Rhinitis medicamentosa

Rhinitis medicamentosa (or RM) is a condition of rebound nasal congestion brought on by extended use of topical decongestants (e.g. oxymetazoline, phenylephrine, and xylometazoline nasal sprays) like Afrin, Otrivin, Iliadin and Kotrin that work by constricting blood vessels in the lining of the nose. This condition typically occurs when such medications are used for longer than 1 week. Patients often try increasing both the dose and the frequency of nasal sprays upon the onset of RM, worsening the condition. The swelling of the nasal passages caused by rebound congestion may eventually result in polyps that block nasal breathing until surgically removed.

Topical nasal sprays work by stimulating the sympathetic receptors lining the blood vessels of the nose causing those vessels to contract. By decreasing blood flow to the lining of the nose, the tissue becomes much less congested and mucous production is slowed. However, after several days use of these products these receptors become upregulated requiring more frequent and higher doses to prevent the rebound congestion that results when the medicine wears off.

The treatment of RM involves withdrawal of the offending nasal spray. Both a “cold turkey” and a “weaning” approach can be used. Symptoms of congestion and runny nose can often be temporized by using prescription nasal steroid sprays 1 to 2 times daily for a few weeks. For very severe cases oral steroids may be necessary.

Although the decongestant oxymetazoline is not addictive in the classical sense because it does not bind to endorphin receptors, use of oxymetazoline creates a dependency that is similar to addiction.

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