Rhinitis medicamentosa

oxymetazoline afrin rhinitis medicamentosa

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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Comments

  1. 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

    • Russell A. Faust, PhD, MD says:

      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)

  2. 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.

    • Russell A. Faust, PhD, MD says:

      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)

  3. 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

    • Russell A. Faust, PhD, MD says:

      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)

  4. Karen Purvis says:

    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

    • Russell A. Faust, PhD, MD says:

      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)

  5. Karen Purvis says:

    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..

  6. 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

    • Russell A. Faust, PhD, MD says:

      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

      • Hi. I’ve been using a decongestant *Oxymetazoline* for at least 1 year, maybe a bit more. I don’t remember. I’ve only recently *Monday* decided to stop. I was wondering how long this stupid Rhinitis Medicamentosa bullshit lasts? I’m in my own hell right now.

        • Russell A. Faust, PhD, MD says:

          Nick:
          I feel your misery! Been there. Everyone is a bit different for how long the misery lasts, but it can be a looong time. Your best solution may be to wean yourself off of it: cut your spray 50:50 with saline and use it a little less than usual; also start daily hypertonic saline nasal rinses to help reduce swelling of the nasal lining. Either way, it’s going to be challenging. Sorry I don’t have a better solution.

  7. My doctor got me off oxy with Atrovent nasal spray. It worked.

    • Russell A. Faust, PhD, MD says:

      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

  8. Velia Peace says:

    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.

    • Russell A. Faust, PhD, MD says:

      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

  9. 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

    • Russell A. Faust, PhD, MD says:

      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

  10. Monae Jones says:

    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.

    • Russell A. Faust, PhD, MD says:

      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

  11. 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?

    • Russell A. Faust, PhD, MD says:

      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

  12. Velia Peace says:

    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”.

    • Russell A. Faust, PhD, MD says:

      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

  13. Catherine Booth says:

    i’ve been to the the ENT specialist about sinusitis and told him i’d been using olbas sprays to ease the pain (for 4 months) and he told me to no longer use them (which i have) but he didn’t diagnose me with RHINITIS MEDICAMENTOSA and just give me treatment for chronic sinusitis, i’m worried i have RHINITIS MEDICAMENTOSA and no ones diagnosed me with it. No doctor cares how much pain i’m in and treat it as though it’s my fault, I always have a headache but was told not to use painkillers so i don’t and just have to manage with and at least once a week it’ll turn into a migraine and i just have to deal with it as no doctor cares!!!! I also cannot breathe through my nose because of it and i now don’t go to the doctors as they don’t care and just tell me to carry on using the steroid spray (which has stopped working). I can’t go on like this i’m only 16 and my life is miserable as i’m constantly in pain and can’t breath but i’ll just to have to carry on because doctors do not care, is there any advice you can give?

    • Russell A. Faust, PhD, MD says:

      The advice I have for ANYONE who is unhappy with their physician: seek another opinion. And another and another if necessary!
      The good news: if your condition is from rhinitis medicamentosa, it WILL resolve with time.

  14. Hi ive been using oxymetazoline for about 9 days now and i stopped using it and noticed that i cant breath very well, im just wondering how long it will take until i can, i plan on taking the “cold turkey” method

    • Russell A. Faust, PhD, MD says:

      Hi Chloe,
      It can take several days for your nose to “return to normal” after stopping oxymetazoline. Some people will only use it in one side of the nose each day, alternating sides for one day at a time, doing that over 3-4 days. This can improve your ability to breathe through your nose at night – at least one side, so you can sleep. Also consider using “hypertonic” nasal saline rinses to help decrease swelling of the nasal lining.
      Best success! Not being able to breathe through your nose can be miserable.

  15. I am 19 weeks pregnant with twins. About two weeks ago I came down with one of the worst colds ever (thanks to my two year old!!) and I used Afrin for about a week (I know, longer than I should have, but I knew that I would wean myself after that point). I started to use it on only one side, but after three days I was still waking in the night due to the congestion on the other side. Then I had a day where my sciatica hurt so bad that I REALLY needed to lie down to sleep that night (previously sitting upright) so I caved and reused Afrin on both sides.

    I ended up getting the best night’s sleep in weeks, but the next day I noticed the spray wasn’t working as well. I decided I would try to wean myself again. So, I had used it on both sides for one week, one side for three days, both sides for one day, then the opposite side for three days to try and wean again. I ended up going to my primary care doctor who said I would just need to quit cold turkey and that there wasn’t anything to be done. It’s been two days and I haven’t gotten much sleep, I have panic attacks (including heart palpitations) when I start to nod off. I swear it starts to get better during the day, but then it will be like a brick in my sinuses after about five minutes of relief. I find that if I’m up and walking around I become unclogged after a while. As soon as I sit down (or lie down), I am completely clogged again and it usually takes a while to become unclogged again.

