Treatments: Rhinitis Medicamentosa (dependence or addiction to nasal decongestant spray)

How is rhinitis medicamentosa treated in the short term?

The essential part of treating rhinitis medicamentosa is discontinuing use of nasal decongestants. Additional measures may be used during the withdrawal phase to lessen the nasal congestion, but not using the nasal decongestant is required if one is to resolve the problem.

1. Discontinuation of Decongestants: The first and most crucial step is to stop using the decongestant nasal sprays. This often leads to a temporary worsening of symptoms, which is a rebound congestion.

2. Saline Nasal Sprays: To alleviate congestion and dryness, saline nasal sprays can provide moisture to the nasal passages.

3. Intranasal Steroids: Corticosteroid nasal sprays may be used to reduce inflammation and help with severe congestion. These medications can take several days to show effects.

4. Oral Antihistamines: If there is an allergic component, oral antihistamines may be helpful in managing symptoms.

5. Decongestants (Oral): Short-term use of oral decongestants (such as oral pseudoephedrine, phenylephrine, or phenylpropanolamine) may be considered, but it is important to use them cautiously and for a limited duration. These drugs may be purchased over-the-counter (without a prescription), though may be subject to restrictions on quantities purchased. Oral decongestants should not be used in certain conditions, such as diabetes, high blood pressure, hyperthyroidism, enlarged prostrate, glaucoma, or problems with the liver, kidneys, or heart. Consult with your physician prior to using oral decongestants.

6. Managing Underlying Allergies: If allergies are contributing to nasal congestion, addressing these through allergen avoidance or immunotherapy might be beneficial.

Patience is essential, as recovery may take time, and symptoms may fluctuate during the initial withdrawal phase. Usually, withdrawal from nasal decongestants and return to baseline takes about one week.

How is rhinitis medicamentosa managed in the long term?

Once rhinitis medicamentosa has resolved, nasal airway resistance due to other causes may persist. This baseline state of nasal airway resistance may have been the reason a person started using nasal decongestants. Evaluation and treatment of causes of nasal airway resistance may be undertaken.