Can long term use of nasal spray lead to over-reliance and negative side effects?

Hi Amy

Allergic rhinitis is a very common condition in Singapore, and a study even suggests that up to 30% of Singaporeans has some form of allergy.

There are many different treatments for allergic rhinitis, and what your GP prescribed to you sounds like a nasal steroid spray.

Please do not be alarmed by the word steroid. Nasal steroid sprays are largely safe when administered as instructed. It is however, very slow acting, and you will only feel better after using it for a period of time, usually 2 to 4 weeks, of continuous daily use. You will not get addicted to the nasal steroids, and it is safe to administer for long term.

When you are feeling better a few weeks later, usually your doctor will start to tail down the dosage of your nasal steroids, so do go back and follow up with your GP and see what's the next plan of action. But if you stop the nasal spray completely, usually the allergic symptoms will come back.

A common side effect of the steroid spray is nose bleeding. So if you do get nose bleeding after you are started on the nasal spray, your GP may want to lower the dose , switch the brand of the spray, or even stop completely. So just go back to your doctor if you have nosebleeds.

One thing you need to be aware if is that there is another product out there in the market. This is the nasal decongestant spray, and this will have a very rapid relief. However, your body do get dependant on this spray, and after prolonged use, you will realise you need a higher and higher dosage to achieve the same effect. For this brand of nasal sprays, please stop after about 1 week of usage to prevent dependance. Nasal sprays like Afrin, Nazolin and Kotrin belongs to this class.

TL;DR, nasal steroids are usually safe to use for long term, but do go back to your GP for adjustment of dosage when your allergic rhinitis symptoms are improving.

Regards,

Dr Seah Heap Yong

Dr Seah has provided a very good and comprehensive explanation of the two common types of nasal sprays for relief of blocked nose. Without being too repetitive, I would like to add the following points:

1. Nasal steroid sprays (e.g. Nasonex, Avamys, Nasacort, Dymista etc)

• Used mainly in the treatment of Rhinitis (Allergic or non allergic) and Sinusitis (sinus infections)
• Reduces nasal blockage, runny nose, postnasal drip and sneezing
• Works by reducing inflammation in the nasal cavity
• Takes time to work (up to 2weeks before optimal effect is seen)
• Has to be used daily (regardless of presence of nasal symptoms)
• Meant to be used long term (like for years if persistently exposed to the trigger)
• Many studies have shown that most of the newer steroid sprays has less than 0.5% absoprtion rate into the bloodstream. Hence the side effects in other organs are negligible. Some nasal steroid sprays are approved for use safely in children as young as 2 years old.

2. Nasal decongestant (e.g. Afrin, Iliadin, Otrivin, Nazolin etc)

• Used mainly for a cold or sinus infection
• Relieves nasal blockage/congestion
• Works by vasoconstriction (causing the blood vessels in the nose to constrict/"shrink")
• Works almost immediately. Because of this, many patients end up being "reliant" or "overused" it.
• Not meant to be used longer than 7-10 days or risk a troubling condition known as Rhinitis Medicantosa aka Rebound Rhinitis. Prolonged use of this medication will result in damage to the lining of the nasal cavity. This may result in more swelling and congestion in the nasal cavity in the long term.

Hope this helps and all the best!