How to Stop Being Addicted to Nasal Sprays

Written by Professor Vik Veer, Consultant ENT & Sleep Surgeon  ·  Published 20th September 2026  ·  Last reviewed 20th September 2026

The Bottle by the Bed

Decongestant sprays such as Otrivine and Sudafed Blocked Nose (xylometazoline) or Vicks Sinex (oxymetazoline) are very good at what they do. Within a minute or two they shrink the swollen lining of the nose, and the relief lasts for hours. The difficulty is that the nose adapts to them. After more than a few days of regular use, each dose works for a shorter time, and when it wears off the nose blocks up more than it did before. The natural response is to spray again, and within a few weeks many people are using it several times a day and cannot get to sleep without it. This is called rhinitis medicamentosa, which simply means inflammation of the nose caused by a medicine. It is also known as rebound congestion.

I see a great many people in clinic who have used these sprays every day for months or years. Most are slightly embarrassed about it, and most have already tried to stop at least once. It is not a failure of willpower. The nose genuinely becomes more blocked when the spray is withdrawn, and a completely blocked nose at three in the morning is a very persuasive argument for reaching for the bottle.

What happens inside the nose when a decongestant spray is used beyond the seven days on the label.

"I recently consulted Mr Veer due to chronic nose congestion. He was friendly and explained my treatment plan and follow-on actions in a very understandable and concise manner." Google Review, 5 stars — Gerald Yong

Why the Nose Becomes Addicted

Decongestant sprays work by shutting down the blood flow to the lining of the nose. The turbinates, which are the ridges of spongy tissue along the side walls of the nose that swell and shrink throughout the day, are mostly blood. Empty them and they shrink away, the airway opens and you can breathe. In the short term it is a marvellous effect, which is precisely the problem.

The structures underneath the lining do not have a blood supply of their own. The cartilage, the bone of the turbinate and the glands within it all take their oxygen and nutrients from the lining (the mucosa) that covers them. Every time the spray goes in, all of that is starved for several hours. The tissue is damaged by being deprived in this way, and when the drug finally wears off the body does the sensible thing and floods the area with blood to repair the damage. That flood of blood is what you feel as the nose closing up more tightly than it was before you sprayed. The only thing that relieves it is another dose, and so the cycle starts.

Two other things happen alongside this. The receptors that the drug acts on become less responsive with repeated stimulation, a process called tachyphylaxis, meaning the same dose produces a progressively smaller effect and lasts a shorter time.^[1][2][3] And the nose loses its normal rhythm. In a healthy nose the two sides take turns to congest and decongest over a few hours, so each side gets a rest; constant spraying overrides that cycle entirely.

Repeated cycles of starving tissue of blood and then flooding it again are damaging in any part of the body, and the nose appears to be no exception. It is a reasonable explanation for why the changes seen down the microscope in long-term users, which are described below, look like the changes of chronic injury rather than of a drug side effect.

Which Sprays and Remedies Cause This

The drugs that cause rhinitis medicamentosa are the true vasoconstrictors, which clamp down on blood vessels. In the UK and elsewhere they are sold as:

• Xylometazoline: Otrivine, Otrivine Adult Congestion Relief, Otrivine Sinusitis, Otrivine Extra Dual Relief (which also contains ipratropium), Sudafed Blocked Nose Spray, and the pharmacy and supermarket own-brand versions.
• Oxymetazoline: Vicks Sinex, Vicks Sinex Soother and Micromist, and abroad Afrin, Drixine, Dristan, Nasivin and Iliadin.
• Ephedrine and phenylephrine nasal drops, which are older and still sold behind the pharmacy counter.
• Tramazoline, naphazoline and tetryzoline, which appear in sprays and drops sold in other countries and often brought back from holiday.

Pseudoephedrine tablets, such as Sudafed tablets, work on the same receptors but do not cause rhinitis medicamentosa in the way the sprays do, because the effect on the nasal lining is far weaker. That does not make them suitable for long-term use either.

