From the Guidelines
Afrin (oxymetazoline) can cause rebound congestion with prolonged use, and it is recommended to limit its use to no more than 3 days in a row to avoid this phenomenon, known as rhinitis medicamentosa, as stated in the study published in 2015 1. When you use Afrin, it works by constricting blood vessels in the nasal passages, which temporarily reduces swelling and congestion. However, with continued use, your nasal tissues become dependent on the medication, and when it wears off, the blood vessels dilate even more than before, causing worse congestion than you started with. Some key points to consider:
- The package insert for oxymetazoline nasal spray recommends use for no more than 3 days 1.
- Rhinitis medicamentosa may develop after the repetitive and prolonged use of topical a-adrenergic nasal decongestant sprays such as oxymetazoline 1.
- Topical decongestants should not be used more than 3 to 5 consecutive days without a prolonged intervening drug-free period due to their propensity to cause rebound congestion and rhinitis medicamentosa 1. If you're already experiencing rebound congestion, you'll need to discontinue the Afrin, though this may temporarily worsen symptoms for 1-2 weeks as your nasal tissues recover. During this withdrawal period, some options to manage symptoms include:
- Saline nasal sprays
- Oral decongestants
- A short course of nasal steroids, as suggested in the study published in 2008 1. For chronic nasal congestion, consider alternatives like:
- Nasal steroid sprays (fluticasone, mometasone)
- Antihistamines
- Saline irrigation, which don't cause rebound effects when used as directed, as mentioned in the study published in 2015 1.
From the Research
Afrin and Rebound Congestion
- The use of Afrin, also known as oxymetazoline, has been studied in combination with fluticasone furoate for the treatment of allergic rhinitis with nasal congestion 2, 3.
- Research has shown that when used in a fixed dose combination with fluticasone furoate, oxymetazoline does not cause rebound congestion or rhinitis medicamentosa, even after long-term continuous use of 28 days 2.
- A study published in the Journal of Asthma and Allergy found that the proportion of patients showing worsening of symptoms after stoppage of medication was similar in both the combination group and the fluticasone alone group, suggesting that oxymetazoline does not contribute to rebound congestion 2.
- Another study published in The Journal of Allergy and Clinical Immunology found no evidence of rhinitis medicamentosa after treatment with the combination of fluticasone furoate and oxymetazoline, suggesting that the addition of oxymetazoline to fluticasone furoate does not increase the risk of rebound congestion 3.
- The available evidence suggests that Afrin, when used in combination with a nasal steroid like fluticasone furoate, does not cause rebound congestion, but rather adds to the effectiveness of the treatment for allergic rhinitis with nasal congestion 2, 3.