Nasal Sprays for Rhinitis

Nasal sprays: Get relief but get hooked too?
Tessa Wong
14 March 2007
Straits Times

"Available without a prescription, they clear blocked noses instantly, but can cause addiction
NASAL sprays gave Ms Shu Lee blessed relief from a chronically stuffed nose, but being able to breathe freely came at a shocking price. She became addicted to these sprays.

A polyclinic doctor had recommended them to alleviate her lifelong nasal problem. Available without a prescription and costing only $10 a bottle, they seemed an obvious option. The effect was dramatic.

'This wonder drug helped me breathe properly for the first time in my life,' said Ms Lee, a 27-year-old advertising executive.

The spray relieves blocked noses instantly - but only temporarily - using a highly addictive chemical compound called oxymetazoline, the main ingredient in popular brands Afrin and Iliadin. When its effect wanes, it causes rebound congestion so users must inhale more to get relief, hence developing a dependency.

Ms Lee was soon inhaling four times a day - twice the maximum recommended dose.
And although the label said the spray must not be used more than three days in a row, she progressed to buying a bottle every month.

'I took it everywhere I went,' she said, adding that in the three years she was addicted to it, she spent more than $350 on her habit.

Experts estimate that at least half the 800,000 Singaporeans who suffer from chronic nasal congestion have been dependent on these sprays at some point. Extreme dependencies may even require surgery to cut away or shrink swollen nasal tissue. Severe addiction, which may cause side effects such as paranoid psychosis, is estimated to affect 1 per cent of patients getting ear, nose and throat (ENT) treatments. But doctors say the real numbers could be far higher, as many people are unaware that they are addicted.

ENT specialist Adrian Saurajen, who is based at Mount Elizabeth Medical Centre, said: 'When nasal sprays are used continuously for more than a week, they can cause dependency.'

Reported cases are rare here, but there is concern because Singapore has the highest incidence of allergies in the world, said ENT specialist Gerard Chee, of the G H Chee Ear Nose Throat and Dizziness Centre.

Ms Lee went cold turkey when she realised the extent of her addiction, going through 'two months of sheer agony and three months of discomfort' before she got over it.

'I had sleepless nights from the congestion. Sometimes I couldn't breathe through my nose even in the daytime,' she said.

That was more than four years ago.

Since then, her sense of smell and taste has largely returned, and - oddly enough - she does not suffer from nasal congestion any more.

'I'm just glad I kicked the habit,' she said.
twong@sph.com.sg

Double-edged

THE spray relieves blocked noses instantly - but only temporarily - using a highly addictive chemical compound called oxymetazoline, the main ingredient in popular brands Afrin and Iliadin.

When its effect wanes, it causes rebound congestion, so users must inhale more to get relief, hence developing a dependency. "

I personally feel that the report could be worded better with some sensitivity - not because I support any drug industry, but rather use of words such as "addicted" can really hurt a person's life.

Let's say if the person's family members are not very well-informed and they jump at catchwords thrown to them by the media such as the word "addicted" especially when they are connected with the word "drugs" - imagine the chaos that can result. This may sound extreme but then a person's life may just fall apart when they are ostracised on par with heroin due to people who jump at certain catch words instead of seeing the whole picture.

These are the products containing oxymetazoline in Singapore:

AFRIN NASAL SPRAY 0.05%
ILIADIN SOLUTION 0.025%
ILIADIN SOLUTION 0.05%
ILIADIN SOLUTION FOR NOSE 0.01%
ILIADIN SPRAY 0.05%
KOTRIN NASAL SPRAY 0.05%
NAZOLIN NASAL SPRAY 0.05%
OXAZOLINE NASAL DROPS 0.05% w/v
OXY-NASE NASAL DROPS 0.025%
OXY-NASE NASAL DROPS 0.05%

A lot of these products can be sold anywhere and bought anywhere, take for example Afrin Nasal Spray - note that it is GSL (General Sales List) - even your Chinese Medicine Hall can stock it for sale.

Oxymetazoline and ephedrine sprays are examples of decongestants and these are not meant for long - term usage. They should be used max for 3 days with a break of few days in between (drug holiday). If this spray (under normal dosing), it's time to see doctor as it could be something more serious and need long-term treatment or alternative forms of treatment.

Miss Shu Lee's case is a case of treatment failure. She should have followed up with a doctor or pharmacist instead of going on her own accord to overdose herself with oxymetazoline. It is not advisable to use the decongestant sprays for so long. The relief from such sprays is only temporary - in some practices, these sprays are used to unblock the nose before applying other sprays for long-term use such as corticosteroids, beclomethasone, mometasone and fluticasone.

If she returns to her doctor, she may be directed to use a corticosteroidal spray that may cost more but with a better safety profile. These sprays are also used prophylatically so you won't have much of sudden onset of nasal blockage.

The doctor may order some lab tests to check whether she has certain allergies - in this way she will know what triggers to avoid. X-rays and CT scans may also be warranted if the blockage is very often - to check for anatomical problems where surgies may be carried out.

Non-pharmacologic methods to help includes using inhalation and maintaining a clean sleeping or working or home environment. Some people get nasal blockage at certain places - work, home or school but as soon as they leave, the blockage stops. This may be due to the aircondition of the place and may mean that the aircon need cleaning. The same thing applies if the person wakes up with a blocked nose - he/she may want to change and/or clean the bedsheets and mattress as well as pillows - these may be due to dust mite allergies. Mites from different regions give different allergy profiles - when you travel overseas (even to dusty places), you may realise that you may not get the stiffles despite the dust.