    Basically, I really want to know how long this will last. I try the neti pot when I am clear, but when I am clogged there is no hope of anything getting through there. I haven’t been taking sudafed because it didn’t really seem to help… just made me anxious. My PC said that three days should about do it… but given how I’m still feeling so awful, I don’t know whether to believe him (not to mention what I’ve been reading online about it possibly taking weeks or even months!). At what point should I seek help? What sort of things can they even do seeing as how I’m pregnant? I would think steroids of any kind would be off limits…

    • Russell A. Faust, PhD, MD says:

      Dear MomToBe:
      First, Congratulations!
      Sorry to hear about the congestion. That can be absolutely miserable.
      My first recommendation is to search this site for “pregnancy rhinitis.”
      Next, consider buying my eBook, “Rhinitis of Pregnancy: 12 Safe Options.”
      That is a compilation of all the SAFE tricks and remedies to help you get your nose working normally again. You can find those remedies in blog posts on this site, or collected in that eBook.
      The only real “cure” is to deliver that baby. Until then, use those remedies.
      Thanks for visiting, for sharing, and please keep me updated.
      Best success!

      • Mark Johnson says:

        Dear Dr. Boogor,
        I’ve been using Nostrilla (Oxymet) for several years during the change of seasons only at night for weeks each time with out getting addicted. It did a great job. However I was sick over Christmas and used it too much and now I’m addicted – Sever rebound when trying to stop – This changed my life now. I need to get free of this now. My doctor prescribed flonase and just go cold turkey. That not going to happen unless ALL else fails. Has the alternating nostril method really worked to wean off the Oxymet? are there actual real live cases? I would like to try that.
        Have you ever heard of diluting down one nostril gradually with saline solution while using enough higher concentrate spray in the other to keep comfortable, and when the diluted one finally stays open by it self, switch to the other nostril and dilute that one till it’s free?
        Is it OK to use doctor prescribed Flonase during the weaning process?
        He also wants me to go on Loratadine – Do you think that will help?
        Thank You so much for any advice and encouragement you can offer.
        Mark

        • Russell A. Faust, PhD, MD says:

          Hi Mark,
          Yes, I’ve had patients tell me nearly every trick for weaning off of oxymetazoline, including those that you suggest. In addition to the Flonase, be sure to start regular hypertonic saline nasal rinses – that will help draw fluid out of the swollen tissues and help open things up a bit sooner. Also add pillows at night: sitting up will help decrease the swelling and congestion. In my experience, the anti-histamines don’t offer much additional help.
          Best success. Please let me know what works for you!

          • Mark Johnson says:

            Thank you so much for the quick reply. Did these tricks actually work?
            Thanks Again,
            Mark

      • Update: the rebound congestion lasted for about four days. After that, the rhinitis of pregnancy lasted the duration of my pregnancy until I had an emergency c-section at 34 weeks 1 day due to severe preeclampsia. The twins stayed in the NICU for three weeks but now are thriving at 7.5 months old! The rebound congestion was awful, one of the worst things to ever happen to me, but I made it through and plan to never use Afrin again.

      • Update: The rebound congestion lasted for four days. It was awful and I got very little sleep, but I survived. The rhinitis of pregnancy lasted for the duration of the pregnancy until I had an emergency c-section at 34 weeks 1 day due to severe preeclampsia. After being discharged from the hospital the symptoms cleared up relatively quickly from what I can remember. The twins stayed in the NICU for 3 weeks, but are now thriving at 7.5 months old! The rebound congestion I experienced after using nasal spray was absolutely awful, one of the worst things to happen to me, even after all of the horrible pregnancy issues. I plan on never using OTC nasal sprays again.

  16. I was prescribed oxymetazoline after a sinus lift surgery in preparation for dental implants. I had never used any nasal sprays before and was against the use of this spray and told my doctors as much. They really insisted that I use it to help insure the surgery was a success. I agreed and now must use these sprays almost constantly. I was prescribed Flonase by my family doctor but it is no relief. It’s nearly impossible to sleep more than 30 minutes at a time and my implant surgery is only a month away. I really need to get off this stuff but also cannot stand the congestion. Shold I use a neti pot or some other alternative?

