Nasal spray addiction: Is it real?

I use Afrin for nasal congestion associated with allergies. Should I be concerned about nasal spray addiction?

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Mayo Clinic asthma and allergy specialist James Li, M.D., and colleagues answer select questions from readers.

Answer

No. You cannot become addicted to a nasal spray. Addiction is a compulsive physiological need for and use of a habit-forming substance known to be physically, psychologically or socially harmful. Over-the-counter nasal sprays don't contain any habit-forming ingredients, and they don't cause the compulsive cravings that mark an addiction. However, it is possible to develop a tolerance to nasal sprays.

Nasal congestion occurs when blood vessels in the lining of your nose (nasal membranes) expand (dilate), such as due to a cold or allergies. Decongestant nasal sprays narrow (constrict) these blood vessels, reducing congestion and clearing your nasal passages.

After a few days of using a decongestant nasal spray, your nasal membranes may become tolerant — or less responsive — to the effects of the medication. As a result, you may need to use more and more of the medication to control congestion or your congestion may worsen if you stop using the medication (rebound congestion). Some people mistake this as nasal spray addiction. But it really isn't.

If you develop a tolerance to decongestant nasal sprays, it isn't permanent. Stop using the nasal spray for several weeks to reverse your tolerance. In the meantime, talk to your doctor about other methods for reducing nasal congestion, such as oral decongestants, saline nasal sprays or steroid nasal sprays. These medications do not cause rebound congestion.

Doctors recommend that you use a decongestant nasal spray for no more than three to four days in a row to prevent rebound congestion.