WHEN SHOULD I WORRY ABOUT...

How Long Does Rebound Congestion Last? (& 5 More Questions About It, Answered)

March 8, 2022 - Katie McCallum

Do you have nasal congestion that won't go away? It might be time to consider how you're treating it.

If a nasal decongestant spray is a fixture in your medication lineup, it's important to know that using these sprays for more than three consecutive days can actually worsen your congestion.

"This side effect of nasal decongestant sprays is called rebound congestion," says Dr. Omar Ahmed, a Houston Methodist otolaryngologist specializing in nasal and sinus disorders. "It's something that's mentioned on the label, but I don't think it's emphasized enough."

Many people say that rebound congestion actually feels worse than the initial congestion that caused them to start using the spray in the first place.

"Additionally, if you're not aware of this side effect, you're likely to just keep using the spray to relieve the congestion that the spray is now causing," says Dr. Ahmed. "And this cycle can go on and on, sometimes for years."

What is rebound congestion exactly?

Nasal congestion itself occurs when illness, allergies or something else causes the blood vessels in your nasal passageways to become inflamed and swollen. The result is a "stuffy" nose.

"There are various types of decongestants available to help relieve congestion, and they do so by acting as a vasoconstrictor of these inflamed blood vessels, shrinking them to relieve the swelling and congestion so you can breathe easier," says Dr. Ahmed.

Rebound congestion, though, isn't your typical nasal congestion.

It's not brought on by allergies or an upper respiratory cold. Instead, the congestion is caused — worsened — by using nasal decongestant sprays for more than three days in a row.

"Since nasal decongestant sprays deliver the decongestant in a localized manner, these products relieve nasal congestion almost immediately," says Dr. Ahmed.

That's the great thing about these sprays. They provide congestion relief in just minutes.

Unfortunately, that's not where the story ends.

"With continued use of these sprays, however, the blood vessels in your nasal passageways become sensitized to their active ingredients," explains Dr. Ahmed. "Once your blood vessels come to expect the vasoconstriction provided by the spray, it has this paradoxical effect where, as the medication wears off, the blood vessels react by swelling back up — causing what's called rebound' congestion."

Dr. Ahmed notes, though, that the exact mechanism behind rebound congestion isn't actually very well understood, and that there are several other potential explanations for why it might occur.

Regardless, what's known for sure is that the blood vessels in your nose can become dependent on these sprays. And this can happen after just three days.

Which nasal sprays cause rebound congestion?

Nasal sprays containing either oxymetazoline or phenylephrine are the rebound congestion-inducing nasal sprays to use with caution.

If a nasal spray contains either of these active ingredients, be sure to use only as directed on the label — three days or less. Afrin is the recognizable name brand choice, but, with generic options available, be sure to check the active ingredients of any nasal spray you use.

Not every nasal spray carries a risk of rebound congestion, though.

"For instance, a nasal steroid spray containing fluticasone, like Flonase, can also help reduce nasal congestion and prolonged use doesn't cause rebound congestion," says Dr. Ahmed. "However, since steroid sprays aren't a direct decongestant, they don't provide the immediate relief that sprays containing oxymetazoline and phenylephrine bring."

Do oral decongestants cause rebound congestion, too?

As for the varieties of oxymetazoline or phenylephrin that are taken orally, such as Sudafed, Dr. Ahmed says there's little risk of rebound congestion.

"Rebound congestion seems to be limited to nasal decongestant sprays that deliver the active ingredients locally," says Dr. Ahmed. "Oral decongestants have other effects, though. For instance, they can raise your blood pressure and heart rate. But they don't seem to cause rebound congestion with prolonged use."

How long does rebound congestion last?

Once you have rebound congestion, the most important thing to know is that it won't go away as long as you keep using the spray.

And once you stop using the spray, the resulting congestion can take a week or longer to go away.

Lastly, depending on how long you've been using the spray, quitting cold turkey can be tough. Really tough. Many find the resulting severe congestion and headaches to be almost unbearable.

"Some people have been on these sprays for years and abruptly discontinuing them is very challenging," explains Dr. Ahmed. "In fact, many people can't tolerate it and actually need to be tapered off with a specific regimen."

How do you get rid of rebound congestion

If you've only been using a nasal decongestant spray for a week or so to deal with a head cold, the flu or COVID-19 and your rebound congestion is new, you may be able to quit a nasal decongestant spray without any problem.

If you've been using a spray for months or years, however, Dr. Ahmed recommends working with your doctor to form a plan to quit the spray.

"I actually give my patients a specific regimen to follow," says Dr. Ahmed. "I have them use the spray at night and in just one nostril only. In the meantime, I also have them start a nasal steroid spray, like Flonase, and use a saline spray to help keep the nose moist. Sometimes I also prescribe an oral steroid to help with the inflammation that comes with discontinuing the spray."

According to Dr. Ahmed, this whole process takes at least a week. By the end of it, though, you're off the nasal decongestant spray and the rebound congestion should be gone.

That doesn't always mean the original cause of your congestion is gone, though.

"Once you're off the decongestant spray, the immediate next question becomes: What caused you to start taking it in the first place?" asks Dr. Ahmed. "If you started using it to deal with a cold or some other upper respiratory virus, that's easy since the congestion is going to resolve on its own. But if something more complex is causing your congestion, we need to treat that root cause."

Other causes of congestion include:

  • Allergies
  • Chronic rhinitis
  • Chronic sinusitis
  • Deviated septum
  • Enlarged turbinates

"This is why it's so important to see an expert about chronic congestion and for help dealing with rebound congestion," adds Dr. Ahmed. "There are reason these things are happening, and we can help identify the underlying issue and fix it or approach it the most effective way."

Is the risk of rebound congestion a reason to avoid nasal decongestant sprays altogether?

When your nose is stuffed up, there's nothing like the immediate relief a decongestant spray can provide. But, with a side effect like worsening congestion, might these sprays be more harm than good?

"No," says Dr. Ahmed. "There's definitely a role for these decongestant sprays that contain oxymetazoline or phenylephrine, especially if you have a cold and you're really congested. I think the key is to make sure you look at the spray as a short-term solution, not a long-term one. Unfortunately, the labels don't really emphasize the risk of taking these products beyond three days, so knowing this in advance can help give you the upper hand."

Remember: Using a nasal decongestant spray for more than three days can actually worsen your congestion.

"I see these sprays as a great way to get a good night's sleep when your symptoms are really overwhelming and you need rest, especially considering that congestion is one of those symptoms that gets worse when you lay down," says Dr. Ahmed. "I don't mind you using a nasal decongestant spray at night for the two or three nights that your congestion is at its worst. After that, though, it's time to consider the other ways to relive it, such as oral decongestant, sinus rinses and nasal steroid sprays."

Plus, if your congestion is more chronic in nature, it's likely also time to consult a doctor about the root cause of your congestion and the best way to manage it.

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