What is the risk of rhinitis medicamentosa (Rebound congestion) from prolonged use of steroid nasal sprays (Corticosteroids)?

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Last updated: March 13, 2025 • View editorial policy

From the Guidelines

Rhinitis medicamentosa does not typically occur with steroid nasal sprays, as this rebound congestion phenomenon is primarily associated with decongestant nasal sprays containing ingredients like oxymetazoline or phenylephrine when used for more than 3-5 days. Intranasal corticosteroids such as fluticasone, mometasone, and budesonide actually treat inflammation and can be used safely for extended periods without causing physical dependence or rebound symptoms 1, 2. If you're experiencing persistent nasal congestion while using a steroid nasal spray, it's likely due to underlying allergic or non-allergic rhinitis rather than medication-induced rhinitis.

Key Points to Consider

  • The risk of rhinitis medicamentosa is not a concern with steroid nasal sprays, as they are designed to reduce inflammation and do not cause rebound congestion 3.
  • Intranasal corticosteroids are effective in controlling the symptoms of allergic rhinitis, including sneezing, itching, rhinorrhea, and nasal congestion 2.
  • Proper technique is important when using steroid nasal sprays - aim slightly away from the nasal septum, and avoid sniffing forcefully after spraying 1.
  • If symptoms persist despite correct usage, consult your healthcare provider as you may need additional treatment or a different diagnosis may be responsible for your symptoms 4, 5, 6.

Recommendations for Use

  • Use steroid nasal sprays consistently as prescribed, typically one or two sprays in each nostril once daily.
  • Allow 2-4 weeks for maximum benefit, as the onset of action may take some time 3.
  • Consider consulting your healthcare provider if you experience any side effects or if your symptoms do not improve with treatment 1, 2, 3, 4, 5, 6.

From the FDA Drug Label

Does Fluticasone Propionate Nasal Spray, USP cause a "rebound" effect? No, Fluticasone Propionate Nasal Spray, USP does not cause a rebound effect Some nasal decongestant sprays may cause your nasal passages to swell up even more when you use them too often or for longer than their label says you should (three days). This is sometimes called a “rebound effect. ” Fluticasone Propionate Nasal Spray, USP is a different kind of medicine and does not cause any rebound effect.

The risk of rhinitis medicamentosa (Rebound congestion) from prolonged use of steroid nasal sprays (Corticosteroids), such as Fluticasone Propionate Nasal Spray, USP, is none according to the drug label 7 and 8.

  • Key points: + The drug label explicitly states that Fluticasone Propionate Nasal Spray, USP does not cause a rebound effect. + This is in contrast to some nasal decongestant sprays, which can cause rebound congestion with prolonged use. + The label recommends using Fluticasone Propionate Nasal Spray, USP for up to six months if you are age 12 or older or up to two months a year if you are age 4 to 11 before checking with a doctor.

From the Research

Risk of Rhinitis Medicamentosa from Prolonged Use of Steroid Nasal Sprays

  • The risk of rhinitis medicamentosa (rebound congestion) from prolonged use of steroid nasal sprays (corticosteroids) is not directly associated with the use of corticosteroids themselves, but rather with the use of topical decongestants 9, 10.
  • Topical corticosteroids are considered safe and effective for the treatment of allergic rhinitis, and their use is not typically associated with rebound congestion or rhinitis medicamentosa 9, 11.
  • However, the use of decongestant nasal sprays, which may be used in conjunction with corticosteroids, can lead to rhinitis medicamentosa if used for an extended period 12, 10.
  • A study found that the combination of a corticosteroid (fluticasone furoate) and a decongestant (oxymetazoline) in a single nasal spray did not increase the risk of rebound congestion or rhinitis medicamentosa, even with long-term use 13.
  • Proper use and instruction on the use of nasal sprays, including corticosteroids and decongestants, are essential to minimize the risk of adverse effects and complications 9, 11.

References

Guideline

clinical practice guideline: allergic rhinitis.

Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2015

Guideline

the diagnosis and management of rhinitis: an updated practice parameter.

Journal of Allergy and Clinical Immunology, 2008

Guideline

the diagnosis and management of rhinitis: an updated practice parameter.

Journal of Allergy and Clinical Immunology, 2008

Guideline

the diagnosis and management of rhinitis: an updated practice parameter.

Journal of Allergy and Clinical Immunology, 2008

Guideline

the diagnosis and management of rhinitis: an updated practice parameter.

Journal of Allergy and Clinical Immunology, 2008

Guideline

the diagnosis and management of rhinitis: an updated practice parameter.

Journal of Allergy and Clinical Immunology, 2008

Research

Topical nasal sprays: treatment of allergic rhinitis.

American family physician, 1994

Research

Corticosteroids in the management of upper respiratory allergy: the emerging role of steroid nasal sprays.

Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 1992

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.