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Nasal sprays for relieving congestion are a common and easily accessible solution that provides immediate relief for blocked breathing. However, few people realize that prolonged use can lead to dependence, turning a quick fix into a difficult habit to break. Many patients report being unable to breathe without these sprays and often need to use them multiple times during the night just to get some sleep.
Dr. Nimrod Amitai, a senior physician in the ear, nose and throat department and a nasal and sinus specialist at Rabin Medical Center (Beilinson Hospital), explains how dependence develops, the health risks of long-term use and how to quit and return to natural breathing.
"The only effective treatment is to stop completely, and that’s very difficult," Amitai says. "Imagine being told, ‘For the next week, you won’t be able to breathe through your nose,’ while the solution is right there in the form of the spray — and you have to resist using it."
An effective, immediate – and addictive – solution
Nasal sprays that contain decongestants — such as the well-known brand Otrivin — use the active ingredient xylometazoline, which works by constricting blood vessels in the nasal passages. This reduces nasal secretions and shrinks swollen tissues, allowing for quick relief from congestion.
These sprays are typically used for immediate relief when the nose is blocked due to a cold or rhinitis. Their fast-acting nature makes them a popular temporary solution for those struggling with nasal congestion.
"Many patients are unaware that using nasal sprays for more than six days is not recommended because their effectiveness decreases over time," Amitai explains. "Both the strength and duration of the decongestion effect diminish with prolonged use, leading to what is known as 'rebound congestion.' When the spray’s effect wears off, the nasal tissues swell even more, creating a cycle where users become increasingly reliant on the spray."
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According to Amitai, this worsening congestion results from prolonged exposure to the active ingredient, which causes a reduction in the number of receptors in the nasal blood vessels. As a result, users need more frequent doses to achieve the same relief. This condition, known as rhinitis medicamentosa (drug-induced nasal inflammation), leads to chronic congestion following long-term nasal spray use.
"One of the main signs of nasal spray dependence is the inability to breathe freely without it," Amitai says. "Patients experiencing dependence suffer from persistent congestion every time the spray’s effect fades and need to use it repeatedly to maintain open airways. Some report being unable to fall asleep without it and waking up several times a night to reapply the spray."
Hard to quit
Although nasal decongestant sprays act locally, long-term use can lead to dependence, which presents a significant health challenge. Quitting is particularly difficult because patients must stop using the spray entirely — even when the congestion feels unbearable. The easy availability of nasal sprays only makes the process more challenging.
"Every few months, I see patients who cannot quit on their own," Amitai says. "The most effective way to stop is an immediate and complete cessation — no gradual reduction. It’s a tough but necessary step to restore the nose’s natural function."
To ease the withdrawal process, Amitai suggests using steroid nasal sprays, which are not addictive. "These sprays can help reduce congestion during the withdrawal period, but they are only supportive — not a true solution," he adds.
In severe cases where patients cannot stop using nasal sprays, surgery may become necessary. "We perform a procedure called inferior turbinate reduction (turbinectomy)," Amitai explains. "It involves reducing the size of the swollen nasal tissues that block airflow due to prolonged spray use. This is not a full tissue removal, but a controlled reduction to restore normal breathing."
Public awareness and professional guidance
David Papo, chairman of the Israeli Pharmacists Association, emphasizes that, while nasal sprays provide quick relief, many users are unaware of the risks of prolonged use. "The more you use the spray, the more your nose becomes dependent on it, and the congestion worsens," he says. "Instead of providing relief, the spray creates a cycle of dependency, where users feel they cannot breathe without it."
Uncontrolled use of nasal sprays can also cause lasting damage. "Excessive use can harm the nasal lining, leading to chronic dryness, inflammation, and even structural changes to the tissues," according to Papo.
He urges the public to recognize that these products are meant for short-term use — typically no longer than three to five consecutive days — and not as a permanent solution. "If you suffer from persistent congestion, consult a doctor or pharmacist for safer alternatives," he advises. "Anyone using nasal sprays regularly should ask themselves if they genuinely need them or if they’ve developed a dependence — and seek professional help if necessary."