Image: overuse of Oxymetazoline -> Rhinitis Medicamentosa
Getting the Oxymetazoline Monkey Off Your Back:
Don’t Become an Oxy-Addict!
Oxymetazoline – Afrin, Neosynephrine, Dristan – oxymetazoline.
If you have chronic nasal congestion, oxymetazoline can provide pure magical relief.
For short periods.
It can reduce nasal swelling to help eliminate an acute sinusitis, or simply to help open your nose during a “cold”.
But if you use it regularly, every day, for a week or more, you are potentially in for some serious trouble.
Your nose can become addicted.
Addiction: in this case, meaning “physical dependence,” whereby your nose has developed a tolerance, and you will experience negative physical symptoms of withdrawal resulting from abrupt discontinuation or reduction in dose.
Simply put, you started using oxymetazoline to reduce nasal congestion, and now your nose needs it in order to remain open. If you stop using it, your nose will slam shut, with congestion worse than before you started using oxymetazoline.
The medical term is Rhinitis medicamentosa
Perhaps you have noticed this? You started using oxy last year when you had that cold, just to open your nose so you could sleep. Now you can’t breathe well enough to sleep without it. Sometimes you use it several times a day just in order to breathe.
First rule of using oxymetazoline: never use it for longer than 5 days in a row.
So … what now?
How to manage Rhinitis medicamentosa?
If your nose is severely dependent on oxymetazoline, you may need some professional help in kicking this addiction.
Things that a professional may consider include:
- Stop using oxymetazoline – either cold-turkey, or gradually (recommended). You can do this yourself, without professional help. I have found that a good trick is to alternate the spray in one nostril for one night, and spray for the other nostril the next night, alternating between the sides of the nose. This gives each side a day spray-free for recovery. Gradually reduce the amount of spray used, and gradually increase nights not using spray.
- Daily hypertonic nasal saline rinses (such as Nasopure) for a week only. The hypertonic nature of these can help reduce swelling of the nasal lining. You can do this yourself. (transparency: I have NO financial or other relationship with Nasopure or Dr. Hana Solomon; it’s simply a great product).
(You can use regular saline nasal rinses forever, but limit use of hypertonic saline to a week to keep those cilia happy.) - Consider systemic (oral) nasal decongestants, such as sudaphed. Many of these are available over-the-counter, and may help reduce “rebound” nasal congestion.
- Topical steroids – nasal steroid sprays. These can also help reduce nasal congestion, especially during the “recovery” or “rebound” phase. They are by prescription.
- Systemic (oral) steroids. They are by prescription. These are a more intensive treatment to help keep your nasal congestion down during the recovery phase, usually during the first 5 days or so. Should be considered with caution, since systemic steroid use can have some nasty adverse effects.
To say that Rhinitis medicamentosa is annoying is a huge understatement.
No, the withdrawal symptoms are nothing like those of withdrawal from heroin that are portrayed in television dramas. On the other hand, the severity of nasal congestion that results from oxymetazline withdrawal can make the worst cold of your life seem tame.
The easiest way to avoid this hassle is to limit your use of oxymetazoline to (maximum) 4 or 5 days in a row. If you must use it, give your nose a break for a few days after every 4 days of use.
Better yet, just avoid it completely. Use nasal saline rinses instead for optimal nasal hygiene.
As a general rule, do not use spay nasal decongestants in children.
(Transparency: links to boogordoctor’s Amazon Store are affiliate links)
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im waiting for operation on my s shaped deviation
with small spur on right side, and some lazor work .
What can i expect and would i be able to fly a few days after Op , Thanys
Hi Gary,
Thanks so much for visiting.
I am going to simply direct you to your surgeon to answer those questions – that’s what they are there for, right?
Let us know how it goes, and best in health.
RF (boogs)
End-stage COPD, on O2 24/7 @ 4 lpm, nebulizing ipratropium/albuterol 1 vial 4 times daily, 1 does of Advair 250/50 twice daily, and I stupidly got my sinuses “addicted” to oxy for just over 2 months now. Given what I take already, could I ask my pulmo doc for a spray like Nasonex or Rhinocort to help me break the addiction and still be able to breathe? Or will he laugh me out of the office because it’ll be too much steroid? I have to be able to breathe the O2 to stay alive. Maybe a “mask”-type O2 delivery instead of my nasal cannula while my sinuses recover? Trying to decide best options to present to the doc. Starting to get panicky over this now that I need the oxy every 5 hours or so.