There is a second group of products that people use in exactly the same compulsive way, based on menthol and aromatic oils:

• Olbas Oil and Olbas for Children (levomenthol with eucalyptus, cajuput, peppermint, clove and juniperberry oils and methyl salicylate), and the Olbas Inhaler stick.
• Vicks VapoRub (menthol, camphor, eucalyptus and turpentine oils), which a great many people dab inside or under the nose, and the Vicks Inhaler nasal stick (menthol, camphor and Siberian pine needle oil).
• Karvol capsules, Snufflebabe, Tiger Balm, menthol crystals and eucalyptus or peppermint oil used in steam inhalations.

These behave quite differently. Menthol does not open the nose; it stimulates the cold receptors in the lining, which produces a powerful sensation of clear airflow while measurements of actual airflow barely change. That is not a criticism, because feeling less blocked is worth having, and these products do not cause rhinitis medicamentosa. What they can do is dry and irritate the lining with constant use, and mask a nose that is genuinely obstructed for a reason that ought to be looked at. Vicks VapoRub in particular is not designed to go inside the nose, and there are case reports of its paraffin base being inhaled into the lungs, so I would keep it on the chest where it belongs.

What Long-Term Use Does to the Nose

Over months and years the changes go beyond the blood vessels. Biopsies from long-term users show loss of the cilia (the microscopic hairs that sweep mucus towards the back of the throat), lining cells changing into a tougher, more skin-like type (squamous metaplasia), an increase in mucus-producing cells, and swelling within the tissue itself.^[2] The turbinates can enlarge. A nose that clears its mucus poorly is more prone to dryness, crusting and irritation, and a nose that is blocked most of the night disturbs sleep, makes snoring worse and makes CPAP considerably harder to tolerate for those who need it.

Some of the drug is absorbed into the bloodstream. Palpitations, a raised blood pressure and poor sleep have been reported with heavy use, although at normal doses these effects appear to be uncommon. If you have heart disease or high blood pressure and use these sprays many times a day, it is worth mentioning to your GP.

The part that concerns me most is that in people who have used decongestants for many years, the lining of the nose does not always recover fully, even after they have stopped. In my experience these are the patients who come off the sprays successfully but remain blocked, and who sometimes need surgery to breathe comfortably. Nobody has worked out how long it takes for the changes to become fixed, and it probably varies a great deal from person to person. The practical point is that the sooner you come off them, the better your chances of the nose settling on its own.

Stopping All at Once

The traditional advice is simply to stop, often called going cold turkey. It is logical, and some people manage it. The difficulty is the first week or so. The nose often blocks almost completely, sleep is poor, the mouth dries out overnight, and many people give up, usually in the middle of the night. In one small randomised trial, people who stopped their decongestant and were given a dummy spray instead of a steroid still had rebound congestion more than a week later.^[4]

Even with specialist treatment and follow-up, a study from Italy found that around 3 in 10 people with rhinitis medicamentosa were still using decongestants a year later. Anxiety and ongoing inflammation in the nose were the factors most strongly linked to not managing to stop.^[7] No trial has directly compared stopping suddenly with reducing gradually, so I cannot give you a reliable success rate for either approach. What I can say is that in my experience, people who try to stop suddenly on their own, without anything else to support the nose, relapse more often than not.

If you do want to stop in one go, a steroid spray makes it easier. In a small trial of 20 people who stopped their decongestant abruptly, those given a fluticasone steroid spray improved faster than those given a dummy spray.^[6]

A Gentler Way Off: Overlap, Then Reduce

The approach I usually recommend is to start a steroid nasal spray and hypertonic saline while you are still using the decongestant, and then reduce the decongestant slowly over around six weeks. Steroid sprays reduce the underlying swelling and inflammation, but they take time. Some effect appears within days, but the full benefit on a blocked nose often takes several weeks, and longer in someone who has used decongestants for years. Stopping the decongestant before the steroid has had a chance to work leaves a gap in which the nose is at its worst, and that gap is where most attempts fail. This is broadly how most ENT surgeons approach it; in a Canadian survey, almost all recommended stopping or weaning the decongestant together with a steroid spray.^[10]

