Health Officials Update Rules on ‘Addictive’ Nasal Sprays

Understanding the Risks of Nasal Decongestant Sprays

Nasal decongestant sprays are commonly used to relieve blocked noses caused by allergies and colds. These products, available under well-known brands such as Vicks, Sudafed, and Otrivine, can be purchased for around £4 at high street pharmacies. They work by shrinking swollen blood vessels in the nose, which helps open airways and ease breathing in the short term.

However, the Medicines and Healthcare products Regulatory Agency (MHRA) has issued a warning that prolonged use of these sprays can lead to serious issues. The active ingredients in the sprays, including xylometazoline and oxymetazoline, can cause a condition known as ‘rebound congestion.’ This phenomenon occurs when the blood vessels become dependent on the medication, making congestion worse over time.

Rebound congestion can create a vicious cycle where patients rely more and more on the medication to breathe, and in some cases, develop a psychological addiction to the products. Medically referred to as rhinitis medicamentosa, this condition can affect anyone who overuses nasal sprays, leading to symptoms like irritation, runny nose, sneezing, and persistent congestion.

In severe cases, chronic swelling from overuse can result in breathing problems and even facial disfigurements, requiring surgical intervention. To prevent this, the MHRA is urging people not to use sprays containing xylometazoline and oxymetazoline for more than five days.

Updated Guidance and Public Awareness

The MHRA plans to update packaging and patient leaflets to reflect this guidance, although full implementation may take several months. In the meantime, officials are encouraging people to follow the advice now. Thao Huynh, head of respiratory imaging and critical care at the MHRA, emphasized that if a person’s nose remains blocked after five days of using a nasal spray, it could be due to overuse rather than the original symptoms.

“Continuing to use it could make the problem worse,” she said. “Instead, talk to a healthcare professional about stopping use of the product and whether alternative treatments could help.”

Professor Amira Guirguis, chief scientist at the Royal College of Pharmacy, added that clearer product information and improved packaging, alongside consistent public messaging, are essential to raise awareness that these products are for short-term use only and to avoid preventable harm.

The Broader Impact and Patient Stories

The MHRA’s warning comes shortly after the Royal Pharmaceutical Society (RPS) issued a similar caution regarding the sprays. Research found that nearly 60% of pharmacists believe patients are unaware they should not use these sprays long-term. Another study revealed that more than a fifth of adults who have used the sprays have done so for longer than a week, putting around 5.5 million people in the UK at risk of addiction.

In January, the RPS called for the risks of overusing these medications to be clearly labelled on packaging. Some patients have even advocated for these medications to be available by prescription only, allowing GPs to monitor and limit supply.

Charlotte Johnstone, a 30-year-old woman who started using nasal sprays at just seven years old, shared her experience with the issue. She described how, at the height of her 23-year battle, she was using the spray eight times a day. “I can’t sleep without having it, I wake up and the first thing I do is have my nasal spray,” she said.

Her addiction-related anxiety has led to nightmares about not being able to breathe, and she avoids places where access to the spray might be limited. After decades of use, she is concerned about the long-term effects on her health. “I go through stages of losing my sense of smell,” she said. “But for the sake of having a clear nose, and avoiding feeling claustrophobic, I’ll just take it.”

Available Treatments and Rehabilitation

Most patients who become addicted to nasal sprays can successfully wean themselves off the drug and suffer no long-term nasal damage, according to experts. However, others may need to use stronger, steroid-based sprays before symptoms improve.

Starting the rehabilitation process can be daunting, as Charlotte Johnstone explained. “Going cold turkey is very scary to think about. You’ve got to be really brave for that and I’d have to book a lot of time off work.”

She expressed shock at the number of people in similar situations and now wants to raise better awareness of the risks of overuse. Rebound congestion is specifically caused by excessive use of decongestant nasal sprays containing oxymetazoline and xylometazoline, rather than saline or steroid sprays.