Rhinitis Medicamentosa

This is Latin for constant nasal congestion caused by the nose having become hooked on over-the-counter nose drops or sprays.ย  The products include Afrinยฎ, Neo-Synephrineยฎ, and more.ย  Their generic ingredients includeย  oxymetazoline, phenylephrine, and others.

These decongestants work by cutting off the circulation in the nose.  If used for more than 3 days, when blood flow returns, it comes back extra strong, causing more congestion.  So you use the spray again, etc. etc. (vicious cycle).  I’ve seen patients who had a simple cold, and 5 years later were still needing the nasal spray.  A good money-maker.

Treatment is difficult, because it means stopping the spray and putting up with congestion for maybe a month or more.  Nasal steroid sprays during this time help enormously (see below).  Before they were invented, I told patients to stop using the decongestant spray in one nostril as long as necessary; when that side finally got back to normal, stop on the other side too.  Another possibility was to use liquid decongestant nose drops, dilute it however tolerated, then dilute it more, bit by bit every day, until no longer congested.

A completely safe product to use is a nasal steroid spray (it’s not the type of steroid abused by athletes).ย  Now sold over-the-counter, they include fluticasone (Flonaseยฎ), mometasone (Nasonexยฎ), triamcinolone (Nasacortยฎ), budesonide (Rhinocortยฎ), and others.ย  But they work for nasal allergies, not colds.ย  To be effective, they have to be used once daily every day (not just when your nose feels stuffed, and not more than once a day).ย  They can be dangerous to people taking certain HIV medications (if they contain ritonavir or cobicistat).ย  See Allergy Medications for explanation how to hold the bottle.

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