    • Russell A. Faust, PhD, MD says:

      Hi Shawn,
      Certainly sounds like Rhinitis Medicamentosa. If so, then yes – saline nasal rinses can help. But only a bit. RM is tough to beat, and aside from the suggestions in this article, my recommendation is to get help from a physician.
      Best success.

      • I just bit the bullet. Been a few days now and it’s getting better. I’ve used the saline spray and breathe right…that’s it.

        I did notice some things that may be helpful for others. Breaking a sweat helped thin out the mucus and blow my nose. I also added some spice to my food to do the same. It helps the first couple of days but there’s no helping with the sleep. Take a Sudafed or nyquil…it’s just going to be rough for a few nights. Keep some Gatorade on the night stand because you’re going to be a mouth breather and wake up every 30 to 60 minutes with a dry mouth and throat. It gets better each day.

  17. Scott keats says:

    So…It’s been at least 30 years of use. My choice is 4-way (now the CVS generic becuase 4-way is not being made anymore) and have tried a few times to seek treatment. This winter has been to worst, stuffed 30 minutes after use…cant sleep, etc… Just got back from the Dr., he gave me a script for prednisone, two different nasal sprays, and told me to take sudafed. I PRAY i have the strenght to do it. I’m sick of using, figuring out how long I can go in meetings without using, but I am so affraid of the next 7-10 days! I will keep you posted on progress

  18. Hi! I used to use Dristan in high school (80s) and into adulthood when I’d have a cold but stuck to the 3 day rule always. Then…..5 years ago I got pregnant with our child and couldn’t breathe at ALL! It was the only pregnancy symptom I had. So I used it the entire 9 months and here I am. Just had surgery a week ago for a deviated AND perforated septum. Yup, all caused by the Afrin (Dristan is no longer made here, Afrin is). The surgery was a week ago yesterday and I STILL can’t get any air in or out through my nose. I understand the splints are still in (and will be until Friday) so that is making me congested in and of itself. But my question is, I haven’t used Afrin since the morning of the surgery. I was planning on taking these two weeks of recovery to wean simultaneously since I knew I’d have to endure the stuffiness anyway. I’ve been using only saline (as instructed by my doc to “clear the crusties”) and only ones where the only ingredients are purified water, sodium chloride and sodium bicarbonate as I was told some other saline sprays have another ingredient that can be just as “addictive” as the Afrin itself. So….do you think I will be able to simultaneously wean and when the splints (and crusties) come out on Friday I’ll be good to go?

  19. I am very grateful for this website & the information you all share. I have been heavily dependent on nasal decongestants since I was 16yo following an SMR. I’m now 59yo & I was totally fed up with The whole rigmarole. I read your info re RM & followed your regime. So simple !! Twice daily nasal rinse with hypertonic saline, one low dose oral antihistamine for 14 days & once daily use of a topical OTC steroid spray.
    Almost instant cure !! I can’t believe that after 45+ years of nasal spray dependence I am now able to breathe normally day & night plus my hay fever has disappeared !! I’ve weaned myself to hypotonic rinses once a day & a spray afterwards. CURED !
    It took me less than 1 month from woah to go.
    Thank you, thank you, thank you. I am forever in the debt of yourself & those of your readers whose stories were
    motivational.
    Bless you all !

    • Russell A. Faust, PhD, MD says:

      Bee,

      So glad to hear from you, and that you dumped the RM monkey from your back!
      Thank you for sharing, and for your kind words.

    • Nichlas Puia says:

      Thank you Bee for all this! You made me try this and it worked! CURED!
      See my post down below.
      Thank you so much! I wish I can meet you to shake your hand. ;)

  20. Swati dhull says:

    Hi, I was addicted to Afrin for 3.5 years and recently decided to kick the habbit. I used rhinostat titration method to wean myself off. I completely stopped using the titration method when the solution had 10% active ingredient ( oxy). I stayed drug free for 25 days where days were fine but I experienced mild congestion at nights which i suffered through hoping it will go away with time. However, the congestion came back about 2 weeks ago where I experienced congestion at nights. I tried to fight it for few days but when it didn’t get better I began my titration method again at 10% oxy strength. I only use rhinostat once before bed. I still experience mild-moderate congestion but I manage to sleep. I am wondering if this is normal in the process of kicking the addiction. Although the congestion that started 2 weeks ago is not as bad as when I began weaning off afrin. it is still bad enough to keep me up at nights. How do I kick this terrible habbit for good? Please suggest.

  21. Hi Doc,

    First of all, thank you SO much for this website. The time your dedicate to explain everything in a simple way, as well as the time you take to respond each and every visitor is a real blessing. I can’t tell you how happy I am by finding this website.

