Nasal Spray Addiction: Symptoms, Alternatives, and Safety

When you have a stuffy nose, a few drops of an over-the-counter (OTC) nasal spray can often provide quick relief.

But what happens if you have to use a nasal spray every day? Are there any downsides to long-term use?

The answer depends on the type of spray you use. many kinds ofdogRafael Cardona, MD, an otolaryngologist at Otolaryngology and Allergy Associates in White Plains, New York, says they can be used safely long-term, but nasal decongestants like Afrin should not be used for more than a few days at a time.

Here, learn about the types of nasal sprays you can use long-term and some spray alternatives that can help clear your sinuses.

According to the Cleveland Clinic, most nasal sprays work by reducing inflammation in the nasal passages, thereby relieving swelling and congestion.

The three basic categories of over-the-counter nasal sprays are decongestants, steroid sprays, and antihistamine sprays. Dr. Cardona says some are designed for long-term use and some are not. Knowing the type you’re using can help you decide whether to use it every day.

Here are the details on each, according to the Cleveland Clinic:

• ‌‌Decongestant Nasal Spray:‌ These sprays can reduce nasal congestion caused by a mild cold or flu. They can only be used for a few days at a time. Common types include oxymetazoline hydrochloride (Afrin and Dristan) and phenylephrine hydrochloride (Neo-Synephrine).
• ‌‌Nasal steroid spray:‌ These are once-daily sprays that can help reduce nasal congestion caused by seasonal allergies. They work best for long-term use if you start taking them a few weeks before (and throughout) allergy season. Common options include fluticasone (Flonase) and betamethasone (Nasacort).
• ‌‌Antihistamine spray:‌ These are once-daily sprays for seasonal allergies and are available by prescription. Common choices are azelastine (Astepro and Astelin) and olopatadine (Patanase).

If you’re not sure which one is best for you, talk to your primary care doctor or allergist for advice.

Antihistamine and steroid sprays are safe (and often encouraged by allergy experts) to be used over longer periods of time (such as throughout allergy season).

But if you use ‌DecongestantAccording to the Cleveland Clinic, you may develop drug-induced rhinitis, or rebound congestion, if you use nasal sprays for an extended period of time.

Dr. Cardona says this happens because “the blood vessels in the nasal passages require a certain amount of decongestants” to stay open. “When you stop using it and the effects of the drug wear off, your blood vessels react with swelling.”

The result is more nasal congestion, which can make you want to use more nasal spray. (Basically, your nose becomes dependent on it.)

It’s not quite nasal spray or Afrin‌addiction‌, but it feels like it. Dr. Cardona says you can’t actually become addicted to a decongestant nasal spray, but you may “find yourself relying on the spray to keep the congestion from returning.”

If you use a decongestant for about a week or more and then suddenly stop using it, you may experience rebound congestion, according to the U.S. National Library of Medicine (NLM). According to the NLM, going back to decongestants for even a few days can put you back into that stuffy-and-spraying cycle.

If you get to this stage, you can slowly reduce the amount of spray you use with your doctor, as stopping suddenly can worsen your symptoms.

If you find that a decongestant spray is the only thing that can wake you up (it works quickly and is convenient, after all), it may be difficult to find a replacement.

You can try steroids or antihistamine sprays to see if they work for you. As far as we know, these sprays can be used long-term.

Fortunately, there are other ways to breathe easier while avoiding severe rebound congestion. According to Dr. Cardona, some other options to try include:

• ‌‌Oral decongestants:If you want to stick with decongestants for quick, long-lasting relief, oral medications like pseudoephedrine are a better choice, Dr. Cardona says. It works similarly, reducing nasal swelling and congestion without causing rebound congestion. (But it can still cause side effects such as restlessness, nausea, or headaches, according to the NLM.)
• ‌‌Nasal saline spray:‌ Prefer a more natural approach? Nasal saline sprays like Vicks Sinex Nasal Saline Spray are “basically sterile saline,” Dr. Cardona says. “They can help relieve nasal congestion, although they may cause some irritation,” he adds.
• ‌‌Nasal irrigation:‌ Use a neti pot filled with a saline solution to physically flush the nasal passages, which works similarly to a nasal saline spray. While there isn’t much research into the differences between them, a full rinse may be cleaner than a spray. Be sure to read and follow the neti pot instructions carefully.

For example, while steroid and antihistamine nasal sprays are safe to use during allergy season, nasal decongestant sprays like Afrin should not be used for more than a few days at a time. If you use them long-term, you may experience rebound congestion, and your sinuses may rely on the medicated spray to keep them clear.

Dr. Cardona recommends seeing your doctor if you regularly rely on nasal decongestant sprays to relieve nasal congestion. They can help determine if your nasal congestion has an underlying cause that needs to be addressed, such as allergies or a sinus infection. They can also help you wean yourself off the spray so you can begin better long-term treatment.