Hooked on spray
* Doctors warn that fast-acting medicines hard to put down

By Jane Weaver jweaver@cecilwhig.com

As allergy season returns, some in the medical profession warn patients to use care in treating a stuffy nose.

An Elkton doctor who specializes in allergy treatments is noticing too many patients have an addiction to over-the-counter nasal decongestant sprays.

“There are many people that get addicted,” said Dr. Maher Nashed.

People suffering from nasal congestion can turn to one of several non-prescription sprays that bring instant relief. The medicines work very well for a few days.

But after that, Nashed said, they can turn on the user and create a vicious cycle of relief and congestion, with more spraying needed to get even briefer periods of relief.

Products such as Afrin and Neo-Synephrin contain a drug that shrinks swollen nasal tissues, allowing the user a period of free breathing. The active ingredient in them is either oxymetazoline or phenylepherine.

According to instructions on the package, the drug should only be used for three to four days. Beyond that, the user risks what is called rebound.

“When they get the rebound effect, they start using again,” Nashed said.

The spray can cause the nasal linings to swell up again. People stuffed up originally from allergies, a cold or sinusitis then find themselves needing more medication to breathe.

Doctors all over the country say the biggest problem in treating rebound is getting patients to admit they are using the sprays. Because the sprays are an over-the-counter remedy, patients often do not volunteer that information in a checkup.

Nashed asks his patients if they are using the over-the-counter sprays.

“If they come in with the nasal symptoms, I ask if they use the inhalers,” he said.

He has seen patients who have used the spray so much that they have done damage to their bodies. Holes in the septum are a common symptom.

“I have seen the breakdown of the cartilage,” he said.

Some doctors have reported seeing what looked like chemical burns in the nasal cavity of addicted users.

While the medical community debates whether this is a true addiction, Nashed is treating people who are struggling to break free.

“It’s a tough condition to treat,” he said. “It’s a really hard addiction.”

Nashed said he would give his patients a steroid treatment, such as Rhinocort or Flonase, which takes a few days to begin bringing relief.

“I add inhaled steroids to replace the over-the-counter medicine,” he said.

Weaning a user off the spray takes as long as a month, Nashed said.

A Connecticut company has developed a system it says will wean users off the spray with very little rebound. Rhinostat is a “dosage titration system,” according to company spokeswoman Lois Myers.

“It works like a nicotine patch for a nasal spray,” Myers said.

The kit includes two bottles of solution, one of which is the chemical component of the over-the-counter spray. The second is a bottle of saline. Myers said the kit allows the user to be “weaned comfortably from the spray.”

She said the key to successful treatment is to address what was causing the congestion in the first place.

“If the person has untreated allergies, they need to treat that, too,” she said.

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