3 Reasons Not To Use Nasal Decongestant Sprays

Three Reasons to Avoid Long Term Use of Afrin

Be careful using over the counter nasal decongestant sprays.

Nasal congestion affects approximately 50 percent of people with nasal allergies, and is often the most bothersome symptom. Anyone who has experienced a bad head cold knows this -- you’re miserable when you can’t breathe through your nose and have to breathe with your mouth open. Allergic congestion is caused by inflammation within the nasal passages, and is often due to the release of leukotrienes, not histamine, from mast cells.

Not all allergy medicines treat nasal congestion; so if this is your worst allergy symptom, choose your medicine carefully.

Nasal steroid sprays are often the best long-term choice for treating nasal congestion caused by allergies. Nasal antihistamine sprays and montelukast (also known as Singulair, which blocks leukotrienes) are reasonable alternatives for treating nasal congestion. Oral decongestants, such as those medications containing pseudoephedrine (Sudafed), will treat nasal congestion, but the side effects of these medications prohibit their long-term use for most people. Oral antihistamines, for the most part, don’t treat nasal congestion, which is why there are antihistamine-decongestant combinations available, such as loratadine/pseudoephedrine (Claritin-D) (again, the decongestant in this limits the long-term use for most people due to side effects).

Afrin (oxymetazoline) and other over-the-counter (OTC) nasal decongestant sprays are very effective for treating nasal congestion associated with nasal allergies as well as the common cold, but their use is limited to about three days.

If Afrin is used for longer periods of time, such as for the treatment of nasal allergies, it is likely that a person will become dependent on this medicine.

Here are 3 reasons not to use OTC nasal decongestant sprays:

1. Dependence

Afrin is not addictive like a narcotic medicine can be, but a person can develop a dependence on Afrin.

It is common for a person who has used Afrin for months (or even years) to have to use the nasal spray every few hours just to be able to breathe through their nose.

Afrin dependence is termed rhinitis medicamentosa, and may require the care of a physician in order to overcome the symptoms. It may be possible for a person to slowly wean themselves off of Afrin, although prescription medications may be needed to accomplish this, including nasal steroid sprays or even a short course of oral corticosteroids.

2. Loss of Efficacy

Chronic use of Afrin can result in the need to use the nasal spray frequently in order to maintain the decongestant effect of the medicine. The efficacy of Afrin then lasts for less and less time, and nasal congestion continues to get worse as the medicine wears off. Many people with a dependence on Afrin find that that need to use the nasal spray every couple of hours to treat their nasal congestion, as the efficacy of the medicine lasts for less time the more the spray is used.

3. Rebound Effect

Chronic use of Afrin also results in a rebound of nasal congestion when the medication is stopped, or doses are missed. This means that a person’s symptoms actually get worse after using Afrin for long periods of time, then stop using. Many chronic users of Afrin already know this from missing doses in the past, and therefore use the nasal spray on a regular basis to prevent worsening symptoms in the future.

Prescription nasal sprays, such as nasal steroids, nasal antihistamines and nasal anti-cholinergics, do not cause dependency or rhinitis medicamentosa, even with chronic, long-term use. Therefore, it is safe to use your prescription nasal sprays without fear of becoming “addicted” to them. Reasonable over-the-counter choices for nasal sprays to treat allergies that can safely be used long-term without fear for dependence include NasalCrom and Nasacort 24 HR Allergy. Just don’t expect any of these medications to work as quickly as Afrin.


Diagnosis and Management of Rhinitis: Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol. 1998;81:463-518.

Continue Reading