    So, since I am 18 years old I have been using nasal sprays. Naphazoline, Hydrocloryde, Oxy…you name it (but all separately!). However, over the last 4 years I have been watered them down to only 40% in order to reduce the rebound effect. I only use them at night, when I really need to relax.

    So, feeling sick of this awful addiction I went to see a specialist. MRI scans showed, indeed, that I have distrophy of turbinates and a mild deviation of the septum to the right. However, Doctor said that the most relevant aspect of my pathology (nasal obstruction) is the actual damage that the spray caused. He did not use this terminology (rhinitis medicamentosa), but I can tell through your explanation and people’s comments that this is definitely the case.

    Right now, following his indications, I have quit from using any nasal spray (decongestant). And to treat the symptoms, I have been told to use Rinhocort (budesonide), two puffs twice a day in each nostril (the reason to have chosen this one in particular is because I can tell is the one that works best for me – the rest just dry my nose), as well as predmisone 25mg only for one week. on top of that, I am rinsing my nose with NeilMed 2-3 times a day, also as part of his directions.

    Well, this message ended up quite long, so thanks a lot for reading.

    May I ask your opinion about it? I would like to add that, over the last 8 months I have started to snore and my nose has been mildly bleeding (in fact, the doctor showed me through this study which introduces a camera in your nose how damaged is my nose inside). I could clearly see the wounds in the tissues. It was definitely disgusting, but it was worth it as it woke me up.

    Once again, thanks a lot!!!!

    • Please, let me add that I have just quit from the spray yesterday!
      Last night was my first time without them and, contrary to my own expectations, I could have a decent sleep, although far from ideal. :)

      • Russell A. Faust, PhD, MD says:

        Congratulations, Ernest!! HUGE step toward freedom :))
        The real challenge will be keeping off the sprays after completing your course of oral steroids (prednisone). Be sure to keep using the saline rinses. Consider trying a hypertonic rinse before bedtime. Hypertonic, or hyper-osmolar saline will help reduce swelling and increase your nasal airway and – hopefully – improving your sleep breathing.
        Thanks so much for your kind comments, and for sharing your experience.

  22. Hello, I have been addicted to Afrin for about 3 1/2 years with quitting for about a month twice and going back on because once I got sick and another time the symptoms came back very slightly but I gave in to the afrin. I quit cold turkey again and it’s been a month and obviously I am not 100% there but close. I will use the saline cleanses to speed up the process. What i wanted to share is that I am also an opiate addict and quitting for example methadone or suboxone can take 1-2 months to feel 98% normal and the other 2% a year, to feel absolutely normal and also depending how long someone has used it either drug. Both Methadone and Suboxone are a 24 hour drug and afrin is a completely different drug, but it works for 12hrs. The use of afrin for several years and quitting will make withdrawals half as long as methadone/depending on the person in my experience. So I saw many people ask how long until they feel better, and I want to say that the body is always trying to get rid of bad chemicals, and their are ways to speed up the process for detoxing most chemicals, but one thing is for sure is the longer your clean from whatever chemical then the better you will feel. Unless their is permanent damage off course. This is temporary, just do it ;)

    • Russell A. Faust, PhD, MD says:

      Thank you for sharing your experience. I’m sure that others who struggle with rhinitis medicamentosa will appreciate your insight.

  23. I read my post again from 1/29/2012. I continued with the struggle with RM through April, 2015. I imagine someone who has not delt with this problem would find it pretty hard to believe someone having and addiction to Oxymetazoline and having it complicate there life for 40+ years! I decided on a regimen based on this website plus research that I gleaned from the internet. I compounded N saline by the quart and began a gentle nasal wash 2 X daily. To this I applied 2 applications of a popular nasal steroid in each nostril for 3 days and then reduced the steroid spray to 1 per nostril 1X daily for 2 weeks. To this I added 1 25mg cap of diphenhydramine 1 X daily. After 2 weeks the congestion was improved and reduced the topical steroid to 1X every 3 days and continued the 1 cap 25 mg diphenhydramine but reduced that to 1 cap per 3 days. I can breath on my own and I dare believe it! Be vigilant my suffering friends, it can happen! I went to an otolaryngologist 2 x during this last year and the physician was not interested in the slightest. I expect this was just my bad luck for no decent physician would be dis-interested.

    • Russell A. Faust, PhD, MD says:

      Bill,

      Yes, it is reassuring for others to hear about successes! Congratulations, and thanks for sharing!

