Revisiting Rhinitis Medicamentosa: Examining the Evidence on Topical Nasal Decongestants

Area of Science:

• Pharmacology
• Otolaryngology
• Evidence-based Medicine

Background:

• Over-the-counter topical nasal decongestants offer temporary relief for nasal congestion.
• Potential for rhinitis medicamentosa (RM) or rebound congestion (RC) limits their use, despite unclear clinical occurrence.
• Uncertainty exists regarding the onset and prevalence of RM/RC with these treatments.

Purpose of the Study:

• To investigate the clinical occurrence and onset of RM, RC, or tolerance with topical nasal decongestants.
• To inform evidence-based recommendations for pharmacists regarding nasal decongestant use.
• To ensure patients do not avoid potentially beneficial treatments due to safety concerns.

Main Methods:

• A comprehensive literature search was performed using ProQuest to identify relevant studies.
• Evidence synthesis focused on RM, RC, or tolerance associated with nasal decongestant sprays and drops.
• Clinical perspectives were incorporated from a respiratory specialist and a community pharmacist.

Main Results:

• Eighteen articles, including 13 studies on oxymetazoline and five on xylometazoline, were assessed.
• No evidence of RM or RC was found after 7 days of oxymetazoline or 10 days of xylometazoline use at recommended doses.
• Well-designed studies indicated no RM, RC, or tolerance with up to 4 weeks of oxymetazoline use.

Conclusions:

• Oxymetazoline and xylometazoline are effective and safe for rapid nasal congestion relief.
• Short-term use at recommended doses shows no evidence of RM, RC, or tolerance.
• Pharmacists are crucial in counseling patients on appropriate use and duration to prevent overuse.