Dependency or Habit? Deciphering Nasal Spray Addiction

An issue has been joked about via social media and on comedy shows like "Saturday Night Live" and "Family Guy": When you begin utilizing specific nasal sprays, it's challenging to stop.

A few active ingredients can indeed make additional stuffiness, causing "the compulsion to use it over and over for relief," said Dr. Edward McCoul, an ear, nose, and throat doctor at Ochsner Health in New Orleans.

Dr. McCoul said that an estimated 9 percent of individuals visiting E.N.T. doctors have what is called rhinitis medicamentosa, or "rebound congestion" — implying that their sinuses become stuffier than they were before utilizing the sprays.

The resulting repeated need for nasal spray isn't viewed as an addiction, said Dr. Jonathan Bernstein, an allergist, and immunologist in Cincinnati. The spray would have to change a person's brain chemistry to fit the official definition.

But, physical dependence is a real phenomenon. When the blood vessels in your nose get too accustomed to specific sprays, you can end up feeling like you are unable to breathe without them.

"It's such a slippery slope," said Dr. Lily Pien, an allergist and immunologist at the Cleveland Clinic.

Hence, doctors say, you should read the instructions on all sprays closely. Most habit-forming splashes have a suggested limit of two sprays each day for as long as three days. Any more, and you run the risk of rebound congestion.

Which sprays are habit-forming?

The sprays to watch out for are the ones classified as nasal decongestants, which contain ingredients like oxymetazoline (Afrin, Sinex) and phenylephrine (Neo-Synephrine), Dr. McCoul said.

Decongestant sprays temporarily restrict the blood flow in your nasal passage, contracting your blood vessels so the air has room to circulate. If your blood vessels get too accustomed to these drugs, they can swell up when you stop using them, making for even narrower airways.

Hence, decongestant sprays are best for short-term use, Dr. McCoul said. "The common cold is the ideal situation for nasal decongestant sprays," he said. "After a couple of days, the cold is normally going to get better, so you'll no longer require the spray."

For allergies and chronic congestion, the experts suggested avoiding habit-forming kinds of decongestants.

Which sprays are not habit-forming?

If you're stuffed up for more than three consecutive days — say, during a bad season — specialists have good news: Not all nasal sprays carry the risk of rebound congestion.

Steroid sprays.

Sprays that contain steroids like mometasone (Nasonex) or fluticasone (Flonase) are safer options for treating long-lasting congestion, Dr. Pien said, because they won't cause rebound congestion

Likewise, with decongestants, steroid sprays reduce nasal inflammation, Dr. McCoul said, however, they won't work as quickly. "Try not to get discouraged if you don't get an immediate effect," he said. Steroid sprays can sometimes take months of once-daily use to work.

Antihistamine sprays

Sprays that contain the antihistamine azelastine (Astepro) are also safe to utilize and don't create dependence, Dr. Pien said. They block the histamine receptors in your nose connected to itching, sneezing, and watery eyes.

Antihistamine sprays generally clear allergy symptoms more quickly than steroid sprays, Dr. McCoul said. But if your nose is more stuffy than runny, steroid sprays may be best, since they're better at directly reducing inflammation. Combining steroid and antihistamine sprays is also a safe option, Dr. McCoul said, and both may work better compared to either on its own.

You can use steroid and antihistamine sprays for as long as you need without risk of rebound congestion, said Dr. Richard Lockey, an allergist and immunologist at the University of South Florida.

"These are remarkably safe medications," he said. "Certain individuals use them indefinitely for their entire lives."

Saline sprays

Sprays that contain saline (generally produced using simply salt and water) are safe and medication-free, Dr. McCoul said. They can reduce dryness and can clear nasal passages free from particles or microorganisms that cause inflammation.

If you prefer a conservative approach, Dr. McCoul suggested trying saline spray before anything else.

But if congestion is an everyday issue, it's really smart to see an allergist, Dr. Lockey said. Also, you should always ask your doctor before using any over-the-counter medication, Dr. Bernstein said.

I believe I'm hooked. How would it be advisable for me to respond?

If you have been using decongestant sprays for over three days and feel as though you can't stop, the experts agree it's the ideal time to get medical assistance.

Using these showers for a long time can harm your septum, the cartilage that divides your nostrils, Dr. Bernstein said.

Start by visiting a primary care doctor, Dr. Pien said. Depending on your situation, you may be referred to an allergist or an E.N.T. doctor.

From that point, doctors could recommend an oral steroid, which can help reduce swelling as you wean off decongestant sprays. Some also recommend alternating decongestant sprays with steroid sprays as you reduce your dependence on the decongestants.