  24. cris gregory says:

    Dear Sir,
    I have been suffering from severe nasal congestion for more than two weeks now. It started as common cold and I used Otrivine nasal drops (contains xylometazoline) and it helped the first few days. I was cured then suffered a nasty headache for 4 days then the colds came back. I went back to using otrivine drops again to cure it, then low and behold, I started suffering severe nasal congestion mostly in my right nostril. I would use otrivine to help m breathe especially at night and by morning,the right nostril is swollen shut. I wanted to use otrivine again, but I’m hesitant after reading it’s possible I may be suffering a rebound effect of nasal congestion from it. I visited a doctor and he prescribed avamys (fluticasone) nasal spray, but I’m not experiencing any relief. This is the very first time in my life I’m suffering from severe nasal swelling in my right nostril. What do I do to end this problem. I’m lucky to even breathe from my left nostril. Please advise me. Thank you very much.

    • Russell A. Faust, PhD, MD says:

      Hi Cris,

      Of course, I have no way to offer medical advice over the internet: this blog is a reference resource only, and should not take the place of your physician. Many people with chronic nasal congestion obtain relief from regular nasal saline rinses. You will find several articles on this site on the topic.

      Thank you for sharing your experience, and please keep me updated. Best success.

  25. Dr. Faust, I just wanted to thank you for having this site and the Q&A. I’ve been Oxymetazoline dependent for 5 years. 36 hours ago I determined I was done with my attachment to the spray. I found this site and read the advice from both you and other commenters and decided to quit cold turkey.

    Perhaps I might add my experience and preparation so far. As with any dependency the first consequences of quitting were very unpleasant. My nasal passages slammed shut tighter than a drum and with extra pressure. It was revenge of the tissues tight. Nothing was getting through even if I forcibly inhaled. I went to bed like that. I did not sleep the entire night.

    The next morning I got a scrip for a systemic corticosteroid and took my first dose. Then I took a dose of Benedryl for my allergies and suffered with swollen passages all day and into the night. I was now a chronic mouth breather so I applied lip balm often and kept a sugar free lozenge in my mouth. Of course swallowing excess saliva was unpleasant since my nose was a vault, but I was/am determined to be free.

    Part of the discomfort of mouth breathing is the dry oral cavity. So I kept a glass of water close. I needed to drink so often I realized that I was getting too much water so when I did drink I kept it to just enough to wet my tongue and swish around my mouth. Swallowing was still uncomfortable 24 hours after cessation of spray. To help with sleep which I really needed by now, I set up a cool mist humidifier and directed it toward my mouth while I slept. This really helped.

    Around thirty hours after stopping use I felt the pressure in my passages ease. I began using breathe right strips at that point while maintaining the lozenges, lip balm and sparing water. Today I felt my passages allow air to pass. I switched to a menthol type lozenge which encouraged further shrinking of the tissue. Together with the breathe right strips I could breathe well enough to be able to respire mouth closed. This condition vacillated though and occasionally I was back to mouth breathing. The improvement was remarkable.

    I’ll continue until I am both free of nasal spray and breathing normally through my nose. Given the progress so far, I think that will be in the next couple of days, but the worst seems to be over. I encourage all to quit. This has been a monkey on my back for far too long. I’ll never use nasal spray again.

    Thanks again for this site. I learned enough to help me through.

    • Russell A. Faust, PhD, MD says:

      Kevin:
      As you describe, rhinitis medicamentosa is a challenging and uncomfortable addiction to recover from! Thanks for sharing your experience. I’m sure there are others out there thinking they are alone in this difficult experience. Congratulations, and best success!

  26. Thank you Dr Faust. I thought I’d update. It has been 60 hours since cessation. Last night I slept for 14 hrs. I was exhausted from no sleep/interrupted sleep the previous two nights. My nasal passages toggled between congested and fairly open. For the most part I could breath mouth closed still using lozenges, breath right strips, lip balm and the humidifier. Today I have been breathing the most freely in years. As I contemplate the past few days and those leading to my resolve to quit, I know that the key is to make that first sacrifice and endure the initial discomfort with resolve. Once I noticed progress, it was easier to remain resolved. I’m sure I’ll experience some occasional congestion as my body adjusts, but the storm has passed and I am free. I encourage those afflicted with this dependency to free yourselves too. What will it be like to go where ever I want for as long as I want and not have to be worried about my nasal spray? Already I have had that reflexive concern about it and then the calm of remembering I don’t need it anymore.

