Dependence on nasal spray

Definition

In the case of an infection of the upper respiratory tract, such as a cold, a variety of drugs are used. One of them is nasal spray. When buying the mostly over-the-counter drugs, pharmacists always specifically emphasise that nasal sprays are not intended for long-term use.

This information is very relevant, as excessive nasal spray consumption can lead to changes in the mucous membrane and dependence. The consequence is an ever-increasing consumption of nasal spray and normal breathing becomes almost impossible without the use of this medicine. Permanent use leads to certain changes in the nose and health consequences due to the effect of the mostly contained substance xylometazoline. A discontinuation is possible in various ways and should be aimed for by all long-term consumers.

Causes

The main ingredient of common nasal sprays is xylometazoline. It belongs to the group of so-called sympathomimetics, a class of active substances that activate the sympathetic nervous system. The decisive effect of nasal sprays is the constriction of the blood vessels in the nasal mucosa, which leads to the swelling of the mucosa and to the release of the nose.

The regular use of nasal spray, however, leads to a so-called boomerang or rebound phenomenon: the mucous membranes have become accustomed to the decongesting effect of the spray and therefore swell up again after it has subsided. The renewed swelling in turn tempts them to use the drug again, which ultimately leads to a vicious circle. The nasal spray treats the swollen nasal mucous membranes and causes the swelling at the same time.

How fast does it go?

In the package inserts of common nasal sprays containing xylometazoline, a maximum of 7 days of use is recommended. After one week, a break of several days should be taken, if there is still a need for the drug at all. Exceptions must always be discussed with the treating physician or the family doctor, as the first changes in the nasal mucous membrane can be observed after more than a week of use. Also a habituation to the active substance takes place relatively quickly. Many patients underestimate the dependency potential of nasal spray and continue to use it beyond the recommended period.

Symptoms

The dependence on nasal spray is mainly shown by an increased use of the drug, with the effect leaving more and more to be desired. The nasal mucosa gets used to the active substance and at some point no longer reacts effectively to the application. This leads to the actual main symptom of nasal spray dependence – chronic rhinitis, also known as drug-induced rhinitis (Rhinitis medicamentosa).

In a drug-induced rhinitis, the nose is permanently congested and cannot be cleared by using the former supposedly healing spray. The inadequate effect not only causes panic among users, but also leads them to resort to sprays with higher dosages. It must be taken into account that poisoning with xylometazoline can also occur.

The symptomatology is very different, as phases with symptoms of physical activation (arousal, hallucinations, cramps) can alternate with inhibited phases (reduced body temperature, drowsiness, up to coma). This is caused by stimulation and inhibition of the central nervous system, which in turn is related to the effect of xylometazoline on the sympathetic nervous system. Once a dependency has developed, it is often difficult to get rid of it.

However, it is very important for your own health that you can breathe normally without using nasal sprays. There are various ways of weaning oneself off xylometazolin-containing medication. For example, you can have your attending doctor prescribe a nasal spray containing cortisone.

This has a slower effect, but also has a decongestant and anti-inflammatory effect. Due to the side effects of cortisone treatment, this nasal spray may also only be used for a short time. It would be better to use seawater sprays (containing salt water), which keep the nasal mucous membrane moist and can prevent irritation-related swelling of the same kind.

Nasal sprays containing cortisone are only available on prescription, whereas seawater sprays are already available in many supermarkets. Another possibility is to reduce the spray bursts by treating only one nostril at a time. Breathing is made possible, but overall the dose of used nasal spray is reduced, thus taking the first step towards weaning.

In the course of the treatment, the nostrils are changed so that there is no unilateral change in the mucous membrane. The aim is to reduce the amount of spray per day until it is no longer necessary to change nostrils and weaning is complete. A third way is to reduce the dose.

In this case, the nasal spray is initially purchased at a lower strength, for example as a paediatric drug. After some use of the attenuated medication, the spray is again diluted with saline solution. This can be purchased at the pharmacy or prepared at home (9 grams of salt per 1 litre of water).

The aim is to switch completely to sea salt spray or – what is even more desirable – to do without nasal spray altogether. Pseudoephedrine tablets (e.g. Rhinopront®) can be purchased in pharmacies to support weaning. In a weakened form, these have the same effect on the vascular system of the nasal mucosa as locally applied xylometazoline, without putting so much strain on the nasal mucosa. The consumer must also reduce the amount of tablets taken daily in order to achieve the desired goal.