Addiction to nasal drops

There are drops that eliminate nasal congestion in a few minutes due to respiratory diseases, as well as allergic and vasomotor rhinitis: put two drops in each nasal passage - and you can breathe freely through your nose. It is these intranasal decongestants (decongestants) that cause addiction to nasal drops.

Causes of nasal drops addiction

With a runny nose, nasal congestion that makes nasal breathing difficult is caused by the dilation of capillaries, small arterioles, and other blood vessels in the nose. This causes swelling of the mucous membrane, and the airways are blocked. Decongestants make breathing through the nose easier, but the reasons for dependence on nasal drops are their long-term use. When such drops are used longer than recommended, tachyphylaxis occurs - a sudden, rapid decrease in the response to the drug after its administration. At the same time, as experts note, increasing the dose of the drug can restore its effect; this is why many people who use such products - to breathe normally - use nasal drops again and again. And become dependent on nasal drops. But why does tachyphylaxis occur?

It should be recalled that the pharmacological group of decongestant drugs that cause persistent addiction includes such nasal decongestants as Naphthyzinum (other trade names: Naphazoline, Rinazin, Imidin, Privin), Nazivin (Nazol, Noxprey), Galazolin (Evkazolin, Dlanos, Rinorus, Otrivin, Suprema-NOZ), etc.

Despite the fact that they contain various active substances (nafonazole, oxymetazoline, xylometazoline hydrochloride, phenylephrine), they are all vasoconstrictors. And their mechanism of action is associated with stimulation of α-adrenergic receptors of the smooth muscles of the vessel walls, innervated by sympathetic nerve fibers. As a result, the overall blood flow in the vessels decreases, venous return increases and, as a consequence, nasal congestion decreases.

Pathogenesis

It is assumed that the pathogenesis of tachyphylaxis when using the above nasal drops is associated with the rapid release of the neurotransmitter norepinephrine from nerve endings due to increased blood pressure: increased blood pressure is a systemic side effect of all decongestant drugs. And this indicates the activation of the adrenal system of catecholamine synthesis after the absorption of active substances of the nasal mucosa and their entry into the bloodstream.

In addition, constant use of vasoconstrictor nasal drops (longer than the 3-5 days prescribed by the instructions) contributes to the dryness of the mucous membranes, which are supposed to be moist. And here the “rebound” effect comes into play: a compensatory reaction of parasympathetic nerve fibers begins to manifest. In response to prolonged forced vasoconstriction, the body's physiology tries to return the system to normal, and the blood vessels expand to support the nutrition of the mucous membrane. This is expressed in increased mucin (mucous secretion) production, swelling and nasal congestion...

There is also an opinion that the reasons for dependence on nasal drops are their damaging effect on tissue trophism in the nasal cavity due to a decrease in blood flow during prolonged narrowing of blood vessels. After all, even the instructions for the drops indicate such side effects as irritation and dryness of the nasal mucosa. As a rule, this leads to the rejection and accumulation of dead cells of the squamous mucous epithelium of the vestibule of the nasal cavity and the ciliated epithelium of the nasal sinuses, which makes breathing through the nose difficult.

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Symptoms of nasal drops addiction

In the vast majority of cases, symptoms of nasal drop addiction are expressed in the form of drug-induced rhinitis.

Its first signs are that without instilling Naphthyzinum, Nazivin, Galazolin and other intranasal decongestants into the nose, it is practically impossible to breathe normally through the nose. According to otolaryngologists, all patients in such a situation complain that "the nose is stuffy." And this is obvious evidence of obstruction of the sinus ostia.

In addition, the symptoms of medical rhinitis are manifested by itching and a burning sensation in the nasal passages; increased secretion and discharge of liquid exudate from the nasal passages (not due to inflammation, but due to the dominance of parasympathetic activity and vasodilation of blood vessels); changes in the resonance of the voice and the appearance of a nasal tone when speaking; deterioration in the perception of odors (i.e., a decrease in the sense of smell).

People with rhinitis medicamentosa often snore in their sleep, and breathing through the mouth leads to dry mouth and sore throat.