It might seem odd to carry on using the spray that caused the problem, but there is reasonable evidence that the steroid counteracts the rebound. In a randomised trial in healthy volunteers, two weeks of oxymetazoline three times a day produced both tolerance and rebound congestion, and adding a fluticasone spray for just three days restored the response to the decongestant and improved airflow.^[3] In another small trial, people who used a budesonide steroid spray alongside their decongestant had rebound congestion that settled within about 48 hours of stopping, compared with more than a week in those given a dummy spray.^[4] A third trial found no rhinitis medicamentosa after four weeks of nightly oxymetazoline when it was combined with a steroid spray.^[5]

These are small, short studies, mostly in people without long-standing decongestant use, so they support the principle rather than prove it for everyone. The six-week timescale is my clinical judgement rather than something tested in a trial.

Stage	Decongestant spray	Steroid spray & hypertonic saline
Weeks 1–2	Carry on exactly as you are	Start both, every day. Saline first, then steroid
Weeks 3–4	Drop the daytime doses first	Continue both, every day
Weeks 5–6	Night-time dose only → every other night → stop	Continue both, every day
After stopping	None — and ideally never again	Continue for several months

Weeks one and two

Carry on using your decongestant as you are now. Start a hypertonic saline rinse or spray and a steroid nasal spray every day. Hypertonic simply means the salt concentration is a little higher than that of the body's own fluids. As well as washing out mucus, it draws a small amount of fluid out of the swollen lining by osmosis, so it decongests the nose slightly, and it does this without touching the blood vessels and without any possibility of rebound. It may sting a little for the first few days. Hypertonic sachets and sprays are sold for exactly this purpose; ordinary isotonic saline is still worth using if that is what you have. Use the saline first, to clear mucus so the steroid can reach the lining. When using the steroid spray, tilt your head slightly forwards and aim the nozzle towards the outer wall of the nose, roughly towards the ear on the same side, rather than at the septum (the central partition). This reduces nosebleeds and irritation of the septum.

Weeks three to six

Begin cutting down the decongestant gradually. Most people find it easiest to drop the daytime doses first and keep the night-time dose until last, because a blocked nose is most troublesome when lying down. When you are down to one dose at night, move to every other night, and then stop. If a step goes badly, go back to the previous step for a few more days rather than abandoning the whole plan. Slow progress is still progress.

After stopping

Keep using the steroid spray and the hypertonic saline. I usually suggest continuing for several months, because the lining takes a long time to recover and the original reason for the blocked nose, whether allergy, a bent septum or something else, is often still there.

Stopping the decongestant before the steroid has had time to work leaves a gap in which the nose is at its worst. That gap is where most attempts fail.

The Preservative Problem: Benzalkonium Chloride

Many nasal sprays contain a preservative called benzalkonium chloride (sometimes shortened to BKC or BAC), which stops bacteria growing in the bottle. There is some evidence that it makes rebound congestion worse. In a study of healthy volunteers who used oxymetazoline for 30 days, those whose spray contained the preservative developed roughly twice as much rebound swelling of the nasal lining as those using the same spray without it, and reported more stuffiness.^[11] When the same volunteers were given the spray again later, only those who had used the preserved version developed stuffiness again.^[12]

The evidence is not one-sided. A safety review of the published studies concluded that there was no clear proof that the preservative harms the nose at the concentrations used in sprays,^[13] and a separate trial found that it caused irritation but did not raise the chemical markers of inflammation.^[14] My view is that the question is not settled, but where there is a choice it makes sense to avoid it, particularly in the decongestant and the saline, both of which are widely available preservative-free. The label will list "benzalkonium chloride" among the other ingredients if it is present.

