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Nasal spray: Caution, risk of addiction! Use certain preparations only for a short time
Cough, runny nose, hoarseness - it is winter, the cold wave rolls over the Hanseatic city and often the plagued nose is hopelessly blocked. So it makes sense to use the soothing nasal spray - spray once and the nose is reliably free for six to eight hours. But be careful! With certain preparations, habituation effects can occur. The Bremen Chamber of Pharmacists explains which active substances are at risk of dependency, how nasal spray addiction manifests itself and how patients escape it or, better yet, do not develop it at all.
More than 10,000 liters of breathing air flow through our nose every day. The mucous membranes in it serve to protect the immune system: their cilia remove viruses and bacteria continuously to protect the organism. If an acute infection of the respiratory tract nevertheless occurs, increased secretion production in the nose begins to strengthen the immune system, the mucous membranes swell and the nose is blocked. Here decongestant nasal sprays reliably clear the airways. The majority contain sympathomimetics as active ingredients, such as xylometazoline, oxymetazoline or tramazoline. These substances bind to receptors of the blood vessels in the nasal mucosa and cause the blood vessels to narrow and the blood supply to be reduced. As a direct result, the tissue swells and the patient can finally breathe freely again.
No general waiver is necessary
Despite the risk of dependency, the Bremen Chamber of Pharmacists does not recommend generally avoiding nasal sprays: “In acute infections, it is important to find adequate sleep. This is easily possible with decongestant nasal sprays. There is no objection to the temporary use of these nasal sprays, ”explains Dr. Richard Klämbt, President of the Bremen Chamber of Pharmacists. He recommends using decongestant nasal sprays only for a limited time. “You shouldn't use the spray more than two or three times a day. We strongly advise you not to use the nasal sprays for more than a week, ideally only five days, ”said the Chamber President.
Once there is a dependency, the person affected has a permanently blocked nose because the number of receptors decreases over time and more active substance is required. Here one speaks of the rebound phenomenon. This allows the patient to use the spray again and faster. Without the constant use of the medicine, the patient can no longer get air through the nose. This drug-induced runny nose is known as rhinitis medicamentosa or privinism - named after the nasal spray "Privin" that has been used for decades.
It is estimated that 100,000 Germans are dependent on nasal spray. The consequences are chronic sinusitis, nosebleeds or viscous secretions running down the throat. In addition, there is a risk that the constantly irritated mucous membranes will dry out over time, which means that they will not be able to perform their defense function and the risk of a germ infestation will increase. This can result in a so-called rhinitis atrophicans, a "stink nose". A strong dependency can also result in the extreme breakdown of the nasal mucosa with its vessels and glands. This is called atrophy. In cases of severe addiction it is possible that cartilage tissue dies as a result of the reduced blood flow, which can lead to a hole in the nasal septum or a sagging bridge of the nose.
Ways out of nasal spray addiction
One option is to do without the spray for only one nostril for a week and then stop using it entirely. Using pure saline is also an option. The same effect arises when those affected dose down from normal to children's nasal spray with less active ingredient and then use the previous one in alternation with sea water spray until only this is sufficient. In severe cases, fear of suffocation and mood swings when weaning may occur. "Patients who were once dependent first have to get by without a preparation containing xylometazoline if they have a cold, otherwise the habituation effect will set in again quickly and the dependency will be there again," explains Klämbt.
With a dependency lasting less than a year, a stringent withdrawal often works: the person concerned should survive a week without nasal spray, then the symptoms, such as difficult breathing, usually already decrease significantly. Raising the upper body during this time also makes sleeping easier. In severe cases, a doctor should be consulted. The doctor can then prescribe nasal sprays containing cortisone for weaning. Depending on the intensity of the addiction, weaning can take several days or weeks. In addition, limited antihistamines can be taken at the same time for relief.
In order to support weaning, patients can use a nasal douche with salt water solution - this allows the nasal mucous membranes to swell reliably for half an hour, which is enough for many people to fall asleep. "To prevent this, patients should always use the lowest dose they can get by, for example children's nasal spray," says Dr. Slaves. The local pharmacy helps sufferers with the appropriate selection of preparations, both for the gentle relief of the nasal congestion and for weaning in the event of nasal spray addiction. (sb, pm)