When Nasal Decongestant Sprays Make You Sicker

Consumer Reports / Ginger Skinner / Feb 2 2016

Overusing Vicks Sinex and other OTC sprays can cause rebound congestion

If you’re battling congestion from a cold or sinus trouble, the good news is that easier breathing might be just a spray or a drop away.

Over-the-counter, 12-hour nasal decongestant sprays like Afrin, Dristan, and Vicks Sinex contain the active ingredient oxymetazoline. That drug shrinks swollen nasal tissues quickly, and usually causes fewer side effects than oral decongestant pills because very little gets absorbed into the bloodstream.

But there is a downside: These sprays are a temporary fix, and come with instructions to stop using after three days. Using them longer than that increases your risk for one very troubling side effect: rebound nasal congestion, also known as rhinitis medicamentosa.

Rebound congestion happens when nasal tissue can’t shrink back to its normal size, and instead stays swollen or becomes even further inflamed, says Zara Patel, M.D., assistant professor of otolaryngology at Stanford University and chair of the Education Committee for the American Rhinologic Society.

“Using these sprays long term—months to years—can even lead to something more dangerous called atrophic rhinitis,” warns Patel. “It’s a rare but difficult-to-treat condition marked by uncomfortably dry, nasal passages, sometimes with chronic crusting, and in some cases, loss of smell.”

What to Do After Three Days

If you’re using an OTC nasal decongestant spray and still feel stuffy after three days, switch to pseudoephedrine pills (Sudafed and generic) to lower your rebound congestion risk. Those are available behind the counter at pharmacies.

Some people are sensitive to pseudoephedrine, which is known to cause nervousness, dizziness, or sleeplessness. Side effects, some of which can be life-threatening, are increased when too much of the drug is taken, so don't exceed the recommended dosage.

Also, don’t bother with decongestants sold on open store shelves, such as those containing phenylephrine (Sudafed PE and generic). Research shows that phenylephrine doesn’t work that well, if at all.

It’s important to note that if you have glaucoma, heart disease, high blood pressure, an enlarged prostate, or thyroid disease, check with your doctor or pharmacist before using any type of decongestant, even sprays, because they sometimes make those conditions worse.

Try Nondrug Treatments

For a safer route to relief that won’t cause rebound symptoms, consider trying nondrug options, such as a saline (salt-based) rinse before reaching for nasal decongestant sprays and pills.

"Saline rinsing acts in two ways to relieve nasal congestion: It draws out excessive water trapped in your tissues, thereby acting as a natural decongestant, and it rinses away allergens that would otherwise stick to the lining,” says Patel.

Saline wash is safe to use long term, but since some tap water contains low levels of organisms, such as bacteria and protozoa, it’s best to rinse with bottled, filtered, or distilled water. You can pick up an already-sterilized saline rinse, such as Ayr Allergy & Sinus Simply Saline, and generic versions, at your drugstore.

Editor's Note: These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by a multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).