Everything You Need to Know About Rebound Congestion

Everything You Need to Know About Rebound Congestion

Can You Become Addicted to Nasal Spray?

Medically reviewed by Alan Carter, PharmD on December 14, 2017 — Written by Corinne O'Keefe Osborn


When your nose is running, it can seriously affect your quality of life. Many people turn to nasal sprays for relief. There are several different types of nasal spray available, including decongestant spray.

Congestion is caused by inflammation in your nasal passages. These are the hollow, air-filled cavities inside your nose . Decongestant nasal sprays (DNSs) provide immediate relief by shrinking swollen blood vessels in your nasal passages. This reduces the inflammation and helps you breathe easier.

DNSs are supposed to be used for a maximum of three days. If you use them longer than that, they can cause rebound congestion. Doctors call this rhinitis medicamentosa. It means congestion caused by medication.

People develop a tolerance to DNSs. This means they need to take increasingly larger amounts to achieve the desired effect. Tolerance can lead to physical drug dependence, which is different than drug addiction. You can become dependent on nasal spray, but not addicted to it. Read on to learn more.

Nasal spray types

A nasal spray is any kind of medication that’s inhaled through the nose. In the treatment of runny nose and allergies , the most common nasal sprays include active ingredients from four categories:

  • saline
  • steroid
  • antihistamine
  • decongestant

Saline sprays

Saline nasal sprays are like a saltwater rinse for your nasal passages. Germs and irritants enter your nose when you breathe. Your nose produces mucus to flush them out. Saline sprays act like mucus, flushing out irritating substances before they cause inflammation. They can also help flush out excess mucus.

Many saline nasal sprays contain preservatives. These preservatives may cause irritation if your nose is inflamed or damaged. However, if your nose is irritated by dry winter air, saline sprays can add healing moisture.

Steroid sprays

Some nasal sprays contain corticosteroids that help reduce swelling in the nasal passages. Steroid sprays work best for chronic congestion caused by allergies or irritants. Some steroid sprays require a prescription from your doctor, while others are available at your local drugstore. Common brand names include Nasacort and Flonase .

Steroid nasal sprays are safe for long-term use in adults. Side effects include:

  • stinging and burning of the nasal passages
  • sneezing
  • throat irritation

Antihistamine sprays

Some nasal sprays contain antihistamines, which work to reduce congestion caused by an allergic immune response .

Sprays containing azelastine (Astelin and Astepro) have proven to be very safe. Studies show that azelastine nasal spray is more effective than oral antihistamines like Benadryl and some corticosteroid nasal sprays.

Possible side effects of azelastine sprays include:

  • bitter taste
  • tiredness
  • weight gain
  • muscle pain
  • nasal burning

Decongestant sprays

Most DNSs contain oxymetazoline (Afrin and generic brands). They work by constricting blood vessels in the nasal passages. DNSs are best for colds, flus, or other short-term problems.

When you’re congested, it’s because your nasal passages are swollen. This makes them feel blocked. The swelling leads to increased mucus production, which causes a runny nose. When DNSs shrink blood vessels, they reduce the inflammation and the associated mucus production.

If you use a DNS, you may experience any of the following side effects:

  • burning
  • stinging
  • increased mucus
  • dryness in the nose
  • sneezing
  • nervousness
  • nausea
  • dizziness
  • headache
  • difficulty falling or staying asleep

Some side effects can be serious. Call your doctor right away if you experience feeling a faster or slower heartbeat than what’s usual for you.

What happens if you use a DNS for too long?

Rebound congestion refers to the unfortunate phenomenon in which using DNSs for too long causes — rather than prevents — congestion. It’s a subject of some controversy. In fact, many researchers question whether it’s real.

Some research shows that the longer you use a DNS, the more you build up a tolerance. Drug tolerance means that you require increasingly larger and more frequent doses to achieve the desired effects.

Decongestants shrink the blood vessels in your nasal passages. When the drug wears off, they swell up again. This causes immediate withdrawal congestion.

According to the National Institute on Drug Addiction , there’s a difference between physical drug dependence and addiction. You’re physically dependent on a drug when skipping a dose causes withdrawal symptoms, such as congestion.

Addiction is categorized by intense cravings for a substance and an inability to stop using despite facing negative consequences.

Addiction is a complex disease with many behavioral characteristics. Unless you have intense cravings for nasal spray, you’re probably dependent — not addicted.

Symptoms of overuse

What are the signs that you’re overusing nasal spray?

  • You’ve been using it longer than one week.
  • You’re using it more frequently than directed.
  • When you try to stop using it or skip a dose, you get very congested.

The primary symptom of DNS withdrawal is congestion. In addition, it’s likely that whatever initially caused your congestion will return. This is especially true if you have chronic allergies.

You may experience:

  • runny nose
  • sore throat
  • sneezing
  • difficulty breathing
  • headache
  • sinus pressure

How is rhinitis medicamentosa treated?

Studies show that people who have been misusing DNSs for months, or even years, can be treated successfully. Recovery typically takes less than one week and withdrawal symptoms can be easily managed.

Research suggests that the best way to stop overusing DNSs is to switch to a steroid nasal spray. About six months after stopping a DNS, most people no longer have a tolerance to it. Studies show that relapse is very rare.

