The perils of nasal spray overuse: ‘I felt like a junkie’

Stacey Krauss couldn’t breathe. As a fitness trainer, she needed to not only participate in high-impact exercise but also teach it, and she couldn’t properly breathe through her nose because of chronic congestion from pollution and allergies.

Krauss turned to Afrin, a seemingly innocuous nasal decongestant spray that she bought at the drugstore one day. It worked great — “immediately and completely.” Her voice and airway felt clearer than they had in years.

That was when she lived in New York City in 2001. She thought the Afrin would offer temporary relief that would lead to a long-term solution for better breathing. Instead, it had a debilitating opposite effect.

“I found myself needing to use it more often to continue the effect,” said Krauss, who now lives in Denver. She said she ended up being dependent on the spray for years and eventually needed to use it up to 10 times a day. “After a while, ‘coming down’ was worse than before I had even started using it.”

Krauss soon was massively congested all the time unless she used the spray. She began having terrible sinus headaches. She’d panic at the thought of not having access to the quick hit of spray, so she stashed the bottles everywhere — “my gym bag, handbag, bedroom, bathroom. … I would roll over in the morning and hit it immediately after pushing snooze.”

Speaking of a particularly unsettling moment that marked her “addiction,” Krauss recalled going on a blind date, “and about two minutes after we met, we had to walk to the store so that I could pick up a bottle.

“I felt like a junkie. I’m serious.”

Krauss isn’t alone in her bizarre experience. While there is little peer-reviewed research published on the subject of sprays like Afrin, myriad blogs and Internet forums can be found with people seeking solutions to the seemingly strange and debilitating habit.

A warning label on Afrin and other nasal sprays that include the medication oxymetazoline tells individuals not to use the solution for more than three days unless advised by a health care provider. Frequent or long-term use of such sprays may cause nasal congestion to recur or worsen. Still, many people end up using the solution for far longer than advised.

While experts say that a person cannot be truly addicted to Afrin, it does cause a feeling of dependency that can get in the way of day-to-day life.

“True addiction is a compulsive physiological need for and use of a habit-forming substance known to be physically, psychologically or socially harmful,” according to Mayo Clinic. “Over-the-counter nasal sprays don’t cause the physiological cravings that mark an addiction.”

Still, with the allergy season upon us, experts warn of Afrin overuse and the addictive feeling of a need for it, or “rebound congestion,” that can occur with the over-the-counter spray. The congestion occurs when the tissues in the nose become swollen and require more and more frequent use of decongestants to unclog, so the person’s nasal congestion feels worse than it would have without the use of Afrin at all. The medical term for this condition of chronic (and often severe) nasal congestion in the setting of long-term intranasal decongestant use is “rhinitis medicamentosa.”

According to Ahmad Sedaghat, MD, assistant professor of otolaryngology at Harvard Medical School, “Afrin acts (and decongestants that work in the same manner act) on alpha receptors that are on the blood vessels in the nose. The alpha receptors are used by the body to naturally keep these blood vessels constricted. However, when these receptors receive a strong signal repeatedly over a period of a few days, their levels go down. So the blood vessels are less responsive to the body’s natural signals (or external stimuli such as Afrin) to constrict and decongest the nose.”

In addition to the possibility of addiction, long-term Afrin use can cause poor sleep quality and a decreased sense of smell because of the chronic congestion. It has also been said to lead to septal perforation, or the development of a hole in the nasal septum (the wall that separates the left and right nasal cavities), said Sedaghat. “This is likely caused by chronic constriction of the blood vessels of the septum, leading to poor oxygen supply to portions of the septum, which may subsequently die.”

Bayer, the maker of Afrin, said in a statement to Yahoo News: “At Bayer, the health and safety of our consumers is our top priority. As with all Bayer over-the-counter drug products, it is recommended that consumers strictly follow the drug fact labeling.”

The FDA also weighed in on the matter. The agency told Yahoo News in a statement: “The FDA reminds consumers to read the drug facts label before use of the product. … We are not currently aware of data that suggests that OTC nasal sprays and [their] ingredients are habit forming when used as directed, but we welcome additional evidence or data around this issue.”

While Sedaghat says it is safe to stop long-term use of Afrin “cold turkey,” it’s not going to be a comfortable experience. There will be at least a few weeks of extreme discomfort because of rebound congestion.

That’s how Tom Griesel finally got himself off the spray. After using Afrin for at least seven years and realizing that he was “totally addicted” and spending quite a bit of money on keeping himself stocked up, he decided to stop using it.

“I was a slave,” said Griesel, 62, of Sun City West, Ariz. “I finally got fed up and annoyed enough to do whatever was necessary to stop, completely knowing that it would be extremely difficult and not sure how my breathing would be after.”

Krauss, the fitness instructor, finally stopped as well, after her “inexpensive solution turned into a semi-expensive dirty habit.” She bought saline nasal spray and committed to it for a month. “I was squirting my nose almost every hour, and blowing it, furiously. It was the opposite of fun, cute, or sexy. I beat it, though, and I’ve never looked back.”

Intranasal steroid sprays, such as Flonase, Nasacort, and Rhinocort, can also help a person wean off of Afrin and curb the severity of rebound congestion, Sedaghat noted. Particularly severe cases of rebound congestion can be treated with prescription oral steroids, such as prednisone.

“Systemic steroids have their own side effects, so these medications should only be used under the direction of a physician,” said Sedaghat. “Nevertheless, regardless of whether an intranasal or systemic steroid is used or not, the rebound congestion will get better.”

Griesel and Krauss both say that they will never use Afrin again because of the debilitating effects it had on their lives. And both believe that the spray should be regulated much more heavily.

“It seems like a miracle when you first use it, but people just don’t understand the consequences of regular use,” said Griesel.