Steroid sprays are more difficult. The steroid sprays I prefer for long-term use are those with very low bioavailability, meaning very little of the steroid is absorbed into the bloodstream, such as fluticasone and mometasone. As far as I am aware, all of these sold in the UK contain benzalkonium chloride. Some sprays sold abroad are made without it, and if you are buying one overseas it is worth checking the label. The benefit of the steroid spray outweighs the concern about its preservative, so please do not avoid the steroid on that account.

When Sprays Are Not Enough

Some people come off decongestants successfully, use their steroid spray faithfully for several months, and are still blocked. This is more common after many years of decongestant use. Often the turbinates have enlarged, or there is a bent septum that was the reason for starting the spray in the first place. For these patients, surgery to open the nasal airway is reasonable, and it often helps people stay off decongestants for good.

In an Australian study of 56 people with persistent rhinitis medicamentosa, defined as daily decongestant use for at least four weeks despite medical treatment, 91 per cent had stopped decongestants completely at a median of 3.4 years after nasal surgery.^[15] An American study found that 86 per cent of people with rhinitis medicamentosa stayed off decongestants after surgery, and their improvement in nasal blockage was similar to that of patients without the condition.^[16] A German study of laser turbinate reduction found that 88 per cent had stopped at six months, but this fell to 74 per cent at one year,^[17] which is a useful reminder that relapse remains possible. None of these studies had a comparison group of patients who did not have surgery, so they show what happened after surgery rather than proving that surgery caused it.

"As a GP, I've worked with many specialists, but few have impressed me as much as Mr Vik Veer. I recently had turbinate reduction surgery under his care to address nasal obstruction and snoring — the entire experience from consultation to recovery was outstanding. The results of my surgery have been excellent. I feel more rested, and my overall quality of life has improved." Google Review, 5 stars — Saima (GP)

Why I Want You Off Decongestants Before an Operation

The first is bleeding. Surgeons in Japan reported two patients who were operated on while still using decongestants, and in both the bleeding was heavy from the first incision and difficult to control.^[18]

The second is healing, and here I should be clear that I am reasoning from how the tissue behaves rather than from trial data. The lining of the nose, and the cartilage and bone underneath it, depend on a good blood supply to heal. Tissue that has been repeatedly starved of blood by decongestants, and has had to recover from that many times a day for years, may not heal as reliably after surgery. In septal surgery (septoplasty), the cartilage of the septum is nourished by the lining on each side. If the lining on both sides fails to heal at the same point, the result can be a septal perforation, which is a permanent hole in the septum that can cause crusting, bleeding and whistling. Nasal sprays can cause perforations on their own; a Norwegian series attributed around 28 per cent of septal perforations seen between 1995 and 2005 to steroid and decongestant sprays.^[19]

In turbinate surgery, if the blood supply to the remaining tissue is poor, part of the turbinate may not survive and can come away in the weeks after the operation. Losing too much turbinate tissue can lead to empty nose syndrome, a distressing condition in which the nose feels blocked or suffocating despite being wide open, because the turbinates play a large part in sensing airflow. It is rare, but it is very difficult to treat once it has happened.

I am not aware of any study that has measured whether these complications are more common in people with rhinitis medicamentosa. The risk is probably small. But these are complications that are far easier to prevent than to repair.

Why I Favour a Smaller Operation

For the same reason, in patients who have used decongestants heavily in the past, I lean towards the least disruptive operation that will do the job. For the turbinates, that usually means reducing the tissue from underneath the lining, for example with radiofrequency reduction, which shrinks the spongy tissue from the inside while leaving the surface lining intact, rather than cutting away large parts of the turbinate. For the septum, it means correcting the part that actually matters for breathing rather than removing more than necessary.

There is a trade-off. A smaller operation may produce a smaller improvement, and occasionally a second procedure is needed. I think that is a reasonable price. A second small operation is straightforward; a septal perforation or empty nose syndrome is not. You can read more about what septal surgery involves on the septoplasty page, and about turbinate treatments on the blocked nose page.

