Decongestant Nasal Sprays: Beware of Addiction

Hi Mr. Vandervelde,

Thank you for sharing your experience with us. You have quite a lengthy period of using a nasal spray. I am very curious about the specific brand you are using. My SharePost warns about addictive tendencies associated with Topical Nasal Decongestants (TND). There are other types of over the counter nasal sprays that are not habit forming (Nasalcrom and nasal saline for example). Not all TNDs are the same. They may vary in potency and therefore have a milder impact on the inner surface of the nose. Nonetheless, TNDs may over time damage the inside of the nose, with prolonged use.

The fact that your nasal spray bottle lasts for weeks is unusual for Rhinitis Medicamentosa. This suggests you are not an avid daily user (using nasal spray multiple times daily, every day). Furthermore, in my experience patients hooked on TND prefer night time use in order to sleep better.

Perhaps you are fortunate not to have suffered from complications related to long-term use of your nasal spray. I am glad you beat the odds. We see similar examples (of beating odds) with some people who smoke cigarettes. Most of us know someone who has smoked for more than 25 years but appears to be in good health. Yet many people that have smoked 20 or more years have significant lung damage and often have signs of chronic bronchitis or emphysema.

Allergy shots have come a long way in the last 30 years, thanks to research and clinical trials. They are a lot more expensive now compared to when you had them, but health insurance often covers them.

Loss of the sense of smell has not represented a measure of nasal damage associated with TNDs, although it may occur when there is any kind of damage to the lining of the upper nasal passage.

I have some questions for you:

Do you think you are habitually dependent on your nasal spray?

When is the last time you went three or more days without using it?

I hope to hear from you again.

To your continued good health,

J. Thompson, MD.

Hi Ms Henry,

I am not aware of prescription nasal sprays (nasal steroid sprays and others) posing a significant risk to the senses of taste and smell.

Topical nasal decongestants may damage the lining of the inner surface of the nose but taste and smell sensitivity are not often reported as a result of this damage. The olfactory nerves are responsible for the ability to smell and are located in the roof of the inner nasal passage. When there is damage to these nerves not only is the sense of smell affected but also the sense of taste.

I reviewed some causes of anosmia in an answer I recently posted (click this link)

Thank you for your question,

J. Thompson, MD

Dr. Thompson,

I have heard of Zicam causing olifactory disruption. The loss of smell has been attributed to Zicam usage. There is even a lawsuit to this effect. "course you can't trust everything you read on the internet...

Respectfully,

Gloria

Ms. Henry,

I realized you posted the linked question/answer I referred to above, after posting the above reply, forgive me.

I hope my comments have been helpful. If you have more specific questions please continue to post them.

Yours,

J. Thompson, MD

Hi Mickey M,

There are probably lots of people that identify with your experience. Many users of topical nasal decongestants (TND) do not get Rhinitis Medicamentosa (RM). Reasons you may not become dependent and suffer complications despite over using (more than five consecutive days of use at a time) include:

-The use of other nasal-sinus medications which allows you to stop the TND

-Use of TND for a limited time beyond the warning period

-Disappearance of the trigger that promotes use of the TND (as you experienced)

-Mild enough rebound that prolonged dependency does not occur

-Low vulnerability factor (difficult to define this, but some researchers think that some people are more at risk to develop addictive behavior than others).

I am glad you did not develop complications from your use of TND. They really can be effective if prolonged use is avoided. Periodic use for three to five days at a time probably poses little risk.

Allergy sufferers are at higher risk of RM because allergy triggers are continuously or seasonally recurring. This pattern of exposure to triggers may promote longer periods of nasal spray usage.

Bottom Line: Rhinitis Medicamentosa is a risk that increases with prolonged use of topical nasal decongestants. Some people will not get RM despite prolonged use.

Thanks for sharing!

J. Thompson, MD

Hi Jeanette,

 I have several questions that need answering (as well as the need to do a physical exam) before being able to give you a complete answer.

Based on the information you provided I think you have multiple problems occurring at the same time. You apparently have a history of allergic rhinitis. You are hypersensitive to irritant odors and fumes (see my SharePost on Fragrances) and you may have Otitis Media (ear infection). Otitis Media is a common complication of active allergic rhinitis.

There are many postings on this web site which address allergic rhinitis, complications (sinusitis, asthma, otitis and more).

You may have a persistent ear infection or combined ear and sinus infection. Sinus infections may require longer courses of antibiotics (longer than 5-7 days). Perhaps a stronger antibiotic may be required if the infection has not responded.

You require further evaluation. An Ear, Nose and Throat specialist may be helpful if your family doctor is uncertain how to proceed. Your ear should be re-checked ASAP.

Please post a follow-up account on your status.

GET RE-CHECKED!

Best to You,

J. Thompson, MD

Hi Gloria,

I appreciate your kind review of my postings. Thank you for your comments.

