Why do some/most nasal decongestants create feedback loops of congestion and (more importantly for me) how can one get over the withdrawal effects created by it's excessive use, and in what timeframe?
For context: my mother said that my father has used these decongestants regularly for as long as she has known him. He passed this habit onto me when I was young, originally with Afrin, then Narix. Given there is a recommendation to not use these decongestants for extensive periods of time and apparently a rebound effect and syndrome called rhinitis medicamentosa comes from ditching it's use after said long periods, my mother decided using it like this is unhealthy and thus cut my use of it for the day, and given this stuff is cited in Wikipedia and a fair number of news/medical articles, it seems legitimate, and thus I agreed.
After that, my skin is more prone to goosebumps and being overly sensitive, my eyes are watering more, my throat feels more scratchy (although I already woke up with that, before my mother made this decision) my nose is running way more than it used to.
Can I blame withdrawal on this?
What happened to me?
How long does this last?
And is this site really where I should turn to to try to find out?
Disclaimer: You should always trust in-person consults with a doctor (GP, Allergologist, or ENT/ORL in this case) over any advice given on the internet by myself or any one really. This post does not constitute a patient-doctor relationship and was made in the interest of general education (ELI5 style)
Please seek consult from a medical professional in your area for any health concerns or emergencies.
— Tl;dr: We don't know for sure but evidence is saying it's cause our bodies weren't expecting the drug.
Decongestants are a class of medications that can polarize many doctors. They treat the symptoms of the disease not the cause. So they are extremely useful in last-ditch situations ("I'm presenting to the board/I'm getting married but my entire face is itching and my nose is a waterfall") but not as useful long term where whatever allergy or irritant or infection caused the problem is still in your body. I have several senior doctors who outright refuse to prescribe them alone, and other seniors who swear by the relief they provide.
The opinion is decongestants don't treat anything so your body feels the need to tell you that the culprit is is still there and escalates the symptoms accordingly so they show up even with the medication. Then you take the meds away and suddenly your body is producing mucus at levels ok for decongestant threshold but way too high for natural state.
Thus, rebound.
That said, anti-histamines help take the edge off this period but get a doctor to prescribe you properly, especially if you are on other medications like steroids, heart meds, or maintenance. You can try some over the counter stuff if a doctor's visit is impossible at the moment.
Stay in cool areas of your house free of dust and pets. Increase your water intake. If it's pollen season where you are, double the reason to have a face mask on. If it's really taking over your life and you're from a dry part of the world, it might be a good idea to invest in a humidifier.
They need to look up your nose and down your throat to check if anything is amiss. The full physical and background check of every decongestant you took also helps as some types are more prone to withdrawal than others. Once they know that, they can then tailor a dosage of something to deal with your withdrawal symptoms.
Source: 2 years in practice, also my entire family up to great grandparents have allergic rhinitis. I of course defer to any seniors and/or specialists who may catch some errata in this post. Hope it helps.
Sounds like withdrawal symptoms but really - you should ask your doctor or nurse about this - since we don't see you, or have a chance to look up your nasal passages and check your medical history.
I'm coming to this late as usual, but wanted to dust off the old toxicology classes and provide a little background on what's happening here. I'd welcome update and correction from anyone with professional experience!
You'd asked:
Nasal decongestant dependence and withdrawal is actually a good model of physiological tolerance and addiction.
In U.S. decongestant formulas, there are two drugs, phenylephrine and oxymetazoline, that act on one of the same neurotransmitter receptors that adrenaline (norepinephrine) does - it's part of the adrenergic neurotransmitter receptor system. The specific receptor, alpha 2, controls blood vessel dilation and constriction. When you get an adrenaline rush in response to a threat, your peripheral blood vessels constrict in part so you don't bleed too much if wounded. Adrenaline acts on a broad range of other cellular receptors that control things like heart rate, smooth muscle contraction, and metabolism as well, but it's the blood vessel effects we're concerned with here.
Allergens and viruses trigger an immune response that releases histamine, which acts on alpha 2-adrenergic receptors to dilate blood vessels. This allows them to leak fluids that might wash away triggering substances. Hence the swollen nasal and sinus tissues and drippy nose. The adrenergic decongestant drugs cause these blood vessels to constrict again. So far, so good. [By contrast, corticosteroid and leucotriene inhibitor nasal sprays act on the initial immune response.]
The problem is, neurotransmitter systems are adaptive - they doesn't waste resources maintaining parts that aren't needed. Flooding neurotransmitter receptors with control substances continuously can cause cells to manufacture and maintain fewer receptors. The system adapts to the new "normal" signal level. Over time, escalating drug doses are required to achieve the same effect as originally encountered.
And when the control drug is abruptly withdrawn, some cellular control systems react as if the opposite signal has been applied in the same magnitude as the drug effect. It's like a push-pull steering control where removing force in one direction causes an abrupt oversteer to the completely opposite direction.
For the nasal alpha 2-adrenergic receptor, it's as if you've suddenly gotten a big dose of histamine with no opposing adrenaline signal. That's the "rebound" effect - you feel as or even more congested than when you first started using the decongestant medication.
There's plenty of research on the alpha 2-adrenergic receptor system - it's also involved in tolerance to some older blood pressure drugs, like clonidine. In most cases, it takes about 3 - 4 weeks for responses to return to the baseline level, but sometimes longer. There are reports of cases where the system never fully recovers to the original baseline after extended drug use, but blood pressure has a complicated and extensive system of controls, so it's hard to say that this is due to permanent adrenergic receptor depletion.
I hope this helps! There's good advice above about decongestant alternatives, though I'd recommend talking to your doctor. You may want to exercise some caution about nasal rinses - contamination can have dire consequences, and you may be best off managing the underlying allergies systemically.
Talk to your mom, and go to the doctor. It sounds like you've figured out your condition, as rebound congestion can happen with decongestants, oral or nasal. However, your doctor is the only one who can actually help you treat this properly.
I will give you my experience cause it seems similar to yours. For the past 4 months I have been dealing with sinus congestion and sinus headaches. I can feel my sinuses constantly draining in my throat. I will sometimes wake up with what feels like a head cold but my mucus is clear and I have no blockage in my sinuses. I also take Flonase as well as another allergy medication cause I do have a history of allergy issues. I have already taken two rounds of antibiotics and had a CT scan to confirm it is not a sinus infection. My last visit with my ENT doc turned up that my mucus is on overdrive and constantly producing more and draining through my sinuses. The term is called Turbinate Hypertrophy and is most likely a result of a deviated septum I just discovered that I had in this last ENT visit. So they gave me a nasal drainage medication called Budesonide that is specific to this condition.
I am going to speak with a surgeon in 6 weeks to look at my options regarding my deviated septum. I’ve been using the nasal drainage medication for about a week now and I feel much better but not cured. I can update you with more in the coming weeks.
For me (and my sinus congested-prone genetics) saline solution nasal irrigation has been a lifesaver. I'd talk to my doctor about that.
In short, inhaling boiled, pH-corrected super-saline solution through the nose to ease congestion. Sounds hard, is easy:
For me it's pretty effective both in clearing general congestion, but also to dampen the effects of an oncoming cold/stuffy nose.
I agree with this solution and it works especially for our patients who have no access to drug stores, and it's cheap and convenient :)
However using this method on someone who already went through decongestants has the potential to double-down on withdrawal.
For you and any one else who wants to cut back on decongestant use after the withdrawal has passed, I'd like to share one half-joking prescription that patients always like to hear and that realistically actually works:
"Go to the beach, have a swim, repeat as necessary."