Many patients are unaware of the possibility of becoming dependent on non-controlled medications. Little do they know that OTC decongestant nasal sprays, such as Afrin, can lead to dependence.
 
Patients have a misconception that OTC medications are safe and do not have any associated risks. However, if patients do not read the package labeling on decongestant nasal sprays, then they can easily get caught in a vicious cycle where they are unable to wean themselves off of the nasal spray due to the severity of their nasal congestion.
 
Rhinitis medicamentosa, otherwise known as rebound congestion, can occur if nasal decongestant nasal sprays are not used properly and are taken longer than 3 days.

Decongestant nasal sprays relieve nasal congestion by constricting the blood vessels opening up the nasal airway. Rebound congestion is the result of abnormal swelling of the nasal mucosa, which then blocks the nasal passages, leading to the inability to breathe.

This congestion can only be alleviated by the continuous use of the nasal spray. This is how the cycle begins.
 
Because decongestant nasal sprays like Afrin are accessible to many, it is possible that many patients a) are not reading the drug label, b) do not understand the label, and/or c) do not know the severity of the consequence of rebound congestion. As a result, rebound congestion may be affecting these patients and can easily go unrecognized.
 
How is rebound congestion treated?
 
Following prolonged use of decongestant nasal sprays, it can be very difficult and frustrating for patients to stop using the products. Typically, patients seek treatment from their physicians and will usually be prescribed steroids in addition to discontinuing the use of the decongestant nasal spray.
 
However, there is also a product marketed under the name RhinoStat that is a dosage titration system designed to gradually wean patients off of decongestant nasal sprays, rather than discontinuing the sprays abruptly, which can be uncomfortable and difficult for patients, and in turn, lead them to restart their use of the sprays.
 
The dosage titration system works by reducing the concentration of the decongestant nasal spray by 15% each day until the patient is weaned. RhinoStat can be used in combination with steroids or alone if steroids are contraindicated.
 
Although the product seems to offer a more confortable way to wean patients off of decongestant nasal spray, pharmacists will need to continue to educate patients on the proper use of decongestant nasal sprays. Rebound congestion is a complex problem, but it can be prevented.