant usage is constantly growing.

What are nasal decongestants, and how do they work?

Nasal decongestants are sympathomimetics, a family of drugs that work by stimulating the alfa-adrenergic receptors, which are part of the sympathetic system. Thus, they increase the effects of the neurotransmitters adrenaline and noradrenaline. They cause vasoconstriction, bronchodilatation, local blood flow redistribution and the reduction of nasal oedema.

Some medications in this group are naphazoline, xylometazoline, tetryzoline, oxymetazoline, and phenylephrine. The effects begin a couple of minutes after application. Depending on the medication, the usage should not be longer than 5-7 days in continuity.

“Rebound effect”

Problems often arise when patients disregard the usage instructions due to the fast effect of the decongestants. With prolonged or excessive use, patients can develop a specific type of nasal congestion called Rhinitis medicamentosa. Consequently, patients have increasing drug tolerance, the nasal mucosa is more and more damaged, and the congestion, the very symptom the patient wanted to eliminate, is worsening.

Symptoms:

• The symptoms of congestion that appear shortly after spray/drop application
• The medication becomes less and less effective over time
• The urge to use decongestants exceeds the dosage stated in the usage instructions

Possible side effects:

• Hypertension
• Insomnia
• Paranoia
• Irritability
• Hallucinations

Extra caution is required when dealing with patients who suffer from cardiovascular diseases, hyperthyroidism, diabetes, prostate hypertrophy and those who are treated with antidepressants at the time of decongestant usage.

Safety

Due to possible side effects, informing patients of potential risks is essential to ensure safe and effective treatment. Despite many people considering themselves to be a decongestant addict, the condition is not recognised as a true addiction. Nevertheless, excessive decongestant use can lead to negative consequences and demanding cessation of use.

Translated by: Dea Radek