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Afrin vs Flonase: How to Avoid Nasal Spray Addiction?

Last Updated: January 13, 2022

Authored by Roger Weiss, MD

Reviewed by Tania Kelly

Nasal sprays are over-the-counter medicines that are used locally to relieve symptoms of nasal congestion and allergic rhinitis. Nasal spray addiction is not a true physiological or psychological addiction, unlike inhalant addiction and abuse. One does not crave the use of medicine for its rewarding effects. It works differently than normal addiction and has a unique mechanism. Nasal spray addiction is mainly the result of rebound congestion which is severe congestion of nose mucosa when the use of spray is discontinued and the person feels the need to use it more often and for a longer than recommended period. It is also known as rhinitis medicamentosa and accounts for 9% of patients using decongestants. Regardless of whether it is a true addiction or not, for instance Flonase overuse and Afrin addiction have their own set of side effects that are avoidable by the recommendations of the health professional.

How Does Nasal Spray Work?

These are common medicines and most of them are available over the counter. So, how does nasal spray work? Whenever nose mucosa contracts a virus, bacteria, or any foreign particle that can cause allergies, it has a sudden inflammatory action. It comprises vasodilation of mucosa which causes inflammation and congestion. Nasal sprays are topical medicine and whether they contain steroids, saline, or decongestants, they work in the same way. They narrow the blood vessels in the nose or impede the underlying mechanism leading to inflammation which reduces the inflammation and provides congestion relief by allowing more air to pass.

Types Of Nasal Sprays

Nasal sprays are of different types which have different mechanisms but have the same effect- decreasing nose stuffiness. It is important to have proper information about what different types of these medicines have as active ingredients and if they can cause addiction to nasal sprays.

The Most Common OTC Nasal Sprays Are:

  • Saline (Xlear, Arm and Hammer Simply Saline)
  • Steroids (Flonase)
  • Xylometazoline (Afrin)
  • Pseudoephedrine (Astepro)

Some of these are completely harmless and do not cause rebound congestion while others have some side effects with prolonged use. For instance, Afrin addiction can cause adverse effects which may need additional medical treatment or surgical interventions to restore the normal mucosa. Read more about different types of decongestants and explore which ingredients can cause nasal spray addiction and which are without any significant side effects.

A sick woman looks at nasal spray in her hand over yellow background.

Nasal Spray for Congestion

Afrin is the most commonly used Nasal spray for congestion. It has Oxymetazoline as an active ingredient which is recommended by doctors as an effective decongestant. However, it has the potential to cause nasal spray addiction over prolonged use. Afrin works by constricting the blood vessels in nose mucosa thus restricting the flow of inflammatory substances and stuffiness due to increased blood flow. Over time, blood vessels become accustomed to a certain amount of xylometazoline to remain in normal form.

In turn, when one stops using Afrin, it causes rebound congestion. This means increased vasodilation of arteries in the nose and increased blood flow which worsens the signs of congestion. It causes Afrin addiction meaning one feels the need to use it for longer than the recommended time simply because congestions worsen upon discontinuation. Afrin addiction can have potential side effects. It can cause thickening of the nose walls which is known as turbinate hypertrophy. It can lead to blocking of the nose and ultimately congestion. Furthermore, nasal spray for congestion causes cilia in the nose to function abnormally which causes sinusitis, that is inflammation of neighboring sinuses. Sometimes, these effects of inhalants resolve on their own when the medication use is discontinued for a long time but in some severe cases, one may need medicines or surgery to return the nose to its normal structure. This is why it is important to use the nasal spray for congestion two times a day for no more than 3 days at a time.

Saline Nasal Spray

They are non-toxic medications. There are no registered saline nasal spray side effects. They are basically a mix of distilled water and salt in a perfect quantity to clean mucus and inflammatory substances from the nose and have a decongestant effect. Addiction to them is not common and they have the least tendency for rebound congestion. There are no studies reporting saline nasal spray side effects, that’s why they are available over the counter and are perfect for quick relief. Due to their safe usage and efficacy, there are no reported saline nasal spray side effects. Saline nasal spray alternatives  include a simple solution of distilled water and salt made at home.

Steroid Nasal Spray

Steroid medications are known for reducing inflammation. As congestion is the result of a series of events leading to the increased blood supply to nose mucosa and inflammation that cause symptoms of congestion, steroids are the perfect group to ease those symptoms. The active ingredient is a corticosteroid which is a powerful anti-inflammatory substance and relieves inflammation caused by overactive immune symptoms. It is also helpful in treating skin allergies and hay fever.

They typically start working after a week of use, so most people tend to use them during the whole allergy season to ensure a clear nose and comfort. One usually needs a prescription for them as they have potential side effects with prolonged use. Steroid nasal spray side effects prolonged use are nose bleed, headache, cataract, and fungal infection due to decreased immunological reaction. These symptoms are profound in people using them for months. This is why it is important to consult the doctor and get proper information. Medical assistance is also pivotal for people who abuse inhalants, and are involved in petrol sniffing or huffing other vapours, such as for example whip its drugs.

