From the Guidelines
If you're experiencing rebound congestion, nasal pain, and insomnia from overusing nasal spray, you should gradually discontinue the spray rather than stopping abruptly. Start by reducing usage to one nostril at a time over 1-2 weeks while using saline sprays in the other nostril, as recommended by the most recent guidelines 1. During this tapering period, try using oral decongestants like pseudoephedrine (Sudafed) for temporary relief, but limit use to 3-5 days to avoid dependence, as cautioned by studies 1. Some key points to consider when using oral decongestants include:
- They can cause insomnia, irritability, and palpitations, so use with caution, especially in patients with certain medical conditions 1.
- They may raise blood pressure, so monitor blood pressure in hypertensive patients 1.
- They are generally well tolerated in children over 6 years of age, but use with caution in infants and young children due to the risk of adverse effects 1. Nasal saline rinses with a neti pot or saline spray can help moisturize nasal passages and reduce inflammation, as suggested by various studies 1. For sleep issues, try elevating your head while sleeping, using a humidifier in your bedroom, and avoiding caffeine and screens before bedtime. If symptoms persist beyond 2-3 weeks of tapering or worsen significantly, consult a healthcare provider as you may need prescription steroid nasal sprays or other treatments, as recommended by the guidelines 1. This approach works because gradually reducing the decongestant spray allows your nasal tissues to recover normal responsiveness while managing withdrawal symptoms, as the overuse of decongestant sprays causes blood vessels to become dependent on the medication to remain constricted, a condition known as rhinitis medicamentosa 1.
From the Research
Symptoms of Overusing Nasal Spray
- Rebound congestion
- Nasal pain
- Insomnia
Treatment Options
- Stopping the use of decongestant nasal spray is the first-line treatment for rhinitis medicamentosa, as seen in studies 2, 3
- Using intranasal glucocorticosteroids, such as nasal steroid sprays, can help speed up the recovery process 2, 3, 4
- Nasal steroid sprays can reduce rebound congestion and alleviate symptoms 4
Important Considerations
- The cumulative dose of nasal decongestants or time period needed to initiate rhinitis medicamentosa has not been conclusively determined, so these medications should only be used for the shortest period necessary 3
- Patients with rhinitis medicamentosa who overuse topical decongestants and are able to stop using such drugs should be careful about taking these drugs again, even for a few days, to avoid the return of the vicious circle of nose-drop abuse 5
- Underlying nasal disorders must be treated after the withdrawal process 5