Drugs with potential for addiction: nasal sprays

The view outside doesn’t bode well: pouring drizzle across the street, the sun is just setting. The thermometer shows an outside temperature of 2 degrees and you can clearly hear the wind whistling around the roofs. In this weather, you wouldn’t even send a dog out the door, but rather curl up on the couch and indulge in the television program. This is understandable in itself, but the problem is that the dry, artificially heated air from the heating system is unfortunately poisonous for the mucous membranes in our respiratory tract. And this is the reason why nasal spray purchases rise in the winter. But why is that a problem?

Decongestant Nasal Sprays – Curse or Blessing?

In order to be able to answer this question, one should internalize the mode of action of decongestant sprays. It all starts with viruses or (actually harmless) allergens that come into contact with the nasal mucosa. In order to get rid of these and not allow them to attach themselves in the first place, the mucous membrane reacts with increased secretion and calls for help: Soon after, specialized immune system cells to fight off pathogens are transported to the nose via our blood. The negative consequence: the nasal mucosa thickens as a result. Many of those affected now turn to their trusted doctor’s office and ask for an antibiotic, but this only makes sense in a few cases – for example, if other symptoms such as fever, pain or increased inflammatory markers appear in the blood. Firstly, because of their numerous side effects, antibiotic medication should only be administered in the case of long-term or recurring infections, and secondly, other therapies should be tried out before you literally “shoot a sparrow with a cannon”. Therefore, a decongestant nasal spray is usually the first choice to counteract the swelling of the nasal mucosa – and it works!

With the help of awkward-sounding active ingredients such as xylometazoline or oxymetazoline, the mucous membrane is prevented from swelling – which effectively makes it easier to breathe deeply. If you suffer from an acute infection and therefore only need the nasal spray for a few days in a row, this is not dramatic. However, after about a week of continuous use, the so-called rebound effect becomes more and more likely: the nasal mucosa now gets used to the helper from the outside and swells even faster – it therefore needs more and more nasal spray to reduce swelling as desired. After months or years of nasal spray abuse, the nasal mucosa can become permanently swollen; you can even lose your sense of smell through long-term use.

Glucocorticoids help with long-term stuffy noses

So what to do when allergy season or a stubborn infection clogs your nose? First, you have a certain selection of nasal sprays to choose from. What many do not know: Most nasal sprays contain preservatives that kill the germs that could otherwise get into the bottle through use in the nose. The disadvantage of these remedies, however, is that they can obstruct or even paralyze the fine cilia in our nose. However, we absolutely need these so that the resulting slime can escape to the outside. If this is no longer possible because the cilia quit their job, we are automatically more susceptible to infections, because viruses and other pathogens now have a free path into our bloodstream. A simple tip to counteract this, would you? Better to buy preservative-free nasal sprays. They usually come with a special attachment that prevents germs from migrating from the nose into the bottle – and are therefore a bit more expensive. But they are usually worth the money and you can even use them for a few days longer than is the case with their counterparts with preservatives.

“Okay, but wouldn’t it be best to stop using a nasal spray altogether?” some might be asking. Surely that’s the best way. But if you can’t breathe deeply otherwise, you need support. Here it is worth talking to the ENT doctor – because there is a tried and tested solution for people who are plagued by allergic symptoms for months in spring, for example: Mometason. This is a glucocorticoid, also known colloquially as cortisone. It does not work immediately, but after about one to one and a half days – but in several ways: anti-inflammatory, anti-allergic and decongestant. However, you can only get it on prescription – another reason to visit the doctor’s office.

This is how the withdrawal succeeds gradually

If you are already addicted and want to withdraw from the nasal spray, there are various ways available. However, the priority is always to reduce the dose either all at once or gradually – either by switching to a spray for children, or by slowly “closing” one nostril first and then the other.

Sprays with hypertonic sea or saline solution are also recommended in winter. Although they are weaker than decongestant sprays, they are not addictive. They also moisten the mucous membranes, making it harder for viruses to take hold. The active ingredient dexpanthenol, for example, is known for its moisturizing and regenerating effect on the mucous membrane. Nose oils that you apply directly with your finger also work well and moisturize even better — though understandably, they’re not for everyone.

Unfortunately, homeopathic sprays do not work beyond the usual placebo effect. Long-term use of a nasal decongestant spray can have serious side effects. Anyone who permanently suffers from restricted nasal breathing should therefore rather start looking for the cause. I offer examinations and advice on possible therapies in my practice. Feel free to contact me and book your appointment conveniently online now.

Sources:

• Fokkens, W. J., Lund, V. J., Hopkins, C., Hellings, P. W., Kern, R., Reitsma, S., … & Mullol, J. (2020). Executive summary of EPOS 2020 including integrated care pathways. Rhinology, 58(2), p. 9.
• DerApotheker (2022). DerApotheker für alle Fälle: Die häufigsten Beschwerden. Die unsinnigsten Versprechen. Die besten Mittel. Lübbe Life. Warum man ein abschwellendes Nasenspray nicht länger als eine Woche benutzen sollte. p. 21-31.
• Deutscher Berufsverband der Hals-Nasen-Ohren-Ärzte e.V. (2012). Abschwellendes Nasenspray nur kurze Zeit anwenden. Retrieved via: https://www.hno-aerzte-im-netz.de/news/hno-news/abschwellendes-nasenspray-nur-kurze-zeit-anwenden.html on 12/06/2022