Hi MIckie,
Sorry to hear about your conditions. Note that my expertise is limited to children.
I do know that some ENT and Pulmonology docs who manage adults will use the topical nasal steroid sprays – or even oral steroids – to help reduce the “rebound” as you try to wean the oxymtazoline.
Being “addicted to oxy” can be miserable!
Please return and let us all know how it goes, and we all wish the best success to you!
Thanks for visiting, and for taking the time to share.
RF (boogs)
Hello Doctor,
I keep getting conflicting information about the use of nasal corticosteroids (spray) for my child. Some doctors say that it is perfectly fine to use every day for as long as we need-even, in the words of one of them, for life. However a couple doctors said that it is absolutely not good to use more than three weeks or so, because even with nasal corticosteroids there will be a rebound effect, and that other serious side effects will crop up in the body (diabetes, etc..). What is your position?
Thank you
Hi Janice,
GREAT question! And I understand your concern. Before giving you my “2 cents”, first let me state a general truism: whenever there are several opinions about something, or several ways to do something, it should tell you that there IS NO BEST way. I don’t think that there is any clear clinical evidence that long-term nasal steroids can cause harm in children (or adults). On the other hand, many of the popular nasal steroids CAN be measured, albeit at very low levels, in the blood stream of those using them. And there is some evidence (again, nothing final or definitive) that they can cause temporary changes in the some of the body’s hormone levels. In my world, for MY children, that means I don’t use them unless there are good, clear medical reasons. And, not all children will significantly benefit from them. However, regardless of the cause of rhinitis, the majority of children with rhinitis will benefit from daily nasal saline rinses. That is my position. Be sure to check out Dr. Hana Solomon’s website, Nasopure.com, for some great videos and other resources on saline rinses. Check out her book, too. I wish I had written it!
Thanks for visiting, and especially for sharing your experience with us!
See you back here, and have a great Holiday and New Year.
RF (boogs)
I got the worst case of RM probably ever seen. Been using nasal sprays for over 20 years. My doctor had me on prednisone for a week, singulair pills for 30 days and omnaris spray, 2 sprays in one nostril once a day, weening me off the nasal spray, using it in one nostril. Its been about 3 weeks now and the nostril using the omnaris clears on its own for awhile but clogs back up, mostly at nights when I need to breathe in order to sleep. He said to be patient, that it wont cure me overnight but I am just wondering just how long will it take til i can breathe totally on my own without the use of any spray. once the omnaris nostril clears 100% then i can work on the other nostril.. hope you can give me some advice on this matter and thanks
Hey Karen,
That Rhinitis medicamentosa is a huge problem!
It sounds like you’re in good hands. Things that can help are daily hypertonic nasal saline rinses – that can help reduce the swelling. Be sure to check Dr. Hana Solomon’s website, Nasopure.com (transparency: not financial arrangements with Nasopure; NOT affiliate link), for great videos and supplies for nasal saline rinsing!
Topical steroid nasal spray can help reduce a little bit of the inflammation and rebound swelling. The other thing that can help is to try sleeping in a more upright position until your RM resolves. That will also help open up your nose, just like when you have a ‘cold’. For really severe RM, I know docs who put their patients on systemic (oral) steroids to help reduce the swelling during the rebound phase of RM, but I am not a big fan of systemic steroids due to all the many potential side effects.
I wish you the best success. Please stop here again to let us know how it is going.
Thanks so much for visiting, and for sharing!
RF (boogs)
Thanks RF.. Was just wondering though.. one site i visited and asked about my condition, I was told the meds my doctor has me on is for allergies and not for RM and they recommended using something called Rhinostat. What is your opinion? Thanks also for the advice on sitting up. I do find that sitting up at night does help, not alot but better than laying down..
I have been using Afrin, oxymatazoline sprays since it was first marketed in the early 1960′s. My nose is constantly sore – I expect I have done permanent damage to my nose and nasal septum. I don’t know if I will ever be able to endure stopping the use of it. The severe and complete congestion that results is truly awful.
Thank you for your info
Bill C
Hey Bill,
Sorry to hear that. That is truly awful. My best advice? Get some help from a good ENT doc. Having used Oxy for years, you will likely need some extra help to kick that habit.
RF
My doctor got me off oxy with Atrovent nasal spray. It worked.