Allergies Nasal Spray

People use allergies nasal spray which has antihistamines. Antihistamines in allergies nasal spray block the release of histamine from mast cells. Histamine is the main chemical responsible for starting the inflammatory cascade and causing congestion, sneezing, runny nose, and other allergy symptoms. Some people opt for oral medicines while others opt for topical antihistamines for quick relief. Antihistamines such as cromolyn sodium do not cause rebound congestion and can be used by all above 2 years of age on the doctor’s recommendation. There is no known side effect of allergies nasal spray and they are available over the counter.

Afrin vs Flonase: Are These Nasal Sprays Addictive?

Afrin is a nasal decongestant while Flonase has corticosteroid as an active ingredient. Afrin (xylometazoline) has more addiction risk as compared to Flonase overuse because it can cause rebound congestion. It means once the effect of xylometazoline wears off, rebound vasodilation can worsen the congestion symptoms, and nasal spray side effects prolonged use can even cause deformity in the normal nasal mucosa. It works within 12 hours and can cause temporary stinginess and a burning sensation.

On the other hand, Flonase is a safe, non-addicting substance that is the first-line treatment for allergies. Flonase overuse doesn’t cause rebound congestion but it has to be used for a long period for it to work properly. However, Flonase overuse can increase the risk of a nosebleed and infections especially if paired up with any other health conditions like diabetes or any bleeding disorder. a

A medical worker holds nasal spray in her hand over white background.

How to Use Afrin Without Rebound?

To use Afrin without rebound, remember to use it for no more than 3 days and in minimal doses. Preferably no more than two doses per day. Afrin dose can last 12 hours, so 2 doses are enough to cover a 24 hours day without causing rebound. If rebound congestion occurs, stop the usage immediately and contact a health professional for more information and change to prescription medicine. Rebound is mainly associated with OTC medicines so using a prescription drug can prevent rebound.

How to Address Problems With Long-Term Use of Flonase?

Long-term use of Flonase can cause bleeding tendencies, infections, cataracts, and dryness especially if used for a long time. They usually don’t need any special medical intervention. If symptoms persist, one should stop taking Flonase and shift to some other prescription medications and these symptoms should settle on their own. In case of fungal infection, seek medical help and get a prescription for topical antifungals. It is important to contact a health professional in case of severe symptoms.

How to Avoid Nasal Spray Addiction?

Addiction to inhalants is a serious problem that can result in short and long term side effects on the body systems. For example, some may wonder what does sniffing glue do to you? Others may reflect on what is huffing paint? While nasal spray addiction is not like other inhalant addictions, it is also dangerous and one should look for a nasal spray addiction cure if they see their loved ones with prolonged use of these sprays. They can cause rebound congestion, turbinate hypertrophy, bleeding, and infections if not managed properly.

This Addiction Is Easily Avoided by Using Just a Few Recommendations, so Use:

  • medications as recommended by professionals and if congestion gets worse after discontinuing, seek help and nasal spray addiction cure
  • nasals spray alternatives like saline solution and steam with herbs
  • a neti pot to flush out mucus and inflammatory substances
  • antihistamines to minimize the risk of rebound congestion. One can use them more frequently and may take them orally if desired

Drug rehabilitation centers can provide the best professionals nasal spray addiction cure along with managing addiction for other inhalants like glue, gasoline, paints, and duster drugs. Contact professionals to treat addictions in the best possible way with full health management.

Frequently Asked Questions

Is Nasal Spray Bad for You?

No, the nasal spray is not bad for you if used according to the recommended dose and at the recommended time. If used for a prolonged time, it can cause certain side effects like mucosal hypertrophy and tendency to bleeding.

Is Afrin Addictive?

Yes, Afrin can cause addiction-like symptoms. Afrin does not cause true addiction but it can worsen congestion if discontinued. That’s why some people feel the need to use it more and more and for a long time.

Is Flonase Addictive?

No, Flonase is not addictive. It does not cause rebound congestion and therefore people don’t feel the need to use it again and again. Some people may abuse it in conditions of chronic congestion.

Is Saline Nasal Spray Safe?

Yes, saline Nasal sprays are safe and recommended by doctors as a safer alternative. They have no known reported side effects. They are even available in general stores in addition to the pharmacies.

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Page Sources

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Published on: January 13th, 2022

Updated on: January 13th, 2022

About Author

Roger Weiss, MD

Dr. Roger Weiss is a practicing mental health specialist at the hospital. Dr. Weiss combines his clinical practice and medical writing career since 2009. Apart from these activities, Dr. Weiss also delivers lectures for youth, former addicts, and everyone interested in topics such as substance abuse and treatment.

Medically Reviewed by

Tania Kelly

Tania Kelly, author of Keep Calm and Treat Addiction is a credentialed Mental Health Nurse and Tobacco Treatment Specialist, passionate about addiction recovery. As a senior clinician, Tania constantly shares the concepts outlined in her book with health service providers, aiming to demystify addiction treatment and equip others in evidence-based practice.