Vasoconstrictor drugs — a panacea or evil?
Vasoconstrictor drops and sprays (nasal decongestants) are medications that temporarily relieve swelling of the nasal mucosa, helping to improve breathing during rhinitis (runny nose). They are widely used in the treatment of acute and chronic ENT diseases (but, of course, they are not a panacea for all diseases and conditions of the nose).
Drops become evil if you neglect the recommended duration of their use for therapeutic purposes, which can lead to addiction and deterioration of the nasal mucosa.
How do nasal drops work?
Nasal decongestants have a vasoconstrictor effect. When applied topically to the inflamed nasal mucosa, they reduce swelling and nasal discharge, and restore nasal breathing. Indications for use:
• treatment of acute respiratory diseases accompanied by a runny nose
• allergic rhinitis
• vasomotor rhinitis
• to restore drainage (outflow) in inflammation of the paranasal sinuses, eustachitis (tubo‑otitis) – inflammation of the auditory tube, and otitis media
• to eliminate swelling before diagnostic procedures in the nasal passages (for example, puncture of the maxillary sinus)
Which spray lasts longer?
Among nasal sprays, the longest‑lasting effect is provided by products based on oxymetazoline. Their effect lasts up to 12 hours, which reduces the frequency of their use during the day and makes them more convenient for patients.
What will happen if you use nasal drops every day? How can you avoid becoming addicted to the drops?
With daily use of vasoconstrictor drops, drug‑induced rhinitis develops, which sometimes persists for a long time and is difficult to correct without surgical intervention. What happens if vasoconstrictor drops are used frequently and for a long time:
- irritation and dryness of the mucous membranes of the nose and pharynx
- rebound swelling (increased nasal congestion after the effect of the drug wears off)
- drug‑induced chronic rhinitis — tachyphylaxis (weakening of the therapeutic effect, forcing an increase in the dose and frequency of use)
- dependence when used for more than 5–7 days
- systemic effects (headache, nausea, increased excitability, palpitations, etc.), which more often develop in patients with hypersensitivity to this group of drugs.
To avoid dependence, you need to:
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Find out the cause of nasal congestion from an ENT doctor during an in‑person consultation with nasal endoscopy;
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Use drops for no longer than 5–7 days;
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Use saline solutions for nasal rinsing;
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Maintain the necessary indoor microclimate (temperature 20–22°C, humidity 50–60%, regular ventilation, especially where there is air conditioning and during the heating season);
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Perform breathing exercises as a distracting maneuver when addiction occurs.
How often can you use nasal drops?
The frequency of use depends on the active ingredient in the drops, usually from 2–3 times to 3–4 times a day. It is important to follow the instructions and not exceed the recommended dosage.
How long does it take for the nasal mucosa to recover after prolonged use (more than 10 days) of drops?
After prolonged use of drops, a persistent physiological and psychological dependence develops, and the elasticity of the mucosal blood vessels decreases. In general, the mucous membranes fully return to normal within 14 to 30 days after overcoming the dependence or from the moment of stopping the use of the drops.
Is it possible to abruptly stop using nasal drops?
Yes, and as soon as possible! It is difficult only in the first days or a week, but over time the withdrawal symptoms should disappear (if you have difficulty stopping the drugs on your own, it is better to consult a specialist in time for appropriate necessary therapy).
What is the advantage of a spray over drops?
Compared to nasal drops, a spray for rhinitis can be considered a more advanced dosage form: a spray is much more convenient to use (it can be used on the go, at home, at work, without drawing attention to yourself), it is more economical in consumption, it allows precise dosing of the drug (1 spray = 1 dose), and increases patient safety by reducing the risk of drug overdose.
The spray evenly affects the mucous membranes and important nasal structures (inside the nose there are anastomoses connecting the paranasal sinuses – maxillary, ethmoidal, frontal, sphenoidal – with the nasal cavity and the external environment, respectively). At the same time, drops can enter the nasopharynx directly, bypassing the lateral wall of the nose.
Drops are more suitable for children of a certain age, most often for children under one year old: the child does not get scared when they are used, as can happen with spraying.
There are situations when young children may not like the taste of drops, which often have a bitter taste (but sometimes a doctor may prescribe this particular form for a specific pathology and at a certain age).
Can a nasal spray be used for children under one year old?
Yes, but only with an oxymetazoline concentration of 0.1 mg/mL (0.01% solution).
In infants, the nasal passages are very small and narrow, so for babies it is better to use drops. For example, Nosacar Infant drops are safe at this age when the recommended duration and dosages are followed. Nosacar Infant is equipped with a safe pipette that allows precise dosing and does not injure the baby's little nose.
From what age can Nosacar spray be used?
Nosacar spray has a wide range of products for any patient. Nosacar Infant drops, containing 0.1 mg/mL of oxymetazoline, are specially designed for children from birth to one year old.
Nosacar Kids spray (0.025 mg/mL oxymetazoline) is suitable for children from 1 year of age.
Nosacar Classic spray, Nosacar Pro Moisturizing, and Nosacar Menthol gel, according to the instructions, can be used in children from 6 years of age and adults.
How many days can Nosacar spray be used?
Nosacar spray, like other nasal decongestants, is not recommended for use for more than 5–7 days. Vasoconstrictor drugs are sold without a prescription in all countries of the world.
What is the difference between a gel and a spray?
The main difference is in the consistency of the dosage form (in the gel, it is a gel‑like suspension).
For example, the Nosacar line includes Nosacar Menthol Gel. After being introduced into the nasal passages, the spray becomes more viscous, adheres well to the mucous membranes, does not run out of the nose, and does not drip down the throat. Nosacar Menthol Gel contains moisturizing agents that help retain moisture, which helps hydrate dry or irritated nasal mucosa. Eucalyptus oil in Nosacar Menthol Gel has antiseptic, anti‑inflammatory, and decongestant effects.
Возможно ли совместное применение назальных деконгестантов с другими растворами в нос?
Можно, главное, чтобы в составе других капель не было действующих веществ сосудосуживающего компонента (т.к. возможна передозировка при совместном применении).
При необходимости совместного применения с другими каплями, предпочтительно использовать сначала сосудосуживающие капли, например, Нозакар Классик, затем очистить нос физиологическим или солевым раствором (по рекомендации врача, используя разные механизмы и объёмы промывания носа), затем уже применять другие лечебные спреи через 5-10 минут.
Is it possible to use nasal decongestants together with other nasal solutions?
When choosing a spray, it is important to consider the patient's age and the composition of the product.
For children, the first thing to go by is age — each package of drops indicates the approved age for use. For example, Nosacar Infant can be used from birth, while Nosacar Kids is only from one year old. The second point is to read the instructions and/or check with a pharmacist or attending physician about the absence of other additional components in the excipients (menthol, chlorhexidine (benzalkonium chloride)) that may cause more pronounced dryness of the mucous membrane in a child and an allergic reaction.
For an adult, we choose any form of vasoconstrictor drugs (drops, spray, gel) and their excipients (for example, the presence of menthol in the absence of allergies) depending on individual preferences, and we choose the "adult" or "child" dosage to reduce the likelihood of addiction.
The main thing is that proper use of nasal vasoconstrictors helps quickly eliminate nasal congestion, helps avoid side effects and dependence.
Stay healthy!
Author: Sogoyan Inna Igorevna, otorhinolaryngologist‑surgeon of the highest qualification category at MedAvenue Medical Center, postgraduate student at the Republican Scientific and Practical Center for Otorhinolaryngology, author of the Instagram blog @doctor_otorhinolaringologist