The solution you are using is similar to saline solution of which I am a big fan of. Saline is a solution that has the consistency of our body fluids. Specific amounts of salt (sodium chloride) and bicarbonate in water make up saline. Your remedy has a few additional ingredients (sodium citrate, citric acid and aloe vera extract). The additional ingredients result in a solution that I am not familiar with. But I am familiar with aloe vera. Holistic proponents are very supportive of this remedy although scientific studies are lacking.

The good news is your remedy does not contain a decongestant. You are not likely to become dependent on it. I cannot speak toward the long-term potential for side effects but it appears to be well tolerated by you so far.

The NIH website (National Institute of Health) has an alternative subdivision which is reviewing the effectiveness and potential risks of many herbs and extracts (click here).

To Good Health!

J. Thompson, MD

Dr. Thompson,

I must say you're a very gracious man. When I had wrongly blasted you about  the "one size fits all" treatment. I apologize for that.

I had suffered a a massive stroke because
I had gone to doctors who unfortunately knew little about the human body, nor did

they know much about practicing "healthcare" their idea for practicing medicine was just write a prescription. Even if they really knew little about  any side effects for what they wrote prescriptions for...

Most of my damage to my brain was the frontal lobe so I tend to come accross harsh.

I am working on this, plus I'm too impulsive (another lovely frontal lobe deficit...)

So now you understand my haranging about side effects...after almost dying I'm a little non-trusting of doctors. I don't take anything anymore without reveiwing my PDR, and researching any side effects.

You on the other hand come accross very knowledgeable!

I do apologize for my directness and lack of tact. I think that may be gone forever

Beleive it or not I've come a long long way, after being in a coma for a month. I've had to relearn EVERYTHING.

Respectfully,

Gloria

Hi Gloria,

I am sorry you had such a bad experience but I am glad you have recovered from it. No apology is necessary. I think we have had reasonable and rational exchanges. I welcome your opinion, questions or critique of future postings. We all have something to learn and share on this wonderful medium.

Have a good day and week!

J. Thompson, MD

Hi Dr. Thompson,

Ok, for anyone reading this post. I'm going to apoligize now if I offend anyone.

When it comes to the drug companies & the loser doctors who "whore themselves" for them, I tend to rant.

My stroke was caused by the hormones in birth control. They "cause blood clots" no matter how healthy you are even "without" any risk factors...The drug companies & incompetent doctors try hard to cover this fact up.

It was a pharmacist who finally told me the truth, he told me "the hormones are really dangerous because they "change your blood chemistry" making it "thick & sticky" so you WILL clot no matter how young & healthy you are. He told me "it wasn't a matter of "if" when you're on these hormones it's a matter of "when"!

Will a doctor ever tell you the truth about this? Hell no, they make too much money in kick backs to push these drugs. If they don't get kick backs they're just incrdibly ignorant to the side effects like my idiot OBGYN who I had repeatedly asked "shouldn't get off these things I'd been on them for 20 years!

His reply: "honey, you're so incredibly healthy, you have no risk factors, you can stay on them thru menopause!" WRONG! One month after turning 40 I was in a coma fighting for my life! I feel sorry for these young naive girls just like I was, taking Yaz & thinking everything is just fine. Because doctors either refuse to tell them the truth, or they just don't know the truth.

If you don't beleive me ask any nurse she'll tell you the women who've died or become disabled like me. The clot will go either to your heart, lung or brain. I survived to educate women not to be so trusting and lacking knowkedge of any pharmaceutical product you're taking. To stay healthy you need to stay educated about what you're taking, not just trust your doctor knows what he's doing...There are unfortunately many many women like me. I'm not the only one...

Actually, this episode in my life became a blessing, I was set on a new path, prior to the stroke I was just another successful business woman.

I'm lucky, I used that drive which made me a succesful business woman, I channeled into overcoming this obstacle. When told by my dr.s "you may never walk again."

My response:"watch me, get your therapists ready to help me!" It took me years to learn to walk but now 11 years later, I'm walking without my cane and able to walk on my treadmill (holding on ofcourse).

Prior, to this I was incredibly healthy, I even had a personal trainer come to my home. Since my career was so stressful, I worked out to keep my blood pressure low. I owned a staffing company.

Plus being in such good health helped my recovery. I built up my muscles that had atrophied after being paralyzed & in the coma.

Some women I've met who had strokes from birth control, haven't recovered as well.

I said this was a blessing, is because I got to meet my husband thru this ordeal. He accepts me with all my limitations and loves me for who I am not just what I can do...

Even though I've been thru hell, it's was worth it to meet my husband and move from southern CA to beautiful southern Oregon.

My poor employees were affected by this since I was forced to close the company. This was many years ago, the economy was much better I stay in touch with them. My secretary went back to school to go into nursing because of my ordeal...so there's quite a bright side to this nighmare.

Hope I didn't offend anyone. Please keep diligent about learning about your own health it pays off!

Gloria

Can you tell me the name of the solution that you are using?

j.

Hi J.

Hope you had a great Thanksgiving!

Yes. I would be happy to tell you. It's a billion times easier than that stupid neti pot!

