Nasal decongestant sprays are a popular remedy for relieving nasal congestion caused by colds, allergies and sinus infections. These sprays provide quick relief allowing for easier breathing. However, while they can be effective in the short term, overusing nasal decongestant sprays can lead to serious health issues.
Author
- Dipa Kamdar
Senior Lecturer in Pharmacy Practice, Kingston University
In April 2025, ITV news reported on people who became dependent on nasal sprays. Many others went on to share similar experiences on social media platforms like TikTok.
Nasal congestion happens when the lining inside the nose and sinuses becomes irritated, often due to allergens, viruses, or pollutants. In response, immune cells release inflammatory chemicals that cause swelling and increased mucus production. This swelling can block airflow, making it difficult to breathe and often disrupting sleep.
Most decongestant sprays contain medications like oxymetazoline , xylometazoline , or phenylephrine . These drugs target adrenergic (adrenaline-sensitive) receptors in the blood vessels of the nasal lining, causing the vessels to constrict. As a result, the nasal lining becomes less swollen, opening up the airways and providing almost instant relief.
This fast-acting benefit is precisely why so many people reach for these sprays. But the convenience can come at a cost.
Rebound risks
Withdrawal from nasal decongestant sprays can be a deeply uncomfortable experience for some. Common symptoms include headaches, nasal stuffiness, dryness and even anxiety.
One of the most concerning side effects of overusing nasal sprays is a condition known as rebound congestion, or rhinitis medicamentosa (RM). This occurs when the nose becomes reliant on the spray to stay open. Over time, the effectiveness of the medication wears off - a phenomenon known as tachyphylaxis . As a result, users may apply the spray more frequently or in higher doses to get the same relief, creating a vicious cycle.
Some symptoms of rebound congestion, such as constant stuffiness and red, irritated nasal passages, can resemble those seen in cocaine misuse. A US study estimated that up to 9% of patients visiting ear, nose and throat clinics present with RM. Unfortunately, it's difficult to estimate how many people are affected in the UK, especially since nasal sprays are sold over the counter at pharmacies and supermarkets, often for as little as £3. With long wait times for doctor appointments, many people choose to self-medicate.
Prolonged use of nasal decongestants can lead to chronic sinusitis: persistent inflammation and infection of the sinuses. The repeated narrowing of blood vessels can also reduce blood flow to nasal tissues, leading to thinning of the lining, chronic dryness, nosebleeds and, in some cases, nasal septal perforation : a hole in the nasal septum.
Additionally, overuse can damage the turbinates - tiny bone structures inside the nose that help filter, warm and humidify the air you breathe. This can cause them to become swollen or inflamed ( turbinate hypertrophy ), worsening congestion. Overuse can also impair the function of cilia, tiny hair-like structures responsible for clearing mucus and allergens from the nose.
Beyond physical symptoms, many users experience psychological dependence . The fear of not being able to breathe without the spray can cause significant anxiety, making it harder to stop using it even when symptoms worsen.
If you find yourself relying on nasal sprays, it's important to begin tapering off gradually to minimise withdrawal symptoms. In some cases, doctors may recommend steroid nasal sprays like beclomethasone to reduce inflammation during the withdrawal process. For severe cases, surgical intervention may be necessary. The good news? Many people recover within a week of stopping the spray with the right treatment plan.
Safer alternatives
So, what can you use instead ? Saline nasal sprays or rinses can help flush out irritants and moisturise the nasal passages without causing rebound congestion. Oral antihistamines and oral decongestants may be more appropriate for allergy-related congestion but can have their own side effects. Antibiotics may be prescribed for sinus infections with severe congestion.
If you're using a nasal decongestant spray, it's important not to exceed three to five days of use - seven days at most, according to experts . Always read the label and follow dosage instructions carefully.
Nasal decongestant sprays can offer rapid relief, but overusing them can lead to serious consequences, including rebound congestion, tissue damage and psychological dependence. Use them sparingly, and if nasal congestion persists beyond a week, consult a healthcare professional.
With safer alternatives and medical guidance, you can breathe easier - without the long-term risks.
Dipa Kamdar does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