Staying Off Them

Coming off decongestants deals with the rebound, but not with whatever made the nose blocked in the first place. Allergy, a bent septum, enlarged turbinates or sinus disease will all make relapse more likely if left untreated, which is why this is best done alongside a proper assessment of the nose. If hay fever or allergic rhinitis is the underlying driver, treating that properly is what keeps you off the spray. Once you have recovered, the nose seems to remain sensitive, and rebound congestion can return quickly if decongestants are used again, even for a few days.^[1][21] I generally advise people who have had rhinitis medicamentosa to avoid them altogether. If you do need one, for a heavy cold before a flight, for example, keep it to a day or two.

"I saw Vik Veer last week and what a lovely experience. I have suffered from sinus problems for 25 years, with different doctors treating me for hay fever. After examination it was discovered I have a deviated nasal septum, enlarged inferior turbinates and lateral nasal collapse. Vik Veer explained everything in great detail and even drew me diagrams. Nothing was rushed, and he sent me videos on the things we had discussed as promised." Google Review, 5 stars — Shaney Morgan

References

1. Graf P. Rhinitis medicamentosa: aspects of pathophysiology and treatment. Allergy. 1997;52(40 Suppl):28–34. Narrative review of rebound congestion, tolerance and nasal hyperreactivity; recommends withdrawal with a topical steroid and caution about any future re-exposure.
2. Ramey JT, Bailen E, Lockey RF. Rhinitis medicamentosa. Journal of Investigational Allergology and Clinical Immunology. 2006;16(3):148–155. Review including histological changes in long-term users: ciliary loss, squamous metaplasia, goblet cell hyperplasia and oedema.
3. Vaidyanathan S, Williamson P, Clearie K, Khan F, Lipworth B. Fluticasone reverses oxymetazoline-induced tachyphylaxis of response and rebound congestion. American Journal of Respiratory and Critical Care Medicine. 2010;182(1):19–24. Randomised, double-blind, placebo-controlled crossover study; 19 healthy volunteers; 14 days of oxymetazoline produced tolerance and reduced nasal airflow, reversed by 3 days of added fluticasone.
4. Ferguson BJ, Paramaesvaran S, Rubinstein E. A study of the effect of nasal steroid sprays in perennial allergic rhinitis patients with rhinitis medicamentosa. Otolaryngology–Head and Neck Surgery. 2001;125(3):253–260. Randomised double-blind trial; 20 participants; with budesonide, subjective rebound resolved within 48 hours of stopping oxymetazoline, compared with over a week with placebo.
5. Baroody FM, Brown D, Gavanescu L, DeTineo M, Naclerio RM. Oxymetazoline adds to the effectiveness of fluticasone furoate in the treatment of perennial allergic rhinitis. Journal of Allergy and Clinical Immunology. 2011;127(4):927–934. Randomised placebo-controlled trial; 60 patients; four weeks of nightly treatment; no evidence of rhinitis medicamentosa with the combination.
6. Hallén H, Enerdal J, Graf P. Fluticasone propionate nasal spray is more effective and has a faster onset of action than placebo in treatment of rhinitis medicamentosa. Clinical and Experimental Allergy. 1997;27(5):552–558. Randomised double-blind trial; 20 patients who stopped decongestants abruptly; faster symptom reduction and greater reduction in mucosal swelling with fluticasone.
7. De Corso E, Mastrapasqua RF, Tricarico L, et al. Predisposing factors of rhinitis medicamentosa: what can influence drug discontinuation? Rhinology. 2020;58(3):233–240. Prospective case-control study; 29.4 per cent of patients had not discontinued decongestants at follow-up; anxiety and local nasal inflammation predicted failure.
8. Zucker SM, Barton BM, McCoul ED. Management of rhinitis medicamentosa: a systematic review. Otolaryngology–Head and Neck Surgery. 2019;160(3):429–438. Nine studies included; topical steroids most commonly reported; insufficient evidence for a standardised protocol.
