Rebound Congestion (Rhinitis Medicamentosa): What to Do If You Overuse Nasal Spray

A stuffy nose gets in the way of sleeping, eating, and all the things in between. Decongestant nasal sprays can provide immediate relief from stuffiness and last for hours.

But when it comes to these nasal sprays, there’s too much of a good thing. Overusing nasal decongestants can cause rhinitis medicamentosa, also called rebound congestion. Rebound congestion takes a stubborn stuffy nose to a whole new level.

But that doesn’t mean you have to throw away your trusty decongestant nasal spray. Here’s what you should know about rebound congestion and how to safely use decongestant nasal sprays.

What is rebound congestion (rhinitis medicamentosa)?

Rebound congestion, or rhinitis medicamentosa, is a condition that develops when you use decongestant nasal sprays for too long. Rhinitis medicamentosa causes inflammation of the nasal passages. This inflammation blocks nasal passages, causing persistent nasal congestion. 

What are the signs and symptoms of rebound congestion?

You can only develop rebound congestion if you’ve been using nasal decongestant sprays. Signs and symptoms of rebound congestion include:

• Persistent or worsening nasal congestion: Nasal congestion from colds and viruses gets better over time as you fight off the virus. You may have rebound congestion if your stuffiness is getting worse instead of better over time. 

• Discomfort or achiness inside your nose: If the inside of your nose starts feeling achy or heavy, you might have rebound congestion. Swollen blood vessels take up a lot of space, and there’s not much extra space in the nose. 

• Using medication more often: Nasal decongestants work almost immediately to relieve stuffiness. That’s what makes them so helpful. But if you develop rebound congestion, you’ll find that your spray doesn’t seem to relieve your symptoms as well or that you need to use more medication to get relief. Over time, you might find that medication isn’t working at all. 

Why does rebound congestion happen?

Rebound congestion develops when your nose becomes dependent on decongestant nasal sprays. 

Conditions like upper respiratory tract infection or seasonal allergies cause swelling inside your nasal tissues. This inflammation makes it hard for you to breathe through your nose, so you experience stuffiness and congestion.

Decongestant nasal sprays, like Afrin and Mucinex, work by shrinking the blood vessels inside the nose — not by fighting off this inflammation. This shrinking still helps relieve some of the swelling so you can breathe again. 

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But it doesn’t treat what’s causing your symptoms. So, after a couple of hours, the medication wears off and your blood vessels open back up. Your stuffiness comes back, prompting you to give yourself another spray.

Your blood vessels start to adapt to the nose spray. With each spray, they shrink less and less. As the medication wears off, they overcompensate by opening up more and more. 

The result is a cycle where you stop feeling the benefits of the medication, so you use more medication. That causes your blood vessels to shrink less and dilate more, worsening your congestion. In the end, you’re left with swollen blood vessels even after that virus or allergen is gone. 

Which nasal sprays can cause rebound congestion?

Not all nasal sprays cause rebound congestion. Only nasal sprays that shrink your blood vessels can cause this problem. These include:

• Phenylephrine (Afrin, Neo-Synephrine and 4-Way Fast Acting, Children’s Afrin)

• Oxymetazoline (12-Hour Decongestant, Afrin, Dristan, Mucinex Sinus-Max Nasal Spray, Vicks Sinex)

Oxymetazoline isn’t as likely to trigger rebound congestion. But cases related to oxymetazoline have been reported.

Nasal sprays that are safe for long-term use

Nasal steroid sprays like fluticasone (Flonase) and mometasone (Nasonex) won’t cause rebound congestion. 

Saline nasal sprays won’t cause rebound congestion either.

How long does rebound congestion last?

Rebound congestion won’t go away until you stop using nasal decongestants. Once you’ve stopped using the medication, your body will adjust back to normal. But this can take a while. 

Most people feel better within a few days. But it can take several weeks for rebound congestion to go away. Studies suggest that nasal steroids may help speed up recovery.

How do you avoid rebound congestion?

You lower your risk of developing rebound congestion by not using over-the-counter (OTC) nasal sprays for too long. 

It’s not totally clear how long is “too long.” In studies, people started developing signs of rebound congestion after 5 days of using nasal decongestants. But in other studies people didn’t develop rebound congestion, even after taking oxymetazoline nasal sprays for 10 days. So it’s possible that some people are more likely to develop rebound congestion than others. But it’s not clear why some people are more at risk. 

That’s why most experts recommend stopping nasal decongestants after a few days. This is often enough time for your body to get over a cold or adjust to new allergy medication. 

Talk with your healthcare team if you experience nasal congestion that lasts longer than 5 days. They may offer you another treatment option that can work just as well as an OTC nasal spray — but one that won’t give you rebound congestion. They might also recommend that you keep taking your OTC nasal spray, but that you add on additional treatments that can lower your risk of developing rebound congestion.

How do you treat rebound congestion?

Treatment for rebound congestion includes:

• Stopping the nasal spray: The first step is to stop using your decongestant nasal spray. If you’re using it often, you may need to cut back gradually. For example, you can cut back on the number of sprays you use every few days until you’ve stopped using it completely. 

• Nasal steroids: You may need to start taking a nasal steroid like fluticasone (Flonase) or mometasone (Nasonex). These medications can bring down swelling in the nose. 

• Saline spray or gel: Sodium chloride nasal spray or gel is a natural remedy that soothes irritated nasal passages. This can bring down overall inflammation and promote healing. 

Rebound congestion takes time to go away. Most people start feeling better in a few days. But if you’ve been using nasal sprays for a long time, it can take longer for rebound congestion to go away.

Working with your healthcare team can help you recover faster. They can also make sure you don’t develop complications from rebound congestion like infections and nasal polyps. 

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Written by:

Tracy Norfleet, MD, FACP

Dr. Tracy Norfleet is a board-certified Internal Medicine physician, health expert, and physician leader with over 20 years of experience practicing adult medicine. Dual-certified by the American Board of Obesity Medicine and the American Board of Lifestyle Medicine, Dr. Tracy possesses a wealth of knowledge and expertise in both traditional medical practices and innovative lifestyle interventions for chronic disease management and reversal.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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