February 07, 2023

Decongestant Nasal Spray Addiction (Afrin, Zicam, Sinex, Neo-Synephrine, etc)


I see about 3-6 patients a month for what I consider a decongestant nasal spray addiction. The typical story starts with a upper respiratory infection causing nasal congestion and obstruction. The patient then goes to the store and gets a decongestant nasal spray (ie, Afrin, Zicam, Sinex, Neo-Synephrine, etc) which works great to open up the nasal passages.

Unfortunately, even though the upper respiratory infection seems to have resolved, the nasal congestion and obstruction persists leading to continued use of the decongestant nasal spray. Over months (and even years), what started out as using the nasal spray only at bedtime, now ends being used 2 times a day... then 3... and even more often to get the nose unblocked.

At this point, the nose has become "addicted" to the decongestant nasal spray! Known medically as rhinitis medicamentosa, whenever the patient wants to stop using the nasal spray, there is a severe rebound congestion which is analogous to "withdrawal effects." Furthermore over time, the patient ends up needing to use the nasal spray more and more often to get the good effects... analogous to the "high" of drug abusers.

Unfortunately, there is no easy way to stop decongestant nasal sprays at this point. One simply must stop using the nasal spray! There are prescription steroids that can be given to help minimize the rebound withdrawal effects, but there still will be a period of misery before the nose finally gets back to normal. This may take anywhere from 2-8 weeks depending on how long and how frequently the patient has been using the nasal spray.

It is recommended to NEVER use decongestant nasal sprays for more than 3 consecutive days... followed by at least 3 weeks of avoiding its use before you can safely reuse.

For more info on this condition and treatment, click here.

Keep in mind that not all nasal sprays have this addiction concern. These nasal sprays are SAFE to use daily for prolonged periods of time.

Saline Nasal Spray

Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.

Banner Map

Pediatric Neck Masses

Adult Neck Mass Workup