  27. Nichlas Puia says:

    Hello everyone,
    First of all I want to thank you for this forum that convinced me to give it a try and believe me that changed my life completely!!!
    Secondly I want to thank Bee (read his post carefully above), thank to his “recipe” I finally got rid of Otrivin completely. I threw away all my spray bottles that I kept beside the bed “just in case”. :) My nose got congested basically every night, so using Otrivin solved the probelm for 12 hrs and then again I had to use it another round and so on…I had to carry one bottle with my every time just in case I visited my friends and my nose got congested. Of course one in the truck in case it happened while driving as I drive everyday or before meeting my clients.
    A friend of mine has the same thing, so every time we went visiting her I had to use her spray in case I forgot mine home. One word, “terrible”.
    I’ve been using it for 10+ years now and Bee’s story determined me to give it a try like I said. He is 59 now and he’d been dependent since he was 16. So if he did at 59 why wouldn’t I do it at 37?? Come on, I knew I can do it. So I went to a pharmacy and asked for exactly what he said in his post:

    – nasal rinse with hypertonic saline
    – oral antihistamine
    – OTC steroid spray

    And as per him, here is what I did:
    “Twice daily nasal rinse with hypertonic saline, one low dose oral antihistamine for 14 days & once daily use of a topical OTC steroid spray.”

    It was kind of terrible for 14 days but stick with it, gotta do it. So, it’s the 3rd week today and just my left nostril is a bit congested during the night but I’m sure that will go away soon. I’ve had enough for 10+yrs so this is minor thing now.
    Also gotta mention, a big role in this is humidity in the house. I had to raise humidity level to 45 and that also made a huge difference. We live in Alberta, Canada and it’s very dry during the winter season here(6 months a year). We came over 8 yrs ago and I never thought it will be like this dry here. I thought I’ll get rid of Otrivin when I get in Alberta but it got worse. :)

    In conclusion I want to thank again to everyone in this forum specially to Bee who determined me to try his “recipe” which worked like a charm.

    Thank you and God Bless!!!

    • Russell A. Faust, PhD, MD says:

      For those U.S. readers: “Otrivin” is “Xylometazoline,” similar to Oxymetazoline used here in Afrin and other decongestant nasal sprays – the primary cause of rhinitis medicamentosa.

  28. Thank you for this post… it made me take the step to call my doctor and set up an appointment for tomorrow morning to try and get help with this. I feel so… silly… about it, but I also realize that my quality of life has gone way down. Luckily, as soon as I explained my worries to a nurse, she quickly made me an appointment. Maybe it’s not so silly after all…

    I also have an added complication to doing this as I can not take any oral decongestants due to a medical condition. These sprays were my only option when I got sick and now they are only making things worse. I’m at my wits end today as I have been having to use Afrin every few hours to even get ONE side of my nose to open up enough that I don’t feel like I am suffocating.

    I will take the information from this article with me to my appointment and ask about my options.

    • Russell A. Faust, PhD, MD says:

      Rebecca:
      NOT so silly: there are somewhere around 16 MILLION people in the US with Rhinitis Medicamentosa. And yes, it feels like you’re suffocating. Horrible experience. I wish you the best success.

  29. Thank you for this post. I have been using Afrin off and on for the better part of 10 years. Definitely way more on recently to the point when I decided enough was enough. I started the process of kicking the habit at 10am yesterday combining a lot of different things. I am 32hrs in. Not a fun process but it has to be done.

    I have a horrible time breathing to start with because the cartalidge on one side is slightly collapsed and I have a slighly deviated septim. Because of that I am doing one nostril at a time. In both I am doing the hydrotonic saline wash twice a day as well as the OTC steriod med. In the right, I am using the Oxy nasal spray (trying to space it out as long as I can). Cold turkey (no stepping down slowly) in the other nostril. By doing one at a time I am at least allowing myself the slight possibility of sleep.

    I won’t lie. This really sucks. There are times when I am completely closed up but there are also spans of 15-20min where both nostrils open up and it feels amazing. I will add that one thing that helped – and I never would have guessed it – but it really does – is moving around – even just going for a walk. You will want to park it on the couch or in bed because you feel like you have the worst cold of your life but getting the blood circulating and not just sitting/swelling up the tissue in your nose really does help.

    I am on a plane to Ireland in three weeks so I am hoping to have this completely kicked (and breathing at least somewhat in both nostrils by then). – is that an unrealistic goal?

    • Russell A. Faust, PhD, MD says:

      Mallory:
      That goal (kicked within three weeks) IS a realistic goal!
      And yes – it sucks!
      Thank you for visiting and sharing.
      Please let me know how it goes for you.

