What is Rhinitis Medicamentosa? What does this have to do with Afrin?

Many patients have various degrees of nasal obstruction. This could be due to fixed anatomical problems such as a deviation of nasal septum. Alternatively, a cold or a sinus infection can give you problems with the nasal passages resulting in obstruction. More chronically, signs of allergies or any polyp formation can also block up nasal breathing.

One way to get immediate relief from nasal obstruction is to use over-the-counter nasal sprays. The generic name for this compound is oxymetazoline. It is usually also marketed under the names Afrin, Vycks, or any of the drug stores own generic brands. This compounds usually works at the level of the blood vessels supplying the nasal passages. Once the medicine is sprayed into the nose, it is absorbed into mucosal membranes. It then travels to the sphincters that regulate the leakiness of the blood vessels. They make the muscles of the blood vessels go into a spasm and effectively reduce the blood flow into the nose. By doing so, the leakage of body fluids from the blood vessels into the surrounding tissues is reduced, and the end result is decongestantion of the mucosal membranes. The patients usually sense an immediate relief in the degree of blockage. The medicine typically stays in the system for a few hours, and slowly the muscle spasm is relaxed, and the membranes can get engorged with blood again. This will result in another sensation of congestion within the nasal passages.

With repeated use of oxymetazoline, the duration of the efficacy of the medicine is reduced. Each subsequent application of the medicine results in shorter amount of relief. If the medicine is used consecutively for a few days in a row, eventually the sphincter muscles of the blood vessels become dependent on it to even maintain regular flow of blood. The patients then become “dependent” on oxymetazoline simply to maintain nasal breathing. This can lead into a long-term dependence on oxymetazoline. The patients on this medication typically need to apply it few times a day. While in most cases the initial problem started after a bout of upper respiratory infection or sinusitis, patients maintain a long history of nasal congestion and need to buy the medication from the pharmacy all the time. This condition is called rhinitis medicamentosa, which means an irritation of the nasal passages actually caused by overuse and misuse of a medication.

The treatment for rhinitis medicamentosa usually consists of immediate cessation of the use of oxymetazoline. Like any other compound patients may have become habituated to, there is usually a period of difficulty before the body can flush it out your system and become “detoxified.” I usually try to explain to patients compassionately that they should anticipate a few tough days before the body chemistry can go back to normal function. I also recommend few different medications to help them during this transitional period. After a few days of not using oxymetazoline, most patients experience a significant relief in their overall symptoms.

If you think that this condition applies to you, my recommendation is to seek immediate medical help. You will also need to stop using the over-the-counter medicines immediately.

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Posted in: Nose

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