Nasal Sprays: Can They Be Addictive?

The cold is long gone, but your nasal mucous membranes are still swollen all the time, so you continue to use a decongestant nasal spray? Not a good idea.

Because faster than you think, you’ll be caught up in a nasal spray addiction that, over time, can severely damage your nasal mucosa and make you more susceptible to disease. Here you can find out why that is and how you can break the vicious circle.

How do nasal sprays work?

“Over-the-counter nasal sprays contain active ingredients that act on certain receptors in the nasal mucosa and cause the small blood vessels there to narrow. Michael Deeg, specialist in ENT medicine in Freiburg.

Anyone who suffers from swollen nasal mucosa due to a virus or hay fever will find the effect of the decongestant active ingredients such as xylomtazoline and oxymetazoline beneficial, because with their help you can finally breathe through your nose again. However, the effects usually only last a few hours and another spray is needed to maintain the effects.

Why can you become addicted to nasal spray?

Actually, the nasal spray should only be used about 2-3 times a day during an acute cold, ENT doctors recommend. “But when the relaxing effect wears off, many sufferers tend to use their nasal spray more frequently,” says Dr. Deeg from experience, “However, if you do this for longer than the recommended application time of one week, the receptors in the nose can be overstimulated and get used to the drug.” Studies also show this.

The erectile tissue in the nose still relaxes after each spray, but swells up again more and more quickly, so that the temptation to use the nasal spray more often is great. A vicious circle that persists for some beyond the actual cold period and can lead to addiction.

And it affects more people than you think. “Specific numbers are difficult to collect, but it is assumed that 2 to 3 million Germans use over-the-counter nasal sprays regularly and too frequently, around 100,000 are considered dependent,” says Dr. Deeg.

How long at a time can I use nasal spray?

“One should only use nasal sprays with decongestants for a week, 10 days is the absolute maximum,” says Dr. Deeg. That’s how long a cold usually lasts. You should also not spray too quickly, ideally only 3 times a day. Because be careful: After about 1-2 weeks of regular nasal spray use, you will get used to it.

At some point the body then begins to work against the effect, whereby the spongy body of the nose is even better supplied with blood and over time ‘wears out’ due to the constant expansion – and even more nasal spray is needed in order to be able to breathe more easily through the nose. This vicious cycle is called the rebound effect. Nasal spray addicts can hardly breathe through their nose without a spray during the day and can neither exercise nor sleep without a nasal spray.

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So are nasal sprays dangerous?

When used correctly, they are not dangerous. “Over-the-counter nasal decongestants are important medications, and it’s perfectly fine to use them as long as you don’t use them for more than 1 week,” notes Dr. Deeg clear, “But they should be used sensibly, in the intended dosage.”

If in doubt, however, you should first clarify the cause of the swollen nasal mucosa in an ENT practice, i.e. whether it is an allergy or an infection, in which case other therapies would be advisable.

Pregnant women should be careful. “In late pregnancy, the decongestant sprays are not safe because there is a certain risk that they can trigger premature labor,” says Dr. Deeg, “Of course it’s also a question of dosage, but there is a risk.”

How do I recognize a nasal spray addiction?

If you’ve been using a spray or drops containing decongestants for more than a week and the intervals at which you get bad breath are getting shorter and shorter, you should take notice.

Other signs of addiction are frequent nosebleeds, a feeling of dryness in the nose and not being able to fall asleep without a spray. Another sign of addiction is making sure you carry a nasal spray with you at all times.

How to avoid nasal spray addiction for hay fever?

There is no question that pollen allergy sufferers need treatment because of their obstructed nasal breathing. “In order to avoid dependence, you should not use the over-the-counter decongestant nasal sprays, but have special anti-allergy sprays prescribed in an ENT practice,” advises Dr. Deeg, “These are better tolerated and not addictive.”

What are the consequences of a nasal spray addiction?

Anyone who uses decongestant, over-the-counter nasal sprays more intensively and for longer than recommended is at risk of changes in the nasal mucosa. “The cilia in the nose no longer beat as quickly, which significantly limits their cleaning function,” explains Dr. Deeg. This greatly reduces the ability of the nasal mucosa to defend itself against viruses, bacteria, pollen, dirt and pollutants, for example. As a result, you get sick more often.

