Congestion Caused by Decongestant Nasal Sprays (Rhinitis Medicamentosa)

Author: Op. Dr. Javidan Asafov · ENT / Otolaryngology Specialist · Last medical review: 02.10.2026

What is it?

Decongestant nasal sprays containing active ingredients such as oxymetazoline or xylometazoline shrink the blood vessels inside the nose and bring relief within minutes. They are therefore suitable for short-term use during a cold or sinusitis, and the package leaflets usually advise using them for no more than a week. When used regularly for longer, each dose wears off sooner, the nose becomes more blocked than before once the effect is gone, and the person starts using the spray more and more often. This is called rhinitis medicamentosa (drug-induced rhinitis). It is not an addiction in the psychiatric sense; it is a cycle in which the nasal lining gets used to the drug and swells excessively without it.

Which sprays cause this problem?

Only vasoconstrictor (decongestant) nasal sprays and drops cause this cycle. Sea-water and saline sprays, and the steroid nasal sprays (intranasal corticosteroids) that doctors recommend for allergy and chronic nasal inflammation, do not have this effect and can be used long term on medical advice. You can tell which group your product belongs to from the active ingredient on the box, or by asking your pharmacist.

Symptoms

The main complaint is constant nasal blockage that does not clear without the spray. The person uses the spray more and more often during the day, wakes at night to use it, keeps it close at all times and cannot sleep without it. Mouth breathing, snoring, dryness, burning and crusting inside the nose and a reduced sense of smell are common. Some people develop palpitations, sleeplessness, restlessness and a rise in blood pressure from the part of the drug that is absorbed into the body.

Why does it matter?

Long-term use damages the structure and protective function of the nasal lining, making dryness, bleeding and infections more likely. It carries extra risks for people with high blood pressure, heart disease, glaucoma, an enlarged prostate or an overactive thyroid, and during pregnancy. More importantly, the problem that led to the spray in the first place (a deviated septum, enlarged turbinates, allergy or sinusitis) often stays hidden behind the cycle and goes untreated.

Treatment: stopping the spray

The cornerstone of treatment is stopping the decongestant spray. To make this easier, a steroid nasal spray is started on medical advice; it reduces swelling of the lining and is not habit-forming. Rinsing the nose with sea water or saline also helps. The spray can be stopped all at once or gradually, for example by stopping it in one nostril first; the right approach is chosen for each person. Blockage increases somewhat in the first days, and most people feel clearly better within one to two weeks.

Treating the underlying cause

Stopping the spray breaks the cycle, but if the cause that started it is not treated, the chance of going back to it is high. The inside of the nose is therefore examined in detail, with an endoscopic examination using a thin camera if needed. Allergy or sinusitis is treated with medicines. Structural problems such as a deviated septum or enlarged turbinates that do not shrink with medicines are solved permanently by septoplasty and turbinate reduction, and the need for the spray disappears.

When to see a specialist

See an ENT specialist if you have needed a decongestant spray for more than a week, cannot sleep without it, or have tried to stop on your own without success. If you have high blood pressure or heart disease, or are pregnant, do not use these sprays without medical advice.

This article is for general information; please consult your physician for diagnosis and treatment.