Can’t stop using Afrin and other decongestant nasal sprays? You’re not alone

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FILE - A woman uses nasal spray on Feb. 5, 2019, in Berlin, Germany. (Photo Illustration by Florian Gaertner/Getty Images)

Comedian Nate Bargatze hosted "Saturday Night Live" last season, joking in his opening monologue about being "addicted to Afrin."

"If you don’t know what it is, I would honestly tell you to not get involved," Bargatze joked to the crowd. "It’s one of the best things I’ve ever been a part of."

Oxymetazoline, and sold under brand names like Afrin, is a decongestant nasal spray drug used for temporary relief of congestion. It works by narrowing the blood vessels in the nose, reducing swelling and improving congestion. 

Afrin is just one well-known brand, and there are many different over-the-counter decongestant nasal sprays that contain oxymetazoline. 

As it states on the bottle, Afrin products should only be used for a maximum of three days – as "frequent or prolonged use may cause nasal congestion to recur or worsen." 

But against their better judgment, many people often use such products for longer than recommended and find themselves in a cycle of congestion, spray, more congestion, more spray. Post after post on Reddit detail similar stories of people who have found themselves "addicted" to the nasal spray.

"I used Afrin multiple times a day for almost 2 years, wife has used it for longer," one person wrote. "I was able to quit using it. The thing about Afrin is it gives you congestion relief, but then afterwards you get a thing called rebound congestion - so eventually you're constantly congested unless you use the afrin. It's no longer due to sickness or allergy or any real irritant, it's just congestion from lack of afrin."

Another person described the "pretty intense anxiety or even panic" some feel if they aren’t able to breathe through their nose, "so that just continues the cycle of afrin/stuffy/afrin."

Is Afrin really addictive? 

Afrin, and other nasal sprays like it, is not addictive in the way that we think of addiction to drugs like fentanyl and heroin, explained Dr. Maryann Amirshahi, an emergency medical doctor at MedStar Washington Hospital Center in Washington, D.C.

"People that use Afrin do not experience a ‘high’ from using it, but rather they become dependent on it to treat congestion," Amirshahi, who is also the co-medical director of the National Capital Poison Center, told FOX Television Stations. 

When Afrin and other oxymetazoline nasal sprays are used for long periods of time, a person can develop a condition called rhinitis medicamentosa or "rebound congestion." 

"Basically, when you stop using Afrin, you get worsening congestion, so you keep using it, leading to a vicious cycle," Amirshahi said. "Sometimes people take more Afrin than they are supposed to, leading to systemic absorption, which can cause changes in heart rate or blood pressure. In addition, you can get irritation of the mucosa of the nose and nose bleeds."

If the medicine is used long-term – such as months to years – permanent damage to the nose can occur, health experts say.

Because such nasal sprays are over-the-counter and not really "a true addiction," Amirshahi said it’s difficult to estimate how many Americans may be in this worsening nasal spray cycle. 

Bayer, the maker of Afrin, stressed how consumers should not continue using the product past its directed usage.

"Oxymetazoline, the active ingredient in Afrin, is an effective, fast acting topical decongestant. Consumers should not exceed 2 doses in any 24-hour period and should not use the product for more than 3 days," the company told FOX Television Stations. "When used as directed, rebound congestion typically doesn't occur. Prolonged or frequent use of Oxymetazoline may cause nasal congestion to recur or worsen. This may be avoided by using the product as directed. Consultation with a healthcare provider is recommended if symptoms persist."

How to treat nasal spray addiction

For someone who is having trouble putting down the nose spray, as always, it’s best to talk to a doctor. Many say the best treatment is to throw out the spray and go cold turkey. 

"Expect to be miserable for a few days while the body recovers," Dr. Susan Besser, a primary care provider at Mercy Personal Physicians in Baltimore, shared for Annapolis Allergy & Asthma. "One can use a nasal steroid (such as Flonase) to help limit the symptoms while the body recovers. In severe cases, an oral steroid can be prescribed, which may help."

Saline spray can also help to reduce inflammation. 

For people with long-term nasal symptoms from allergies, there are many safe and effective treatment options available, including nasal steroids and nasal antihistamines, according to Amirshahi – who adds that both classes of these medications are safe for regular daily use.

"If the nasal symptoms are due to allergic rhinitis, you can start using one of these sprays to control the symptoms and then discontinue the Afrin," Amirshahi said. 

"It is important to reiterate that Afrin should only be used for a few days. It is really intended to be used in the setting of a cold, which is temporary," she added.

This story was reported from Cincinnati.