Correctly using a DNS

Use a DNS only as directed. Follow the instructions on the box or the directions of your doctor. Some general guidelines are:

  • Don’t use it for longer than three days.
  • Use it once every 10 to 12 hours.
  • Don’t use more than twice in 24 hours.

DNSs work best for short-term congestion caused by a virus or infection.

The takeaway

The misuse of DNS isn’t an addiction. However, if you’ve been using it for weeks or months, then it’s likely that you have become physically dependent on it. Talk to your doctor about other treatment options, including steroid nasal sprays and oral allergy medications.

Medically reviewed by Alan Carter, PharmD on December 14, 2017 — Written by Corinne O'Keefe Osborn

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What Is Rebound Congestion?

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Ear, Nose & Throat

ENT Disorders

What Is Rebound Congestion?

Congestion Related To Use Of Nasal Decongestants

By Kristin Hayes, RN | Reviewed by Susan Olender, MD
Updated November 06, 2018
Woman using nasal spray for controlling rhinitis

BURGER / Getty Images
Ear, Nose, and Throat Conditions (ENT)

More in Ear, Nose & Throat

Rebound congestion is a worsening of your nasal congestion due to nasal decongestants such as Afrin (oxymetazoline), Sudafed (pseudoephedrine), or Sudafed PE (phenylephrine). Rebound congestion is also known as rhinitis medicamentosa, chemical rhinits, nasal spray addiction. Your nasal passages can develop a dependence to these medications in as little as 3 days; for this reason, the boxes and your doctors will tell you to only take these medications for no more than 3 days.

How Decongestants Work

A common belief is that congestion is caused by mucus blocking your nasal passages. This is only partially true. The underlying cause of congestion lies in the blood vessels that line your nose. Certain conditions can cause these vessels to become swollen or constrict.

When the blood vessels in your nasal passages become swollen due to a cold , allergies, sinusitis , exercise, or hormonal changes, congestion occurs. However, when the blood vessels constrict, there is more space in the airways and your symptoms subside.

Medications used to treat congestion, called decongestants , help alleviate the symptoms by causing the blood vessels in your nose to shrink (a process called vasoconstriction). They are available both in oral and nasal spray formulations.

Causes of Rebound Congestion

The reasons why rebound congestion occurs are complicated and not well understood. you may again begin to feel severe congestion, which is only relieved by the additional use of a nasal decongestant. Thus, a vicious cycle is set up. This is thought to be related to two possible causes:

  • Use of nasal decongestants causes inadequate blood supply (because of the constriction of blood vessels) which causes swelling to occur in your nasal passages.
  • Use of nasal decongestants causes nasal receptors that respond to decongestants to down-regulate (reduce in numbers) which leads to congestion.

When evaluating you for rebound congestion, your physician will take a thorough medication usage history as well as perform a nasal exam. Typically with rebound congestion, your nasal passages will appear to be red with a thicker than the normal nasal mucous membrane.


Rebound congestion most commonly is associated with significant congestion in the absence of a runny nose or sneezing. You may also experience headaches, anxiety, and restlessness.

Rebound congestion is more likely to occur if a decongestant is unable to resolve the underlying condition. For example, if Afrin is routinely used to treat hay fever , its inability to resolve the allergy may reduce sneezing but increase congestion.

Symptoms of rebound generally do not change according to the time of year or whether you are indoors or outdoors.

If rebound congestion continues untreated it can actually lead to other conditions including chronic sinusitis, atrophic rhinitis, and enlarged turbinates . If you have rhinitis medicamentosa you may also frequently snore or experience sleep apnea, a condition which can lead to serious health problems.


If you are already addicted to a nasal spray, talk to your doctor. Some doctors may recommend a gradual decrease in the use of the medication until you are completely weaned off it. This may be preferable than trying to quit the medication outright, which may result in severe congestion for a number of days.

One of the best ways to wean you off nasal sprays is with a Rhinostat kit , a metered dose delivery system that dilutes the nasal spray dose by 10 percent to 15 percent every day until your nasal turbinates return to their normal state.

For example, if your rebound congestion was caused by Afrin and your doctor gave you a prescription for “Rhinostat” you would essentially receive Afrin in a special bottle that allows you to very gradually decrease the dose because of the way it is dispensed.

Another class of medications, called nasal corticosteroids, may also be helpful during the process of weaning off of nasal decongestants. Oral steroids are also sometimes used but only as a last resort. The first week is usually the most difficult and you may experience severe congestion and headaches which then begin to subside.

Treating the underlying condition for which nasal decongestants were originally used is also an important part of the treatment process.

What Type of Congestion Do You Have?

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Article Sources

  • Mortuaire, G, de Gabory, L, François, M, Massé, G, Bloch, F, Brion, N … Serrano, E. (2013). Rebound congestion and rhinitis medicamentosa: Nasal decongestants in clinical practice. A critical review of the literature by a medical panel. European Annals of Otorhinolaryngology, Head and Neck Diseases, 130(3): 137-144.
  • Ramey, JT, Bailen, E & Lockey, RF. (2006). Rhinits Medicamentosa. J Investig Allergol Clin Immunol. 16(3): 148-155
  • Rhinitis Medicamentosa. Medscape website. http://emedicine.medscape.com/article/995056-overview#a5. Updated November 17, 2015. 

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