9. Yang X, et al. Variants of rhinitis medicamentosa treatment: a systematic review. European Archives of Oto-Rhino-Laryngology. 2025. Twelve studies, 373 patients; differing designs prevented a unified treatment algorithm.
10. Fowler JB, Chin CJ, Massoud E. Rhinitis medicamentosa: a nationwide survey of Canadian otolaryngologists. Journal of Otolaryngology–Head and Neck Surgery. 2019;48(1):70. Survey of 69 specialists; 96 per cent recommended cessation or weaning and 94 per cent intranasal steroids.
11. Graf P, Hallén H, Juto JE. Benzalkonium chloride in a decongestant nasal spray aggravates rhinitis medicamentosa in healthy volunteers. Clinical and Experimental Allergy. 1995;25(5):395–400. Randomised double-blind study; 30 days of oxymetazoline with or without benzalkonium chloride; greater rebound swelling measured by rhinostereometry with the preservative.
12. Hallén H, Graf P. Benzalkonium chloride in nasal decongestive sprays has a long-lasting adverse effect on the nasal mucosa of healthy volunteers. Clinical and Experimental Allergy. 1995;25(5):401–405. On re-exposure, only volunteers previously given the preserved spray developed recurrent nasal stuffiness.
13. Marple B, Roland P, Benninger M. Safety review of benzalkonium chloride used as a preservative in intranasal solutions: an overview of conflicting data and opinions. Otolaryngology–Head and Neck Surgery. 2004;130(1):131–141. Review concluding that benzalkonium chloride at standard concentrations is generally well tolerated.
14. Riechelmann H, Deutschle T, Stuhlmiller A, Gronau S, Bürner H. Nasal toxicity of benzalkonium chloride. American Journal of Rhinology. 2004;18(5):291–299. Randomised crossover trial; 16 healthy adults; burning and irritation, but no rise in inflammatory markers.
15. Li W, Misra S, Harvey R, Kalish L. Long-term treatment outcomes in refractory rhinitis medicamentosa managed with nasal surgery. International Forum of Allergy and Rhinology. 2023. Prospective cohort; 56 patients; median follow-up 3.4 years; total decongestant cessation in 91.1 per cent.
16. Samad M, et al. Outcomes after functional nasal surgery in patients with versus without rhinitis medicamentosa. The Laryngoscope. 2024. Retrospective case-control study; 36 patients with rhinitis medicamentosa; 86.1 per cent maintained long-term cessation; symptom improvement similar to patients without the condition.
17. Caffier PP, Frieler K, Scherer H, Sedlmaier B, Göktas Ö. Rhinitis medicamentosa: therapeutic effect of diode laser inferior turbinate reduction on nasal obstruction and decongestant abuse. American Journal of Rhinology. 2008;22(4):433–439. Prospective study; 42 patients; 88 per cent off decongestants at six months and 74 per cent at one year.
18. Fukui K, et al. Two cases of surgical treatment for rhinitis medicamentosa. Practica Oto-Rhino-Laryngologica. 2025. Case report; profuse intraoperative bleeding in two patients operated on while still using decongestants.
19. Døsen LK, Haye R. Nasal septal perforation 1981–2005: changes in etiology, gender and size. BMC Ear, Nose and Throat Disorders. 2007;7:1. Prospective series of 197 patients; nasal steroid and decongestant sprays accounted for 28.4 per cent of perforations in the later period.
20. Hagen M, Varbiro G, Montanari E. Revisiting rhinitis medicamentosa: examining the evidence on topical nasal decongestants. Journal of Pharmacy Practice. 2025. Review of 18 articles; no evidence of rebound congestion with short-term use at recommended doses.
21. Mortuaire G, de Gabory L, François M, 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. 2013;130(3):137–144.

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Page created 20th September 2026 by Professor Vik Veer, Consultant ENT & Sleep Surgeon, 150 Harley Street, London. This page is patient education and does not replace individual medical assessment. Do not start or stop prescribed medication on the basis of a web page — speak to your GP or ENT surgeon, particularly if you have heart disease, high blood pressure or glaucoma. Patient comments are genuine published reviews; individual results vary.