Does Rhinitis medicamentosa (rebound congestion to topical decongestants) exist
Rhinitis medicamentosa (RM) or rebound nasal congestion has been
attributed to extended use of topical nasal decongestants (e.g.,
oxymetazoline phenylephrine, xylometazoline, and naphazoline nasal sprays.
These nasal sprays are commonly used (and purchased over the counter in
many countries) for nasal congestion (and rhinitis) due to the common cold
or allergic rhinitis. Medical students and pharmacy students are told that
these medications should be used for short periods e.g. 3 day.
Manufacturers recommendations are that topical decongestants should not be
used regularly for more than 1 week in view of the risk of rebound mucosal
hyperaemia with persistent nasal obstruction and refractoriness to further
effects of decongestants.(1) None of this data on RM comes from
randomised trials. The trial data found no such problem. In a trial of
adults given xylometazoline 1.0 mg/ml and 0.5 mg/ml three times daily and
given up to one week there was no evidence of RM. A similar finding was
reported in another study of the common cold using xylometazoline 0.1%
three times for seven days.(2) In a group of patients with perennial
allergic rhinitis adult patients were given oxymetazoline 0.05% two puffs
daily for four weeks and there were no cases of RM.(3) This information
casts doubt on the existence of RM at least in adults with prolonged use
of nasal decongestants.
1. Watanabe H, Foo TH, Djazaer IB, Duncombe P, Mackay IS, Durham SR.
Oxymetazoline nasal spray three times daily for four weeks in normal
subjects is not associated with rebound congestion or tachyphylaxis.
Rhinology 2003;41:167-74.
2. Eccles R, Eriksson M, Garreffa S, Chen SC. The nasal decongestant
effect of xylometazoline in the common cold. Am j Rhinol 2008;22:491-6.
3. Baroody FM, Brown D, Gavanescu L, DeTineo M, Naclerio RM.
Oxymetazoline adds to the effectiveness of fluticasone furoate in the
treatment of perennial allergic rhinitis. J Allergy Clin Immunol
2011;127(4):927-34.
Rapid Response:
Does Rhinitis medicamentosa (rebound congestion to topical decongestants) exist
Rhinitis medicamentosa (RM) or rebound nasal congestion has been
attributed to extended use of topical nasal decongestants (e.g.,
oxymetazoline phenylephrine, xylometazoline, and naphazoline nasal sprays.
These nasal sprays are commonly used (and purchased over the counter in
many countries) for nasal congestion (and rhinitis) due to the common cold
or allergic rhinitis. Medical students and pharmacy students are told that
these medications should be used for short periods e.g. 3 day.
Manufacturers recommendations are that topical decongestants should not be
used regularly for more than 1 week in view of the risk of rebound mucosal
hyperaemia with persistent nasal obstruction and refractoriness to further
effects of decongestants.(1) None of this data on RM comes from
randomised trials. The trial data found no such problem. In a trial of
adults given xylometazoline 1.0 mg/ml and 0.5 mg/ml three times daily and
given up to one week there was no evidence of RM. A similar finding was
reported in another study of the common cold using xylometazoline 0.1%
three times for seven days.(2) In a group of patients with perennial
allergic rhinitis adult patients were given oxymetazoline 0.05% two puffs
daily for four weeks and there were no cases of RM.(3) This information
casts doubt on the existence of RM at least in adults with prolonged use
of nasal decongestants.
1. Watanabe H, Foo TH, Djazaer IB, Duncombe P, Mackay IS, Durham SR.
Oxymetazoline nasal spray three times daily for four weeks in normal
subjects is not associated with rebound congestion or tachyphylaxis.
Rhinology 2003;41:167-74.
2. Eccles R, Eriksson M, Garreffa S, Chen SC. The nasal decongestant
effect of xylometazoline in the common cold. Am j Rhinol 2008;22:491-6.
3. Baroody FM, Brown D, Gavanescu L, DeTineo M, Naclerio RM.
Oxymetazoline adds to the effectiveness of fluticasone furoate in the
treatment of perennial allergic rhinitis. J Allergy Clin Immunol
2011;127(4):927-34.
Competing interests: No competing interests