How Nasal Spray Use and Overuse Affects the Nose

• Fluticasone¹³
• Beclomethasone¹³
• Triamcinolone¹⁴
• Budesonide¹³
• Mometasone¹³

The rebound effect

If decongestant nasal sprays are used for more than three days in a row, the user may develop rebound rhinitis medicamentosa (RM).¹⁵ This is sometimes also known as rebound congestion.¹⁵ It tends to feel like regular congestion but is specifically triggered by the use of some medications, including nasal sprays containing ingredients like oxymetazoline.

Rebound congestion happens when the mucus membrane, or “nasal mucosa,” becomes inflamed by topical nasal decongestants, such as nasal sprays.¹⁵ This side effect has been reported from the overuse of ephedrine-derived nasal sprays, like those made with pseudoephedrine.¹⁵

Some active ingredients may be less likely to trigger rebound congestion than others, although the findings are mixed.^16,17 For example, some research suggests that imidazoline-derived ingredients like oxymetazoline may have a lower risk of rebound congestion, although others disagree.^16,17 However, these ingredients can pose other risks, including toxicity to pets, if medications aren’t secured properly.¹⁸

Other potential side effects of nasal spray overuse

Besides rebound congestion, other side effects can also occur while using nasal sprays. Some common side effects of using steroid nasal sprays include nosebleeds, infections, headaches, sneezing, and irritation or dryness in the nasal cavity.^12,19 Similar side effects can also be seen while using decongestant nasal sprays.^6,9

Research suggests that decongestant nasal sprays containing oxymetazoline can cause side effects like a more blocked or running nose, headaches, dizziness, drowsiness, lightheadedness, and cardiovascular effects like an increased heart rate.⁹ Xylometazoline hydrochloride, another active ingredient used in some decongestant nasal sprays, is also associated with some similar side effects, including nosebleeds, itching, and headaches.^20,21

Saline nasal sprays tend to have fewer side effects than their steroid or decongestant-based counterparts.⁸ Despite this, some sprays may contain other ingredients besides the saltwater solution that can raise medical concerns.²² Some concerns have been raised about the use of some preservatives in saline sprays, like preservative benzalkonium chloride (BKC), and the long-term effects it may have on a type of white blood cell.²²

Tips for responsible nasal spray use

Limiting the amount of time the nasal spray is used could also help avoid rebound congestion. Many nasal sprays have an advisory of how long they should be used in their instructions.^20,21 When using any medication, these instructions should be followed.

Some people might consider using saline-only sprays to avoid the side effects of medicated decongestant sprays, like rebound rhinitis.²² However, these sprays may not be suitable for everyone. For example, some people may have an allergic reaction to it and require treatment.²³ Similarly, some issues that lead to congestion may not be treatable simply by moisturizing the nasal cavity, meaning that saline sprays aren’t useful. If congestion is recurring and long-lasting, medical advice should be sought from a healthcare professional, such as a nurse practitioner, healthcare assistant, or medical doctor, as it could indicate a more serious concern and suggest that the condition needs a different line of treatment.

References

1. Naclerio, R. M., Bachert, C., & Baraniuk, J. N. (2010). Pathophysiology of nasal congestion. International Journal of General Medicine, 47-57.
2. Harvey, R. J., Roland, L. T., Schlosser, R. J., & Pfaar, O. (2024). Chief Complaint: Nasal Congestion. The Journal of Allergy and Clinical Immunology: In Practice, 12(6), 1462-1471.
3. Stewart, M., Ferguson, B. J., & Fromer, L. (2010). Epidemiology and burden of nasal congestion. International Journal of General Medicine, 37-45.
4. Eccles, R. (2021). The role of nasal congestion as a defence against respiratory viruses. Clinical Otolaryngology, 46(1), 4-8.
5. Meltzer, E. O., Caballero, F., Fromer, L. M., Krouse, J. H., & Scadding, G. (2010). Treatment of congestion in upper respiratory diseases. International Journal of General Medicine, 69-91.
6. NHS. (2017, October 18). Decongestants. Retrieved from nhs.uk website: https://www.nhs.uk/conditions/decongestants/
7. NHS Choices. (2018, September 7). Non-allergic rhinitis. Retrieved from nhs.uk website: https://www.nhs.uk/conditions/non-allergic-rhinitis/
8. Santoro, E., Kalita, P., & Novak, P. (2021). The role of saline nasal sprays or drops in nasal hygiene: a review of the evidence and clinical perspectives. Rhinology Online, 4(4), 1-16.
9. Dokuyucu, R., Gokce, H., Sahan, M., Sefil, F., Tas, Z. A., Tutuk, O., ... & Cevik, C. (2015). Systemic side effects of locally used oxymetazoline. International Journal of Clinical and Experimental Medicine, 8(2), 2674.
10. Wang, J., Mao, Z. F., & Cheng, L. (2024). Rise and fall of decongestants in treating nasal congestion related diseases. Expert Opinion on Pharmacotherapy, 25(14), 1943-1951.
11. Johnson, D. A., & Hricik, J. G. (1993). The pharmacology of α‐adrenergic decongestants. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 13(6P2), 110S-115S.