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Medical professionals are cautioning about the escalating number of individuals becoming dependent on nasal decongestant sprays, an issue that can sometimes lead to concerning facial disfigurements. These readily available remedies, often costing under £4 in pharmacies and supermarkets, are frequently used for quick relief from a blocked nose. However, prolonged usage beyond a week can irritate the delicate blood vessels within the nasal passages, inducing inflammation. This reaction exacerbates congestion, creating a harmful cycle where individuals become increasingly reliant on the medication to facilitate breathing. In severe instances, some patients require surgical intervention to rectify the damage resulting from persistent swelling, which can result in visible scarring. Consequently, those affected are advocating for these medications, including brands like Sudafed, to be reclassified as prescription-only, enabling General Practitioners (GPs) to control their availability.
The Rising Concern of Nasal Spray Dependence
Professor Claire Hopkins, a distinguished Ear, Nose, and Throat (ENT) surgeon, rhinologist, and sinus specialist at OneWelbeck in London, confirms that this issue is a frequent observation in her practice. “It’s likely becoming more prevalent as patient access to healthcare diminishes,” she stated in an interview with ITV. “We are aware of the challenges patients face in securing appointments in primary care or ENT clinics. Consequently, they are more inclined to resort to over-the-counter treatments.”
Patient Testimonies of Nasal Spray Addiction
Curtis Arnold-Harmer from Hastings is one such patient caught in a pattern of what he describes as ‘addiction’. He recently shared with ITV that at the peak of his 18-month reliance on Sudafed, he was using the spray every hour. “If I didn’t use the spray, I couldn’t breathe. It was that straightforward,” he explained. In a TikTok video, viewed nearly 2 million times, Mr. Arnold-Harmer recounted that medical professionals, upon examining his nose, were so alarmed by the extent of the damage that they initially suspected cocaine misuse.
Surgical Intervention and Long-Term Consequences
Ultimately, Mr. Arnold-Harmer underwent a turbinate reduction, a surgical procedure designed to reduce the size of the turbinates, internal nasal structures. These structures had become inflamed and enlarged due to prolonged nasal decongestant spray use, leading to his persistent nasal congestion. While the surgery has provided respite, Mr. Arnold-Harmer will need to undergo this procedure every five to ten years for the remainder of his life.
Mr. Arnold-Harmer expressed surprise at the numerous social media users recounting comparable experiences. “I anticipated a few comments on my video labeling me an idiot for not reading the instructions. However, I was unprepared for the tens of thousands of comments from individuals in the same predicament as me.”
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- One user commented: ‘I’m addicted to Sudafed nasal spray; how do I stop? I use it every morning, afternoon, and night.’
- Another added: ‘The same happened to me. I developed pregnancy rhinitis and became dependent on Sudafed for two years!’
- A further comment read: ‘It’s not just upon waking anymore; it’s every single day, every hour… I’ve been doing this for six years.’
Hannah Brumpton, from Lincoln, is another patient who required surgery due to developing a dependency on decongestant sprays. She described the condition as causing an almost intense level of discomfort. “It felt so heavy in my face—not just my nose, but all under my eyes. They felt completely swollen,” she recounted. “The only way I could describe it is that I constantly felt the urge to either punch myself in the face or tear my nose off.”
Georgia Hardacre, from Fleetwood, Lancashire, also detailed her decade-long reliance on decongestant sprays. “It’s awful,” she said. “You constantly feel stifled. I get severe headaches if I don’t relieve the blockage.”
Calls for Prescription-Only Status
Mr. Arnold-Harmer has initiated a petition urging Members of Parliament (MPs) to take action and implement controls on the sale of these medications. Prof. Hopkins noted that the risk of serious harm requiring surgery from prolonged spray use is low. She emphasized that most patients can successfully discontinue the medication and avoid long-term nasal damage. Medical professionals have also offered advice on methods to reduce the use of such products.
As nasal decongestant sprays are available over the counter, the precise number of regular users—and hence those at risk of rebound congestion—remains unknown.
Understanding Rebound Congestion (Rhinitis Medicamentosa)
Rebound congestion, medically termed rhinitis medicamentosa, is exclusively triggered by the overuse of decongestant nasal sprays containing oxymetazoline and xylometazoline, not saline or steroid sprays. A spokesperson for Kenvue, the manufacturer of Sudafed, stated: “Patient safety is our utmost concern, and we treat reports of product misuse with the utmost seriousness. SUDAFED® Blocked Nose Spray (xylometazoline hydrochloride) is designed for brief use only and should not be used consistently for more than seven days, as explicitly stated on the product labeling and in the patient information leaflet. To ensure the safe and correct use of over-the-counter medicines, always adhere to the instructions on the label and consult your GP or pharmacist for guidance.”
PAGB, the industry body representing manufacturers of branded over-the-counter medicines in the UK, added: “As over-the-counter medications, nasal decongestants are intended for temporary symptom alleviation, and product packaging and patient information leaflets clearly state that they should not be used continuously for longer than seven days. These medicines should only be taken as needed and not beyond the recommended duration specified on the product packaging and patient information leaflet. The patient information leaflet, included with all nasal decongestant sprays, details the risks associated with prolonged use beyond the intended duration.”
Precedent for Prescription-Only Regulations
Certain over-the-counter medications have already been reclassified as prescription-only due to concerns about potential public health risks. Last year, cough syrups containing codeine were made prescription-only over fears of individuals developing dependencies on the potent opiate component. There have also been calls to restrict the availability of other codeine products, like tablets, to prescription only.
However, mildest formulations of codeine—combined with analgesics like paracetamol, aspirin, or ibuprofen—remain available over the counter. Experts caution that even these reduced doses can produce an intoxicating effect, carrying a continued risk of misuse. Approximately 25 countries, including Germany, Japan, and the US, have already prohibited over-the-counter codeine sales. One product withdrawn from UK shelves by regulators in 2023 was common cold and influenza treatments containing pholcodine, following findings that they increased the likelihood of severe allergic reactions among patients undergoing general anesthesia.