Decongestants

Decongestants can be used for short periods for an acute infective rhinitis or to prevent barotrauma when flying. They should not be used long-term because they rapidly cause a rebound congestion which can become chronic, 'rhinitis medicamentosa'.

Note that with nasal decongestant sprays and drops containing xylometazoline hydrochloride / oxymetazoline hydrochloride, there is an increased risk of rebound congestion, rhinitis medicamentosa, and tachyphylaxis with overuse (1):

• have been reports of worsening nasal congestion when the effects of nasal decongestant sprays or drops containing xylometazoline hydrochloride and oxymetazoline hydrochloride, wear off
  • typically occurs when these medicines are used for longer than recommended
• patients and caregivers should be informed not to exceed the recommended dose and not to use for more than 5 consecutive days
• medical advice should be sought if symptoms of nasal congestion persist, worsen or do not improve after 5 days, as alternative treatment may be required

Wang et al noted (2):

• among various forms of decongestants, nasal sprays are the most preferable due to their extensive distribution in the nasal mucosa, rapid onset, and high safety
  • nasal sprays
    • are not easy to swallow, because they do not flow
    • are absorbed in the upper respiratory tract
    • rare inhalation into the lungs can avoid systemic adverse events
  • nasal droplets
    • may flow into the hypopharynx and, if swallowed, can cause adverse events or even toxicity

Reference:

1. MHRA Drug Safety Update (April 30th 2026). Nasal decongestant sprays and drops containing xylometazoline hydrochloride / oxymetazoline hydrochloride: increased risk of rebound congestion, rhinitis medicamentosa, and tachyphylaxis with overuse.
2. Wang J et al. Rise and fall of decongestants in treating nasal congestion related diseases. Expert Opinion on Pharmacotherapy 2024; 25(14):1943–1951.