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Many nasal sprays are downright dependent
Cough, runny nose, hoarseness - it's winter, the cold wave rolls over the Hanseatic city and often the plagued nose is hopelessly blocked. So it makes sense to resort to soothing nasal spray - once spraying and the nose is reliably free for six to eight hours. But beware! With certain preparations it can come to habituation effects. The Apothekerkammer Bremen explains which drugs are in danger of becoming addicted, how the nose sprays are expressed and how patients escape from them or better not even develop them.
More than 10,000 liters of breathing air flow through our nostrils every day. The mucous membranes in them serve the immune defense: their cilia continuously carry viruses and bacteria to the outside to protect the organism. If an acute respiratory infection nevertheless develops, an increased production of the secretion in the nose begins to strengthen the immune defense, the mucous membranes swell and the nose is blocked. Here, decongestant nasal sprays relieve the respiratory tract reliably. The majority contains as active ingredients sympathomimetics such as xylometazoline, oxymetazoline or tramazoline. These substances bind to receptors of the blood vessels in the nasal mucosa and cause the blood vessels to constrict and the blood supply is reduced. In the direct consequence, the tissue swells and the patient can finally breathe freely again.
Nasal spray is widespread. (Image: matthias21 / fotolia.com) No general waiver necessary
Despite the danger of dependency, the Apothekerkammer Bremen does not advocate giving up nasal sprays altogether: "In acute infections, it is important to find enough sleep. This is well possible by decongestant nasal sprays. There is nothing wrong with the temporary use of these nasal sprays " Richard Klämbt, President of the Apothekerkammer Bremen. He recommends to use decongestant nasal sprays only for a limited time. "You should not use the spray more than two or three times a day. We strongly advise you not to use said nasal sprays for more than a week, ideally only five days, "said the President of the Chamber.
Once there is a dependency, the person has a permanently blocked nose, as the number of receptors decreases over time and more active ingredient is needed. This is called the rebound phenomenon. This makes the patients reach for the spray again and faster. Without the constant use of the remedy, the patient no longer gets air through his nose. This drug-induced cold is called rhinitis medicamentosa or privinism - named after the nasal spray "Privin", which has been used for decades..
According to estimates, 100,000 Germans are dependent on nasal spray. The consequences are chronic sinusitis, nosebleeds or tough secretions run down the throat. In addition, there is a risk that the constantly irritated mucous membranes dry out over time, whereby they can not fulfill their defensive function and increases the risk of a germ attack. The result may be a so-called rhinitis atrophicans, a "stink nose". Heavy dependence can also result in extreme degradation of the nasal mucosa with its vessels and glands. This is called atrophy. In cases of severe addiction it is possible that cartilage tissue may die as a result of the reduced blood flow leading to a hole in the nasal septum or a sagging nasal bridge.
Pathways from nose sprays
One possibility is to forego the spray for a week at a nostril and then to stop it completely. Also, using pure saline solutions is an option. The same effect occurs when sufferers of normal dosed down on children's nose spray with less active ingredient and finally use the previous so long alternating with seawater spray, until only this is sufficient. In severe cases, suffocation fears and mood swings may occur. "Patients who were once dependent on a cold have to do without xylometazoline-containing preparations, otherwise the habituation effect quickly sets in again and the addiction is there again," clarifies Klämbt.
A less than one-year-old dependency often leads to a stringent withdrawal: the affected person should be able to cope with a week without a nasal spray, and then the symptoms, such as laborious breathing, usually decline significantly. An elevated upper body during this time also makes sleeping easier. In severe cases, a doctor should be consulted. This can then prescribe cortisone-containing nasal sprays for weaning. Depending on the intensity of the addiction, weaning may take several days or weeks. In addition, at the same time limited antihistamines can be taken for relief.
To aid weaning, patients can use a nasal douche with salt water solution - this will reliably drain the nasal membranes for half an hour, which will be enough for many sufferers to fall asleep. "To prevent it, patients should always use the lowest dose they can get along with, such as pediatric ashes." Klämbt. The on-site pharmacy helps sufferers to select suitable products, both for the mild relief of nasal congestion and for weaning in case of nasal sprays. (Sb, pm)