What You Need To Know About Overuse of Nasal Spray

A stuffy nose or sinus congestion is not only annoying, it can interfere with your sleep, which in turn can upset with your daytime functioning. It can be tempting to reach for a decongestant nasal spray for relief. However, there are several types of nasal sprays, and there is also the risk of overusing this over-the-counter (OTC) medication.

To help you stay safe, in this article, I’ll first discuss the different types of nasal sprays. Then I’ll explain what can happen if you use these too much, including the symptoms of nasal spray overuse. Lastly I’ll cover how to use nasal sprays correctly and when to see a doctor about your nasal spray usage or chronic congestion.

What Is Nasal Spray?

Nasal spray refers to different types of medicines that are sprayed into the nose. These are most often used for nasal congestion, runny nose, or allergy symptoms. Many are available over the counter, but a few require prescriptions.

Nasal spray types

There are several types of nasal spray:

• Saline nasal spray: The most basic saline nasal sprays are sterile water and a little salt. Some also contain preservatives to keep the mixture sterile. These open up the breathing passages by thinning and loosening mucus in the nose. Saline sprays contain no drugs and have no side effects. They are safe to use daily as needed.

• Steroid nasal spray: These contain a corticosteroid medication that helps reduce inflammation in the nasal passages. They may alleviate sneezing or an itchy, runny nose and, in some cases, may reduce the need to take oral OTC allergy medications. However, long-term steroid use can thin the skin, which may increase the risk of nosebleeds. Before using nasal steroid spray in children, get their medical provider’s approval. Some steroid sprays, like fluticasone propionate (Flonase), are available OTC, while others require a prescription.

• Antihistamine nasal spray: Like oral antihistamines, antihistamine nasal sprays block histamine from triggering allergy symptoms like runny nose, sneezing, and itching. For people whose allergy symptoms primarily involve the nose, this option may be more effective than oral antihistamines. Some antihistamines sprays, like cromolyn sodium (Intal), are available OTC, while others require a prescription.

• Decongestant nasal spray: These temporarily shrink blood vessels in the nose, which can lead to short-term relief from nasal symptoms like stuffy nose. Nasal decongestant sprays are available OTC as oxymetazoline (Afrin, others) and pseudoephedrine (Sudafed, others). 

Drug-free nasal sprays, like saline, can be used by people of all ages. Some nasal sprays that contain medication (steroids, antihistamines, or decongestants) are designed specifically for infants and children.

Whatever the age of the person using them, use as directed and speak with a medical provider before using any nasal spray regularly.

Nasal Spray Overuse

Saline nasal spray is safe to use often or longer term. Still, do not use any type of nasal spray long-term without your medical provider’s approval. Some nasal sprays can lead to complications when overused. 

Overuse of steroid nasal spray can thin the tissues of the nose and lead to more frequent nosebleeds. Using decongestant nasal spray for too long or not as directed can lead to a situation known as rebound congestion, where blood vessels in the nose swell more than before.

This can happen in as little as 7-10 days of consistent use. Though sometimes referred to as “nasal spray addiction”, this rebound effect is not an addiction to the medication.

Instead, it is a disruption to the normal functioning of blood vessels and can result in long-term swelling or damage to nose tissues and vessels.

Nasal spray dependence

The main risk of nasal spray overuse is forming a dependence on needing the medication more often. While you don’t become addicted to the medication, your body may become tolerant to the medication, causing you to need more in order to relieve symptoms. 

Symptoms of Nasal Spray Overuse

Signs of overuse or dependence on nasal spray include:

• Congestion or other symptoms returning quickly after using nasal spray

• Feeling as if nasal decongestants or sprays are ineffective

• Strong or frequent urges to use nasal spray

• Relying on nasal spray to breathe normally in your everyday life

Your medical provider can recommend how often it is safe to use nasal spray to avoid rebound congestion or dependence, but most doctors recommend using it no more than twice daily for up to three days.

If your symptoms persist or nasal spray is ineffective, see your medical provider for other treatment options.

How to Treat Nasal Spray Overuse

If you have been overusing nasal spray, stop and see your medical provider. In the short term, your congestion will worsen as your nasal tissues return to normal.

Your provider may recommend one of the following treatments to ease symptoms and help discontinue nasal spray overuse:

• Nasal spray corticosteroids to decrease inflammation

• Short-course oral corticosteroids, like prednisone

• Oral antihistamines

Using Nasal Sprays Correctly

Use over-the-counter nasal sprays as instructed on the package or by your medical provider. Each OTC product may have slightly different timing or duration of use. If a product doesn’t relieve your symptoms when used as directed, see your healthcare provider.

When to See a Doctor

If you have been using nasal spray long-term or you rely on it to breathe normally, see your healthcare provider. They can recommend other treatments to help you find relief.

Also see your doctor if you experience frequent congestion from allergies or sinus problems. They can direct you on how best to use nasal spray or other medication to address your symptoms.

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