  30. Mommytobe says:

    Thank you so much for this post.
    I’m currently 25 weeks and 4 days pregnant with my 3rd. My first two pregnancies I never suffered from severe congestion. About 4 days ago I started with a congestion, two nights ago it got so bad that I decided to use Neo Synephrine to be able to sleep. It relieves me for a little bit but that’s it. After much reading I’m now concerned that this can harm my baby. Can you please tell me what are possible problems given that I’m this far along and that I’ve only used it for 2 nights (nights only)?

    • Russell A. Faust, PhD, MD says:

      Hi Mommytobe,

      All of the spray decongestants were once considered safe to use during pregnancy. However, all of them function by constricting blood vessels in the swollen nasal tissues, and all of them can be absorbed systemically. Most of these are considered “Pregnancy Class C” by the FDA – “risk cannot be ruled out.” If it were me, I would not use it (easy for me to say, right!).

      Your best (safest) treatment of rhinitis of pregnancy is saline nasal rinses.

      Congratulations on your growing family! Thanks so much for sharing, and best success.

  31. I thought I’d update once more. I have been free for a little over 7 months. I almost never have congestion. When allergy season came I expected the usual symptoms but they did not come. I remained free breathing the entire time. I have speculated that my allergy symptoms may have been the aggregate consequence of years using nasal spray every couple of hours. It is possible I could have been allergic to the spray I was using to relieve my congestion? What a miserable irony! Once again, thank you Dr. Faust. Also, I continue to encourage all to quit the spray. Liberty and peace of mind awaits you on the other side!

    • Russell A. Faust, PhD, MD says:

      Kevin:
      Congratulations, and thanks for the follow up! So glad that information here helped you.
      Be well.

  32. Hi doc,

    I’ve been addicted to xylometazaline for over 10 years. I have been using xylophone my entire first pregnancy. No I am 20 weeks preg. I overused oxy due to my MR combined with preg. rhinitis and had an awful sore nose. I have been prescribed avamis for 5 days. In the second day I have a sore nose, but don’t have congestion. Do I have sore nose due to avamis or it’s because of oxy use? After reading this article and readers’ review, I decided to stop using any of the sprays. If I use cold turkey method, do you think I would be able to become free of my addiction? How long appr. Will it take? P.S. I used saline nose rinse 3 times a day now, nose is not congested due to last avamis use( one day oxy free sort of) but sore. I applied three times only coz I was afraid that it will effect fetus. I didn’t sleep last night.

    • Russell A. Faust, PhD, MD says:

      Ochi:
      An oxymetazoline (or xylometazoline) addiction is a powerful problem. Rinsing three times per day will definitely irritate your nose. Length of time to “cure” depends on your own personal physiology, which is now complicated by the upheaval of pregnancy hormones. Even without the history of oxy use, pregnancy alone can completely obstruct your nasal airway, causing sleepless nights. So sorry. But you definitely should not be chronically using oxy/xylo-metazoline while pregnant.
      Please keep me updated.

  33. Hi I’m 18 years old and I’ve just been told of the condition by my doctor, I’ve been using the spray for around 2 years now since a bad cold and couldn’t seem to breathe without it,
    I’m using nasal steroid spray conscripted by my doctor to help me, but I’m nervous it will never get better, should I be nervous of what happens? I haven’t been able to sleep at night without it so I have no idea what I’m going to do. How can I ease this transition, I’m scared of the long term effects I’ve caused.

    • Russell A. Faust, PhD, MD says:

      Hi Paige:

      Consider seeing an ENT doc for help! Rhinitis medicamentosa is a VERY challenging condition to overcome, and you should get help.

  34. Hi I’m 21 I’ve used otrivin for 6 days but used more than 3 times a day … my nose is blocked at the moment how long do you think it will pass ? Haven’t used anymore trying to get it better without the Nagel spray

    • Russell A. Faust, PhD, MD says:

      Hi Natasha,
      I’m so sorry to hear about your use of Otrivin.
      Based on the version of Oxymetazoline / Xylometazoline that you mention (Otrivin – aka Afrin here in the States), I’m assuming that you are in the UK, or perhaps Europe. Those are all pretty much the same, and are a serious problem if used continuously for more than 4 or 5 days, twice daily. I’m not familiar with “Nagel spray.” Regardless, you may require help from a physician to overcome your condition – Rhinitis Medicamentosa. Sure, nasal saline rinses, twice daily, can help, but you may require additional treatment to overcome RM.
      Best success!

