There is a sentence I hear often in my clinic: “I bought the spray for a few days, and now I can’t sleep without it.” This is far more common than patients think, and it has a medical name: rhinitis medicamentosa, or medication-induced nasal congestion.
In this article I summarise how this cycle develops and what research says about stopping.
1. Why Does the Spray First Relieve, Then Block?
Most over-the-counter decongestant sprays contain oxymetazoline or xylometazoline. These substances constrict the blood vessels inside the nose and reduce swelling within minutes.
The problem starts with prolonged use:
- The effect weakens: The nasal tissue gets used to the medicine, so more frequent and larger doses are needed for the same relief.
- Rebound swelling occurs: When the effect wears off, the lining swells more than before. The nose becomes more blocked than it was before the spray.
- A cycle forms: The person tries to clear this congestion with the spray again, and use stretches from days to weeks and months.
Studies have shown changes in the nasal tissue of long-term users, such as loss of cilia, altered cell structure and an increase in inflammatory cells. Preservatives found in some sprays have also been reported to worsen this swelling.
2. How Many Days Are Safe?
It is not known exactly on which day dependence begins, so experts recommend using the spray for the shortest possible time.
- Do not exceed the duration and daily dose stated in the patient leaflet.
- In April 2026 the UK medicines regulator (MHRA) reduced the upper limit for adults and children aged 12 and over from 7 to 5 consecutive days.
- Congestion that does not improve within 5 days may point to another cause.
In controlled studies with healthy volunteers using the spray within the recommended period, no clear rebound swelling was shown. Some authors also stress that part of what is thought to be “addiction” may in fact come from an untreated allergy or a structural problem. There are still no standard diagnostic criteria for rhinitis medicamentosa.
3. What Does Research Say About Stopping?
Although systematic reviews note that the evidence is not strong enough to set a standard treatment protocol, there is general agreement on the approach:
| Step | Purpose |
|---|---|
| Stopping the spray | The key step. Can be done at once or gradually. |
| Intranasal corticosteroid spray | To reduce swelling during withdrawal and speed up recovery. Used on a doctor’s advice. |
| Saline nasal rinse | To reduce crusting and soothe the nose. |
| Short course of oral corticosteroids | When the nose is completely blocked, only on a doctor’s decision. |
The first days of stopping can be difficult; congestion may increase for a while. Planning supportive treatment with your doctor makes this period easier. Because the cycle has been reported to return quickly if the spray is used again, care is needed afterwards too.
4. Could There Be an Underlying Cause?
Most people start using the spray because their nose is already blocked. If congestion continues after stopping, one of these may be the underlying cause:
- Allergic rhinitis
- Deviated septum
- Enlarged turbinates
- Chronic sinusitis (cold or chronic sinusitis?)
When congestion caused by a structural narrowing does not improve despite medical treatment, procedures such as turbinate reduction or septal correction may be considered. This decision is made after an examination and endoscopic assessment.
Conclusion: What Should You Do?
If you have been using a decongestant spray every day for weeks and cannot breathe when you try to stop, this is not a matter of willpower but a reaction of the nasal tissue to the medicine. An ENT consultation is recommended to address both stopping the spray and the underlying cause of the congestion.
For a treatment plan tailored to you, be sure to consult an ENT specialist.
References
J. Ramey, E. Bailen, R. Lockey. “Rhinitis medicamentosa.” Journal of Investigational Allergology and Clinical Immunology, 16 3 (2006): 148-155. https://pubmed.ncbi.nlm.nih.gov/16784007/.
P. Graf. “Rhinitis Medicamentosa.” Treatments in Respiratory Medicine, 4 (2005): 21-29. https://doi.org/10.2165/00151829-200504010-00003.
G. Mortuaire et al. “Rebound congestion and rhinitis medicamentosa: nasal decongestants in clinical practice. Critical review of the literature by a medical panel.” European Annals of Otorhinolaryngology, Head and Neck Diseases, 130 3 (2013): 137-144. https://doi.org/10.1016/j.anorl.2012.09.005.
S. Zucker, B. Barton, E. McCoul. “Management of Rhinitis Medicamentosa: A Systematic Review.” Otolaryngology–Head and Neck Surgery, 160 (2019): 429-438. https://doi.org/10.1177/0194599818807891.
J. Fowler, C. Chin, E. Massoud. “Rhinitis medicamentosa: a nationwide survey of Canadian otolaryngologists.” Journal of Otolaryngology – Head & Neck Surgery, 48 (2019). https://doi.org/10.1186/s40463-019-0392-1.
X. Yang et al. “Variants of rhinitis medicamentosa treatment: a systematic review.” European Archives of Oto-Rhino-Laryngology, 282 (2025): 4407-4416. https://doi.org/10.1007/s00405-025-09344-6.
M. Hagen, G. Varbiro, E. Montanari. “Revisiting Rhinitis Medicamentosa: Examining the Evidence on Topical Nasal Decongestants.” Journal of Pharmacy Practice, 39 (2025): 117-139. https://doi.org/10.1177/08971900251350510.
M. Samad et al. “Outcomes after Functional Nasal Surgery in Patients with Versus without Rhinitis Medicamentosa.” The Laryngoscope, 135 (2024). https://doi.org/10.1002/lary.31839.
Medicines and Healthcare products Regulatory Agency (MHRA). “Nasal decongestant sprays and drops containing xylometazoline hydrochloride / oxymetazoline hydrochloride: increased risk of rebound congestion (rhinitis medicamentosa) and tachyphylaxis with overuse.” Drug Safety Update, 19 9 (2026). https://www.gov.uk/drug-safety-update/nasal-decongestant-sprays-and-drops-containing-xylometazoline-hydrochloride-slash-oxymetazoline-hydrochloride-increased-risk-of-rebound-congestion-rhinitis-medicamentosa-and-tachyphylaxis-with-overuse.