Millions of Britons risk developing a dependency on nasal decongestant sprays, the UK’s medicines regulator has warned, as it issued fresh guidance limiting their use to a maximum of five consecutive days.
The Medicines and Healthcare products Regulatory Agency (MHRA) said products containing the active ingredients xylometazoline and oxymetazoline, widely available over the counter as sprays and drops for colds, allergies and sinusitis, should no longer be used for longer than five days. The new limit, based on advice from the Cardiovascular, Respiratory, Renal and Allergy Expert Advisory Group and the Pharmacovigilance Expert Advisory Group of the independent Commission on Human Medicines, replaces the previous seven-day limit recommended by the NHS and manufacturers.
The mechanics of rebound congestion
Prolonged use of these decongestants can trigger a condition known medically as rhinitis medicamentosa, or rebound congestion. The sprays work by constricting blood vessels in the nasal passages to reduce swelling. However, when used beyond a short period, they can deprive nasal tissues of necessary blood flow, causing inflammation that worsens as the medication wears off. Rather than providing continued relief, the medication begins to perpetuate the very problem it was designed to solve, creating a cycle that drives users to reach for the spray more frequently.
The condition is entirely avoidable when users stick to the five-day limit. Symptoms include persistent nasal blockage without an obvious trigger, worsening congestion that requires increased frequency and dosage of the spray, and a sensation that the spray no longer works effectively. The term “rebound congestion“ was first recorded in 1944, with “rhinitis medicamentosa” entering medical vocabulary two years later. The first diagnostic criteria were proposed in 1952.
In severe cases, rhinitis medicamentosa can lead to chronic nasal congestion and damage to nasal tissues. While generally reversible, more serious instances can result in longer-lasting changes to the nasal lining and structures, sometimes requiring surgical intervention. Treatment typically involves gradually reducing the use of the spray under the supervision of a healthcare professional. Recovery usually occurs within three months if the condition is recognised early. The Royal College of Pharmacy described it as a preventable ailment.
The scale of potential dependency is significant. An ITV News survey and Ipsos research found that more than one in five adults who had used these products did so for longer than seven days, translating to an estimated 5.5 million Britons who may have placed themselves at risk. Pharmacists have reported intervening in suspected cases of overuse, with nearly three-quarters believing packaging needs to be clearer about usage limits.
Packaging changes and interim advice
Manufacturers will update all packaging and accompanying leaflets to include the five-day warning. The MHRA acknowledged that this process will take several months to complete. In the meantime, consumers are advised to follow the new guidance immediately rather than waiting for updated products to reach shelves.
Thao Huynh, head of respiratory imaging and critical care at the MHRA, said: “If your nose is still blocked after five days of using a nasal spray, it could be caused by overuse of the product, rather than your original symptoms.” He urged those with persistent congestion to consult a healthcare professional about discontinuing use and exploring alternative treatments.
The Royal College of Pharmacy has endorsed the regulatory intervention. Professor Amira Guirguis, its chief scientist, said: “We support clearer product information and improved packaging, alongside consistent public messaging, to improve awareness that these products are for short-term use only and to avoid preventable harm.”
Repeated use of these decongestants can also lead to tachyphylaxis, a rapid reduction in the medicine’s effectiveness. Additionally, the preservative benzalkonium chloride (BKC), found in some nasal preparations, may exacerbate rhinitis medicamentosa.
For those seeking alternatives, several options are available. Saline nasal sprays are medication-free and can help loosen mucus and moisturise nasal passages without causing rebound congestion. Corticosteroid nasal sprays, such as fluticasone propionate, reduce inflammation and are not habit-forming or addictive, often used to help patients wean off decongestant sprays. Other options include antihistamines for allergy-related congestion, oral decongestants like pseudoephedrine, steam inhalation, humidifiers and warm compresses.
The MHRA emphasised that these decongestants remain safe and effective when used as directed. Consumers are encouraged to read the information leaflets and guidance printed on the outer packaging.