  35. Jennifer Tesinsky says:

    Hi doctor. I have a question about Afrin. I have been having nasal passage swelling for 7 months now that kind of just came on suddenly and always feel stuffy to some extent. I have tried many things( nasal steroids, nasal antihistamines, saline rinses etc..) and they do not help or I get nasty side effects from them. I have Never used Afrin before, but my allergist is recommending that I use it for 3 to 4 days, give it a break for a week and then use again for 3 to 4 days, give it a break for a week and so on. He said I would not get the rebound if I only use it for 3 to 4 days and give it a break for a week in between uses. What are your thoughts on this? Is it safe to use this way in order to avoid rebound issues?

    • Russell A. Faust, PhD, MD says:

      Hi Jennifer:
      The tolerance issues with Oxymetazoline (Afrin) usually develop after 5 days or more. I have recommended the dosing schedule that you describe for my own patients. However: be VERY cautious. As with any drug that is prone to addiction, it is easy to convince yourself that you will be okay if you use it “just one more day.” Before you know it, you can’t breathe without it. You definitely do NOT want “rhinitis medicamentosa” added to your list of woes!
      Thanks for visiting and for sharing. Best success.

      • Jennifer Tesinsky says:

        Thank you for your response. I definitely do Not want any rebound issues which is why I have avoided Afrin thus far. I just wanted to make sure if I did use it for like a day or two and then stopped using it for a week that I would not develop the RM. I am super sensitive to All medications so I usually cannot tolerate many. I like the oral sudafed, but it makes my heart race so I do not take it very often at all. Azelastine helped me some but it also caused my heart to race after being on it for a month so I stopped it. Do you know of any other remedies that can be used to help take down the swelling of the turbinates? ( I was dx with vasomotor Rhinitis). I also had a positive nasal culture for Coagulase negative staph and I wonder if that is what is causing all this inflammation in my nasal passages. What are your thoughts?

        • Russell A. Faust, PhD, MD says:

          Hi Jennifer:
          It sounds like you’ll need a long-term solution (chronic ailments deserve chronic solutions).
          In that case, please consider daily nasal saline rinses to help shrink inflamed, swollen tissues. Go to the search box on this blog and type in “nasal saline rinse” and check out the articles for ideas and guidance. Additives – like Manuka honey and Xylitol – offer both improved anti-inflammatory effect, along with antimicrobial activity.
          Thanks again for visiting, and please keep me updated.

  36. Bruce Thompson says:

    I had turbinate reduction surgery, and now only uses afrin at night now….I thought the surgery would let him get me off forever? I guess one every 24 hours isn’t so bad

    • Russell A. Faust, PhD, MD says:

      Like all addictions (and oxymetazoline is addicting), achieving the same effect will require greater doses, and greater frequency. You are better off finding an alternative to keep your nose open. Tried nasal saline rinses yet?

  37. I’v been on naphazoline for 20 years. Here in Europe we don’t have things like Afrin, that is Olynth here I think but my “drug” was Naphazoline. After 20 years, six months ago I quite with that, all by my own, cold turkey method. I used saline nazal oitment, hypertonic nasal spray and lot of regular saline solution. First few days was very hard and now I can say I breath completely normal, like I never use nasal drops. Regards from Europe to all of you

    • Russell A. Faust, PhD, MD says:

      Dusica:
      Congratulations for kicking that habit!
      And thanks for sharing your experience with us.
      Thanks for your kindness, and best success.

  38. I used Vicks Oxymetazoline spray (UK) spray for 10 days to relieve a stuffed nose when suffering with a cold. My cold symptoms have gone but my blocked nose remains. I have gone without the spray for nearly 48 hours now, attempting the cold turkey option, i keep reading posts to try and encourage me to keep going rather than choose the spray in one nostril option. My sense of taste is not so good, I assume to having a blocked nose. My nose has unblocked from time to time today but now is blocked again of an evening. I have two young children so sleep is relatively important to me. How
    much longer is it expected that I will have to suffer a blocked nose going cold turkey? When will I taste again? It’s not like I have been using oxymetazoline for years, only 10 days, my husband isn’t very supportive, don’t you just wish he was suffering like me considering he abuses the spray more so than me when i get a stuffed nose!

    • Russell A. Faust, PhD, MD says:

      Hi Kirsty,
      By the time you read this, you should be breathing easier.
      If not, you may consider seeing your doc.
      Re your husband’s experience vs yours: everyone has a slightly different response to Oxymetazoline, including how well it helps them, and how long it takes to recover. Some people experience very strong “rebound” – the term for the excess swelling after stopping use, as you describe.
      You will benefit from nasal saline rinses to help you recover more quickly.
      Thanks for sharing, and best success.

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