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Nasal Septal

Decongestant nasal sprays are difficult for doctors to recommend. If used correctly, they are the best medicine that we have as a short term decongestant, but if used for just a little bit too long, they cause problems. They are generally safe even if overused. People who use them daily for long periods of time will have problems until they completely discontinue the sprays.


There are 2 common ingredients of sprays: phenylephrine (Neo-Synephrine), and oxymetazoline (Original Afrin or Neo-Synephrine 12 hour). Oxymetazoline nasal sprays are the best of the decongestant sprays because they are the most available and do not increase blood pressure or heart rate as much phenylephrine. They last 12 hours, and are generally safe.

How much can you safely use?

The common advice is that you can use 2 squirts in each side, every 12 hours for 3 days, then you must stop entirely for a week before starting again. That's 12 full squirts in 10 days. If you have a cold or a brief allergy exposure, then this should be almost long enough. If you have used it for a cold or other possible infection, you should throw the bottle out to prevent spreading the infection to others or giving it back to yourself at a later time.

There are ways to get the benefits for longer. The so called rebound effect occurs locally in the tissues and is related to the dose and to the frequency. This means that if you use it on just one side, the other side doesn't accrue the negative influence for that dose. People get by pretty well with just one side of their nose open. If you wanted, you can spread out the doses by using the medicine on one side one night, and the other side the next night. I suspect you can go a week or a bit longer without problems if you alternate sides with each application.

Also, the rebound effect is less dramatic if you use a lesser concentration. Consider dumping out 1/2 of the bottle and filling with nasal saline spray. By cutting the spray concentration in half, you can extend the amount of time that these sprays can be used. Use one squirt of half strength spray, this will still open most people up quite well, and it is only 1/4 of the full dose.

So how does this medicine make you addicted?

Addicted isn't really the best word, I think "trapped" better describes it. The phenomenon is called the rebound phenomenon. Let's go over the course of events that represents the most common victim of this trap.

OK, so Jack usually doesn't have chronic nasal problems. One day he wakes up all congested. It's probably a cold or some acute allergic exposure. He buys a bottle of 4-Way® spray at the grocery. A couple of big squirts, and everything is great. He uses it at night and in the mornings. Initially, when this medicine is sprayed, it dramatically shrinks swollen membranes. Once it wears off, initially in 12 hours, the membranes go back to their previous condition. He continues this pattern for days. Now, unknown to Jack, at about day 5, the swelling from his cold has passed for the most part, however, when it is time for bed, his nose is still congested. He uses the spray again, no sense in not breathing well though the night, is there? This pattern continues for weeks.

After the first 4 or 5 days, things have changed. The spray doesn't quite last 12 hours and more importantly, when it wears off, the mucous membranes don't go back to their previous condition, they go to their previous condition plus they swell up some just from wanting more spray. A self fulfilling prophesy has begun. The swelling and congestion is now from recent use of the spray, not from the cold or allergy that started the whole process.

So now if Jack had just muddled through a the little bit of congestion that was present on day 4 and 5, the problem would be gone, but now the a new problem has replaced it. On day 4+, you can convert over to decongestant pills, they don't work as well and have more side effects but they don't cause the rebound effect like the sprays do. Some people fall into this trap and remain in the vicious cycle for years.

I've got a question, why does the bottle clearly say to use it for 3 days only, and why do the bottles have enough for a month at the full rate?

OTC Meds

Treating a Cold
  With OTC Meds

Treating Allergies
  With OTC Meds

Treating Chronic
  Problems with OTC

Specific OTC Meds



Decongestant Sprays

Pain Relievers

Cough Suppressants

Mucous Thinners

Saline Rinses

Zinc Gluconate

Cromolyn Spray

Steroid Sprays

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