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Nasal decongestants, a trail to legal addiction?

legal addiction Oct 10, 2021

                I am pretty sure some of us have used over-the-counter (OTC) nasal decongestants at least  once to relieve a blocked nose. But do we know how they work? Do we know what happens when we take them for a prolonged period? Did you know that they can cause drug dependence? Read on to find out more!
Nasal decongestants come in many compositions: oxymetazoline, xylometazoline, phenylephrine, propylhexedrine and more, under several popular brand names and are frequently portrayed in the media.

How do they work?

                The reason we have a stuffy nose in the first place is due to the swelling of tissue in our nasal passages. This is a result of inflammation (the body's normal response to an infection) which makes it difficult to breathe. Using a nasal decongestant often helps. They function by acting on the blood vessels in our nasal area, to cause vasoconstriction (narrowing of the blood vessels), which leads to a reduction in the swelling of our nasal tissue.

Do they really have addictive potential?

                Plainly said, the overuse of OTC nasal decongestants does not produce a classic picture of addiction - it is more of a drug dependence, on prolonged use, one develops tolerance to the drug. This leads to a self-destructive cycle, urging the user to indulge in higher quantities and more frequent sprays of the OTC nasal decongestant.

What happens when we use it for a long time?

              ‘Rhinitis medicamentosa’, sounds like a really scary name, doesn’t it? Simply put, it is rebound congestion causing recurrence of nasal congestion without any discharge or cold on prolonged use of nasal decongestant sprays.

Eventually, this can lead to severe inflammatory conditions like atrophic rhinitis, turbinate hypertrophy, chronic rhinosinusitis. Every pack ‘supposedly’ has a warning which advises against the spray continuously, for more than 3 to 5 days, which of course, most of us overlook.

How to prevent rebound congestion?

               The best way would be to use the spray carefully, as directed by a physician or as per the instructions given on the package. But if by any chance, you have not, your physician may try to wean you off the spray by replacing it with a less problematic saline spray or alternating it with a steroid spray. Sometimes, some patients may end up needing surgical intervention.

Whether commercialising its use by advertising without proper warning leads to an increase or not in the number of dependent patients, or claiming that it is paving a way towards legal addiction, is debatable. I can only assume that as long as you read the warning and side effects on the pack, you’re good to go.

To have an addiction to illegal drugs is serious, but being addicted to OTC drugs is a whole other story because, it’s more likely that people may not take you seriously or laugh it off but believe me, it’s a real thing and people suffer from it.

One that met the public eye

               Of all the decongestant compositions,  the one that came under the spotlight was propylhexedrine. FDA(Food and Drug Administration) released a press statement on 25th March 2021 enumerating the abusive potential and preventive measures for propylhexedrine abuse.

Propylhexedrine was originally intended to replace amphetamine sprays to reduce the risk of abuse. But propylhexedrine has its fair share of dangers of misuse or abuse. It causes heart and mental health problems -some of which include fast or abnormal heart rhythm, paranoia, and can also lead to hospitalisation or even mortality. The reason behind abuse is due to its psychostimulant properties when taken orally or by intravenous injections.

“We are requesting that all manufacturers of OTC propylhexedrine nasal decongestant inhalers consider product design changes that support its safe use. Modifying the product to create a physical barrier would make tampering with the device and abusing it more difficult. In addition, decreasing the amount of medicine the device contains could also reduce the risk of serious side effects if abused or misused.”, said the FDA.

Looking at the statistics, the FDA identified 460 cases involving propylhexedrine abuse or misuse between January 1, 2000 and December 31, 2019. They also specified that the majority of these cases were due to intentional use rather than an accidental or suicidal cause.

What can/ should we do about this?

             When you suspect rebound congestion or cannot stop voluntarily using the spray, seek medical care  immediately. Saying that addiction to nasal spray is “not so serious” or “it’s not a real thing” would be a gross understatement. It’s a simple and preventable disease, yet borderline dangerous with unanticipated and serious consequences.

The question is, are drugs with abusive potential which are sold OTC safe enough even with a proper warning? Or does it necessitate listing them under the Schedule H category (i.e, prescription-only)? That’s a question to debate upon and yet to be answered.


Nampally Vamshi Krishna

A Final year medical student from Osmania medical college, trying to create a positive attitude towards health. Passionate to be trained in Surgical Histopathology.

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