What is Rhinitis Medicamentosa?

While many over-the-counter medications are completely harmless when taken as directed, overuse of them can lead to unintended consequences. The body has a tendency to adjust to its environment, and if this environment involves high levels of a medication, it can lead to a localized "addiction" to the compound. When this happens, stopping the usage of this medication will lead to the very symptoms that it was originally used to prevent. One such condition, rhinitis medicamentosa, can arise from the use of nasal sprays.

Identification

• Rhinitis medicamentosa is a medical condition that is brought on by overusing a medication, hence the name (rhinitis means inflammation of the nasal area). Rhinitis medicamentosa is nasal congestion that occurs as the result of using certain decongestants, such as sprays that contain phenylephrine, oxymetazoline, or naphazoline.

Mechanism

• Most decongestant nasal sprays work by activating a signaling pathway in the nasal blood vessels (in this case, the sympathetic a1 receptors). These nasal sprays create a signal that causes the blood vessels to contract, which decreases blood flow, resulting in less mucus being produced and decreased congestion. However, when these medications are used for extended periods of time (more than five days), the blood vessels become accustomed to this signal and, as a result, cause increased congestion when it is withdrawn.

Symptoms

• Most cases of rhinitis medicamentosa occur after using topical nasal sprays for five to seven days. The primary symptom is nasal congestion. In response, many people suffering from this condition begin to use more and more of the nasal spray, which only makes the problem worse. The nasal passage swelling can become serious enough that it causes permanent blockage that must be removed surgically.

Reasons for Overuse

• There are a number of reasons why people may use decongesting nasal sprays for extended periods of time, leading to rhinitis medicamentosa. One cause is a deviated septum, which results in a long-term feeling of congestion. Other causes include infections of the upper respiratory tract, chronic rhinosinusitis, and cocaine use.

Treatment

• The most effective way to treat rhinitis medicamentosa is to stop using decongestant nasal sprays. This can be done gradually or "cold turkey." In very severe cases, the patient may need to take corticosteroids to help reduce the inflammation. Patients struggling with cessation of their usage of nasal spray may obtain relief by switching to oral decongestants instead.