The Hidden Dangers of Overusing Afrin

Did you know that Afrin, the most commonly sold over-the-counter nasal decongestant spray in the U.S., can lead to a condition called rebound congestion? Rebound congestion can occur if you use Afrin for more than three days.

It’s not just Afrin that causes rebound congestion. It can occur with all nasal decongestants. The easiest way to figure out if your nasal spray is a decongestant is to go to the back of the bottle. Look under "purpose" at the top. If it says NASAL DECONGESTANT then you are at risk of rebound congestion. When I use the term Afrin, I am referring to all nasal decongestants.

Today I'll discuss

- The journey of a typical Afrin user

- The insidious process of rebound congestion

Afrin is a go-to solution for many when they're battling a cold, allergies, or a sinus infection. But what if I told you, "The relief you're experiencing could turn into a nightmare."

Rebound congestion tricks you into thinking you're getting better, when in reality, you're getting worse.

The Slow Descent into Rebound Congestion

Rebound congestion isn't something that happens overnight. It's a slow, insidious process that worsens slightly every day you continue using Afrin beyond the recommended three days. Before you know it, you're using it several times a day, and your congestion is worse than when you started.

How does rebound congestion occur?

If you are congested at say an arbitrary level of 10 and use Afrin, your congestion will go down to an arbitrary level of 5 and the beneficial effect will last for 12 hours. This 10 down to 5 model works for 3 days. If you keep using Afrin beyond 3 days, the numbers change. After 3 days your congestion goes down to 5.1, and when the Afrin wears off your congestion goes to 10.1.

You aren't going to notice this small difference. However, if you keep using Afrin the process continues and in a few days your congestion goes down to 6 and you "rebound" to 11. Hence the term rebound congestion. Most patients with severe congestion are delighted to see improvement to level 6 and keep using the Afrin. In a week or so the numbers have changed again and you only get an improvement to level 8 but a rebound to 13.

To make matters worse, with continued use of Afrin the length of improvement decreases from 12 hours to 6 hours or less.

Patients are hooked at this point. Their baseline congestion is now 15. They use Afrin to get to level 10 where they started to begin with and only get improvement for a couple of hours.

There are two types of patients that get addicted to Afrin.

Patient 1 - initially had no nasal problems at all. They just happened to get a bad cold or sinus infection. They got severely congested and took Afrin too long and are now addicted to it. When we get them off their Afrin, they'll be back to normal and won't require any additional therapy.

Patient 2 - has some underlying condition causing their congestion. These conditions could include allergies, septal deviations, inferior turbinate hypertrophy, chronic sinus infections, etc. It's harder to get patient 2 off Afrin. Once they are off Afrin, patient 2 either needs aggressive medical therapy or surgery to correct the underlying condition or both. Otherwise, their congestion is going to continue and the likelihood of getting re-addicted to Afrin is high.

Hopefully, today’s newsletter helped you understand the problem of rebound congestion. The topic of how to wean yourself from Afrin is too long to include in today’s newsletter. It'll be the topic of next week’s letter.

The best way to avoid Afrin addiction is to use it responsibly. If your congestion persists beyond 3 days, seek medical advice instead of reaching for that nasal spray again.

Till next week,
Jim Atkins, MD, Follow me on Twitter

P.S.

Don't miss out on a theme about “Is Inferior Turbinate Hypertrophy the Cause of Your Nasal Congestion?”