The company who makes the nasal irrigation is called Nasal Care nasal cleanse they have a patented applicator that just allows the right amount of liquid going into your nose without any "backwash" to contaminate the bottle or remaining solution. I'm small, so I don't use a full applicator one "pre-mixed" pack lasts me 3 rinses! I had been using decongestants & steroids for 40 years so I went overboard and rinsed 3 times a day! I now no longer need to rinse at all! I'm breathing wonderfully congestion free!

The starter kit comes with the applicator and a package of 30 nasal rinse packets. I've been using this for 21/2 weeks now. I still have 17 packets left! If you buy, 1 starter kit & 1 extra 30 day supply. you don't pay for any shipping cost. A30 day supply costs only $8.99 which is what shipping is. It is soo worth it! I can't tell you I never knew how your nose is suppose to work!

Plus, being inexpensive it's safe! That's a claim the drug companies can never offer you! I do use saline solution to keep my nose moist throughout the day.

Good luck! Here's to free & clear breathing...

G.

Hi Mickie,

It doesn't seem you've had a good start to the New Year but Happy New Year anyway.  I'm sorry your attempt to stop the over-the-counter nasal spray decongestant has caused such severe rebound congestion. Your overuse of the nasal spray has caused dependency which results in the severe blockage you are experiencing. You really need professional medical help to assist you in staying off the topical nasal decongestant. It's often too hard to do cold turkey on your own. Nasal saline just doesn't cut it, as you can see.

It is probably too difficult for you to see your doctor or a specialist on the holiday. You may have already gone back to using your nasal spray by the time you read this message. If so, don't worry. There is a way to approach your problem that often works, at least in the short term. The long term outlook is more based on your level of determination, in my opinion.

It is very important you see a doctor that is familiar with treating rhinitis medicamentosa. Make a copy of my Sharepost and find a medical doctor that treats patients for this type of sinus disorder (preferably an allergist or ENT specialist). Some internist or family doctors may be able to treat you based on their experience. Prescription nasal sprays as well as oral steroid may be prescribed after you are evaluated. Sometimes other problems are identified, such as sinus infection, deviated septum or nasal polyps.

Again, seeing an allergist or ENT specialist would be ideal but it may take some time to get an appointment.

Best Wishes,

J. Thompson, MD

Hi Froggie,

Sorry about the delay in replying to your comment. Sinus Buster is relatively new to the drug market and as you may know was developed by Wayne Perry. This is the guy that went around the country, years ago, demonstrating how to defend against would be attackers or muggers. In the process he allowed himself to be sprayed in the face with Red Pepper Spray (Ouch!!). He even made the Oprah show.

For a while he was quite successful peddling his defense video tapes but later fell on hard times. But he discovered that the pepper spray quickly relieved one of his "cluster headaches" during one of his demos. Cluster headaches are similar to migraines but more common in men, and more associated with nasal symptoms.

To make a long story shorter, Mr. Perry invented the idea of using the main ingredient of Red Pepper Spray as a nasal spray therapeutic. With a roughly $350 investment he developed a million dollar enterprise in a matter of months.

There are no good studies to reflect on its effectiveness and safety (that I am aware of). I am very familiar with the active ingredient, Capsaicin which has been studied for years for other types of treatments. Currently there are only testimonials driving the market for this drug. I have not come across a specific explanation on how it works on the sinuses. I don't know how effective it would be for Rhinitis Medicamentosa (addiction to some OTC nasal sprays). I have not seen any studies to prove it.

Final Comment:

Good clinical studies are needed to answer your questions. Some wonderful medications start out this way though. Stay tuned to this drug regarding reports and clinical trials. If it is as good as some reports say it is, it will be around for a long time. I prefer to learn a little more about it before recommending it for use in sinus treatment.

Thank you for your comments and questions!

J. Thompson, MD

Hi C.H.,

Somehow I missed the comments along this thread of emails. I humbly apologize. your spouse may not need my advice now. But for what its worth, having him see an allergy specialist would be of potential benefit. He really needs to get off OTC nasal spray decongestant. He appears to really be hooked. I hope he has already seen a specialist by now. Try to locate an allergist by checking these Websites: Google- AAAAI or ACAAI

Then click on allergist locator.

Good Luck!

J. Thompson, MD

Hi,

I'm so sorry about the delay in answering your question. If you by chance are still struggling with this problem, see an ENT (Ear, Nose and Throat) specialist. The ENT spec. will thoroughly examine your nose and sinuses. You may have some irritation from the nasal spray, or possibly an infection. If you are still having this problem, stop the nasal spray medication, try nasal saline spray until you can get evaluated by an ENT specialist.

Good Luck!

J. Thompson, MD

Hi,

High blood pressure and prostate enlargement means extra caution (many times avoidance) of oral decongestants. Antihistamines won't raise blood pressure but they can aggravate bladder/prostate problems. Prescribed steroids are okay, but with some precautions because of some salt retention related to cortisone based steroids.

These issues would be under consideration by any board certified allergist on the case. An allergist should be giving you guidelines to treat this problem.

Good Luck!

J. Thompson, MD