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Damaged nasal mucosa also slowly dries out and begins to itch. Studies have shown that prolonged use can lead to tissue damage. In particularly severe cases, the mucous membrane and nasal cartilage are damaged to such an extent that holes can even appear in the nasal septum.

“In extreme cases, chronic inflammatory processes develop there, which can lead to a so-called ‘stinky nose’,” says Dr. Deeg. In the case of such an illness, known in the technical jargon as ozena, the nose secretes a sweetish-putrid odor that the affected person can usually no longer smell himself, since his sense of smell has already greatly diminished at this point.

What helps with nasal spray addiction? How can I dispense?

dr Deeg has already accompanied numerous nasal spray withdrawals in patients in his practice.

These methods, in which the dose is gradually reduced, are proven and also promising:

tapering off: To do this, you replace your nasal spray with a seawater spray: if the spray is half empty, unscrew it and fill it up with a seawater spray. If this is also half used up, you top it up again with the non-addictive seawater spray, etc. Alternatively, you can increasingly replace your adult spray with a children’s nasal spray.

One Hole Therapy: No longer spray the spray into both nostrils at the same time, but only into one at increasing intervals.

Reduce according to plan: Continuously reduce the applications over a defined period of time. So if you have been using it 10 times a day so far, lower the frequency to 9 times on the first day, then 8 times and so on. Keep a record of your progress in writing, for example in the calendar. Finally, you should only spray at night before you get off the nasal spray altogether.

“Most people who have only been addicted to nasal spray for a few weeks can break the habit within 2 to 3 weeks with the right motivation,” says Dr. Deeg from experience.

Of course, ‘cold turkey’ is also possible. To do this, you stop using the nasal spray completely after a certain point in time. In his experience, the nose is severely blocked for a week, but after that the symptoms improve quickly. If you decide to do this, you should not plan any anaerobic sports units for this period and take it easy otherwise.

“The nasal mucosa usually regenerates after a few weeks.” Nasal rinses with common salt and nasal ointments with nourishing ingredients also help to regenerate blood circulation in the dry nasal walls.

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It becomes more difficult if you have regularly and excessively consumed nasal sprays for years. If mucosal atrophy has already formed, this is often irreversible. In such cases, ENT treatment is required.

What alternatives are there to nasal spray?

Anyone who has ever gotten rid of a nasal spray addiction will certainly not want to resort to decongestant nasal sprays again the next time they have a cold. Fortunately, there are good alternatives to clear a stuffy nose.

Saltwater Sprays: do not contain any chemical agents and can therefore be used for longer (eg from tetesept). Admittedly, their effect occurs less quickly and is also somewhat easier, but their effect has been proven in independent studies. If that is not enough in the acute phase, you can alternately supplement it with decongestant nasal sprays for children.

Isotonic Nasal Sprays: moisten the nasal mucosa and relieve the symptoms when the nose feels dry and irritated (e.g. from Bepanthen).

“After a spray addiction, isotonic nose drops help to get a good feeling in the nose again faster,” says Dr. Deeg.

For info: Saltwater sprays vary in salt concentration. The isotonic (0.9 percent) are intended for moistening, the more concentrated (hypertonic) have a decongestant effect.

nasal douches: gently and thoroughly remove dirt, pollen and mucus from the nasal mucosa and help to get rid of viruses and bacteria more quickly. Using a nasal douche looks more complicated than it is: bent over a sink, a saline solution (eg from Emser) runs into one nostril and is allowed to flow out through the other. After just a few times, the application is routine.

Purchasing a nasal douche is worthwhile: the mucous membranes are cleaned and moistened. With regular use, pollen and cold viruses can be flushed out in good time before they cause sneezing and runny noses.

If you have a bad cold, decongestant nasal sprays are perfectly fine. In order not to slip into an addiction that can severely affect your nose and health, you should use sea salt sprays and nasal douches at the same time and replace your nasal spray completely with them after a week at the latest.

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Christine Naefeke



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