Nasal spray: why you shouldn't use it for too long

When your nose is blocked, decongestant nasal spray works like a small miracle: one spray - and you can breathe again. But this „miracle“ can become a problem if you use it too long or too often.

How does decongestant nasal spray actually work?

Decongestant sprays with active ingredients such as Xylometazoline or Oxymetazoline the blood vessels in the nasal mucosa contract. The swelling goes down and you can breathe better - often after just 1 to 2 minutes.

This is very helpful for a short time, for example if you have a bad cold. But this effect has a catch.

What happens if it is used for too long?

If such a spray is used over a period of days and weeks, a so-called Rhinitis medicamentosa („nasal spray rhinitis“) can develop. The nasal mucosa then reacts hypersensitively, swells faster and more strongly - especially as soon as you stop using the spray.

Studies show:

• Already 3 days to a few weeks Continuous use can trigger harmful effects, depending on the preparation and dose.
• After 4 weeks with a spray containing oxymetazoline or xylometazoline, there was significantly more mucosal swelling, a change in the reaction of the nasal mucosa and an increased feeling of congestion.
• Preservatives such as Benzalkonium chloride (BAC) can further increase the swelling of the mucous membranes.

The result: you spray in order to be able to breathe freely again - but this is exactly how you keep the vicious circle going.

Can you become „addicted“ to nasal spray?

Many sufferers report that their lives revolve heavily around the spray: fear of leaving the house without it, constant stockpiling, arguments or shame in their social environment, sleep disorders and even feelings of panic when their nose is closed.

A qualitative study found that all the typical components of an addiction (e.g. loss of control, severe craving, withdrawal symptoms) in people with nasal spray overuse. One case report also describes oxymetazoline use over 20 years with a massive desire to quit, but strong addictive pressure.

Frequent side effects due to incorrect use

Observations from studies show:

• Many people use nasal sprays for longer than recommended (more than 3-5 days).
• Common complaints of overuse are Dryness, irritation, headaches, and Restlessness/anxiety.
• In addition to the nose - especially if used incorrectly or excessively - the following can also occur Cardiovascular effects occur (e.g. increased pulse rate, blood pressure problems).

„But the pack says 3-7 days - is that really so dangerous?“

Short-term, correct use (e.g. a few days in the case of a severe cold) is considered well tolerated in studies and results in during this time usually does not lead to rebound constipation.

The problem starts where you:

• spray more often than permitted,
• longer than the recommended maximum 3-5 (up to 7) days use,
• you reach for the spray again and again with every little cold - sometimes for months or years.

This significantly increases the risk of rhinitis medicamentosa.

How do you realise that you are using nasal spray for too long?

Typical warning signs:

• You need the spray every day, often several times.
• Without spray, your nose is permanent worse than before the first application.
• You are afraid to leave the house or go to sleep without a spray.
• You regularly buy new bottles, perhaps „hiding“ their use from others.

If you recognise yourself in it, it's worth going to your doctor or to us at the Hasen Apotheke.

And what about other nasal sprays, e.g. cortisone or seawater?

Not every nasal spray causes this „nasal spray rhinitis“. It is important to differentiate:

Spray type	Risk with long-term use	Typical role
Decongestant sprays (e.g. xylometazoline, oxymetazoline)	High risk of rhinitis medicamentosa with overuse	Only for short-term acute relief
Sea water/salt sprays	No rebound, rather caring	For moisturising, rinsing
Cortisone nasal sprays	Well tolerated locally, but systemic side effects rarely possible in case of massive overdose	Permanent therapy for allergies, polyps, etc. as prescribed by a doctor

Table: Different types of nasal spray and their long-term risk

Systemic effects such as adrenal cortex weakness or loss of bone density have been described in isolated cases, particularly with very high, prolonged overdoses of cortisone nasal sprays. Therefore, the same applies here: Adhere to the dosage exactly as prescribed by your doctor.

How do you get out of the nasal spray vicious circle?

You should not continue to use decongestant sprays for months, should not continue them „forever“ and should not stop them abruptly. Strategies such as

• Nasal spray Gradually reduce (e.g. first only one nostril, then both).
• Switch to Seawater sprays or nasal showers for support.
• Additionally at night Nasal ointments to regenerate the nasal mucosa (in parallel with seawater sprays).
• Use of Cortisone nasal sprays (prescribed by a doctor) to soothe the mucous membrane while the decongestant spray is being phased out.

In many cases, the mucous membrane improves when the decongestant spray is professionally discontinued and the actual underlying disease (e.g. allergy, nasal septum problems) is treated correctly.

When should you definitely go to the doctor?

Please have your nose checked by a doctor if:

• You decongestant spray longer than one week take,
• Your nose since Weeks or months hardly gets free without spray,
• You notice nosebleeds, severe dryness or pain,
• you have palpitations, dizziness or headaches in connection with the spray.

Your team at the Hasen Apotheke

Decongestant nasal spray is a useful, powerful medication Not a harmless everyday helper. Used correctly, it will help you through a few unpleasant cold days. However, if used incorrectly or for too long, it can massively prolong your symptoms.

If you are unsure how to use your spray or how to phase it out, feel free to drop by the Hasen Apotheke or talk to us: We'll see together what's best for your nose right now.