I have had a very congested nose for months now and have been using a nasal spray. I know I’m having an adverse reaction to it but I don’t know how to stop it. If I stop using the spray all together, I can’t breathe through my nose at all. Please tell me what I can do to get off of the nasal spray.
Persistent nasal congestion while using a nasal spray to prevent congestion is a very common problem. Although you didn’t mention the name, I suspect you have been using one of the over-the-counter (OTC) nasal sprays. Familiar brands are Afrin, Neo-Synephrine, and Otrivin.
All the OTC nasal sprays contain a drug called a sympathomimetic, which mimics the actions of the sympathetic nervous system. In the nose this causes constriction of the blood vessels, shrinkage of the membranes and a reduction of mucus formation. These all reduce the congestion that people experience due to colds or allergies, and make it possible to breathe through the nose. However, there are drawbacks, and one of them is that with prolonged use these sprays cause the same congestion that they are supposed to relieve.
The labeling on all of the OTC nasal sprays mentions that they should not be used for more than three days. This prohibition of longer term use is included precisely to avoid your problem. Over a few days, the sprays themselves become irritating, and the irritation produces the continuing congestion. They still may relieve the congestion, although usually requiring larger doses to do so, and the sufferer is then caught in a vicious cycle of spray, congest, spray more, congest more.
Many doctors will simply tell people to just stop the spray cold turkey. Stop using the spray and tough out the congestion until your nose returns to normal, which may take several days to a week or so. Unfortunately, some people really can’t tolerate that, and require alternate medication to see them through.
I have used two strategies to try to help people through the process of kicking the sprays. One involves substituting an oral sympathomimetic for the spray. Psuedoephedrine, which is available OTC in 30mg tablets, will still provide some decongestant effect, perhaps not as much as the sprays, but enough to allow someone to get through the worst days. Interestingly, taking the drug orally does not perpetuate the congestion as the nasal form does. Two 60mg tablets of psuedophedrine may be taken every six hours or so. It should not be taken by people with a heart condition or hypertension. It gives some people palpitations and makes many people jittery and prevents them from getting to sleep, so I tell my patients not to take it after dinner.
To prevent congestion at night when going to bed, you can switch to a combined antihistamine/decongestant preparation which makes you sleepy, like Actifed which is also OTC. Get the cheaper house brand next to the brand name product. Don’t use one of the new antihistamine/decongestant products that don’t make you sleepy such as Claritin D or Allegra D. You want the pill to make you sleepy.
The alternative is to start using a steroid (cortisone) type nasal spray, of which there are many different brands. They all require a prescription. Since they take four to seven days to reach maximal effectiveness, a person may need to continue using the sympathomimetic nasal spray for a few days or can switch to oral pseudophed if that is not contraindicated. Use the steroid spray after the congestion has been reduced by the decongestant spray, so that the steroid will reach all the membranes. After three to four days, stop the decongestant spray and use the steroid alone. The nasal steroid sprays are generally quite safe, although they may raise the intraocular pressure in people prone to glaucoma, and occasionally will facilitate fungal infections of the nose. When used to come off the decongestant spray, a person will only need them for a couple of weeks.