Judy,
Awesome info!!! I have never used that for oxymetazoline addiction (Afrin), but it stands to reason, based on the physiological action of Atrovent. Thanks so much for sharing!!
RF
Dear Doctor,
I stopped using Oxy eight days ago to try to solve this terrible problem of RM. I have used this product for years.
Can you tell me how long it will take to resolve? It is very uncomfortable.
Thank you.
Hi Velia,
I am so sorry to hear about your rhinitis medicamentosa!
It will be some days (!) before the swelling resolves.
You can help it along by doing the following:
(1) elevate the head of your bed; consider sleeping in a lounge-chair position, either with several pillows, or in an actual chair;
(2) consider using daily, or even twice-daily hyper-tonic nasal saline rinses; this will help reduce the rebound swelling;
(3) consider requesting a nasal steroid spray from your doctor – this will help reduce the rebound inflammation and swelling even more, and this can be weaned off over a couple weeks without difficulty.
(4) even consider requesting a short burst of oral steroid to help reduce the rebound swelling, but there are some reasons to hesitate before doing this; talk to your doc.
Best success, and thanks for visiting.
Please come back and let us know how it goes.
RF
Dear Doctor
I was wondering if you knew if the red light therapy gadgets (Treatment based on the principle of photo therapy) that are sold in Lloyds Pharnacy’s for nasal allergies,work with the condition of rhinitis medicamentosa?
Once again,I find myself craving for oxymetazoline after using it for over two months.I was only going to use it for a few days,of course one day leads to another leads to another. The metazoline is just toooo good!
Kind regards
Hi Vinnie,
So sorry to hear about your Rhinitis medicamentosa! That is miserable!
I don’t know anything about those “cold red lasers”, but I will be interested to hear about it if you decide to give it a try.
Thanks for visiting and sharing!
boogs
Doctor, I’ve been on nasal spray (Dristan) going on 4 years now and now the oxymetazoline is starting to not even work on me anymore. My doctor told me there’s nothing she can do, I would have to go cold turkey but I’m only 17. When ever I runout of my dristan it’s like I turn into a 10yr old. I get really miserable! So you can see why that wont work.
My question for you is how should I handle this since I can’t go cold turkey. What exact products should I buy? What kind of doctor should I see?
Thank you.
Hi Monae,
Sounds like rhinitis medicamentosa!
You should see an Ear, Nose & Throat doc (otolaryngologist) to help with this. In the meantime, try those nasal adhesive strips (for example, BreatheRight strips) to help you get through the night without feeling like you’re suffocating.
Please keep us updated and let us know what works for you.
Best success,
RF
Man I must say oxymetazoline Is a wonder drug if you are stuffed up and can’t breathe. I usually push it when I’m sick and use the spray for about a week and so far I haven’t gotten Rhinitis Medicamentosa. I was wondering how long it takes for my sinuses to fully recover from a week long oxy binge before I can go on another binge. I have a very addictive personality and have had to kick heroin before and frankly RM sounds like it is just as bad to kick. I actually equate taking the nasal spray with shooting up junk, because you know that sweet relief is gonna hit you in about 45 seconds after that squeeze just like that rush you get when you hit a vein. Anyways I love the blog thinking about making it my homepage. Also what are your thoughts on those capseicin treatments?
A Bomb,
Thanks for the props.
Yes, sounds like you have the dreaded RM.
With your history, I strongly urge you to see an ENT doc to help kick your Oxymetazoline habit! They can help with some prescriptions that can reduce the “rebound” once you stop spraying the Oxy.
Thanks for visiting and sharing, and best success!
RF
I stopped using Oxy and tried nasal saline spray and nasal steroid spray prescribed by my doctor. Neither helped. The doctor then gave me two steroid injections spaced ten days apart. Gradually the swelling deminished and I am able to breathe again after two
months of misery. The doctor has recommended surgery because my CT scan revealed severe sinus disease with deviated septum. He told me surgery would be a “real
challenge”.
Hi Velia,
The timing of your “recovery” – that is, the length of time that you were off the Oxymetazoline may have more to do with your recovery than the treatments. Recovery usually occurs after about two-four weeks of being off the spray. In my experience, the two most effective remedies to get through the early “rebound” (high misery) period are hypertonic nasal saline rinses, and Breathe Right nasal strips at night.
Thank you for visiting and sharing!
RF