In this case, patients often try to “break through” nasal congestion by increasing both the dose of vasoconstrictor drops and the frequency of their use. And this only worsens the situation: swelling of the nasal passages caused by the above-mentioned “rebound” effect can ultimately cause complications such as atrophic rhinitis and sinusitis, as well as atrophy of the nasal mucosa. With atrophy, scarring of the mucosa occurs, often accompanied by nosebleeds.

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Complications and consequences

The most severe consequences of drug-induced rhinitis are expressed in erosion of the nasal mucosa with subsequent perforation of the nasal septum, as well as in thickening and proliferation of the mucosa (hyperplasia of the nasal turbinates), which closes the passages of the internal nasal openings. Then nasal breathing is blocked irreversibly, and surgical intervention may be required to solve this problem.

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Diagnostics of nasal drops addiction

General diagnostics of nasal drop addiction is based on a carefully collected patient history. In all cases, otolaryngologists perform a rhinoscopic examination, which allows identifying the presence of anatomical anomalies (for example, a deviated septum) or nasal polyps.

Since drug-induced rhinitis usually coexists with other diseases that initially necessitated the use of decongestants, the following may be helpful in making a diagnosis: a nasal swab, blood tests for IgE and ESR, skin testing for allergies (for patients with a history of allergic rhinitis and asthma), CT scan of the sinuses.

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Differential diagnosis

The purpose for which differential diagnostics should be carried out is to identify dependence on nasal drops, and not on any other medication, since rhinitis can be provoked by some antihypertensive drugs, beta-blockers, antidepressants and antipsychotic drugs, exogenous hormones (including those in oral contraceptives), etc.

For example, almost a fifth of pregnant women experience rhinitis, caused by high levels of estrogen and a gradual increase in the synthesis of the neurotransmitter acetylcholine, especially in the third trimester of pregnancy.

Treatment of nasal drops addiction

To overcome addiction to nasal drops, you need to go to an ENT doctor who will make a diagnosis and prescribe appropriate treatment.

Some doctors use a method of gradually reducing the dose of drops used by the patient over two to three weeks. At the same time, it is recommended to rinse the nose twice a day with a solution of table salt (a teaspoon per glass of lukewarm boiled water).

Topical medications may also be prescribed. Fluticasone aerosol (Flixotide nebuls, Nasofan Teva), which contains synthetic analogs of glucocorticoids. It is used twice a day, two sprays in each nasal passage; the maximum daily dose is 400 mcg. This drug is contraindicated in respiratory diseases of viral and fungal origin, as well as during pregnancy and lactation. Its use can cause headaches, unpleasant taste in the mouth, nosebleeds.

The drug Budesonide (Rinocort, Tafen) in the form of a nasal spray (also based on GSK); two sprays (morning and evening) are prescribed in each nostril; the course of treatment lasts at least a week (the duration of therapy is determined by the doctor after examining the nasal mucosa). Budesonide has the same contraindications and side effects as Fluticasone.

It should also be borne in mind that topical steroids can also have systemic side effects in the form of adrenal suppression, sleep disturbances, and mental disorders (anxiety, depression, aggression).

Sinupret Forte dragees or Sinupret oral drops help with inflammation of the upper respiratory tract, so some otolaryngologists recommend taking them for drug-induced rhinitis: adults - two dragees three times a day; children aged 6-14 - 25 drops three times a day, children aged 2-6 - 15 drops. Sometimes this medicine causes heartburn, nausea and vomiting.

It is also useful to take vitamins: A, C, E, B2, P and vitamin complexes with the addition of micro and macroelements (iron, calcium, potassium, magnesium, zinc).

Physiotherapeutic treatment is carried out using ozone therapy and ultraviolet irradiation of the nasal mucosa, electrophoresis with corticosteroids, and tube quartz treatment of the nasal passages.

And homeopathy offers a spray of mineral and plant composition - Euphorbium compositum Nazentropfen S, which helps restore atrophied nasal mucosa and helps improve nasal breathing. This homeopathic remedy should be sprayed into each nasal passage (two presses on the spray dispenser) up to five times during the day. Treatment is allowed for children from 12 months, pregnant and lactating women.

Folk treatment of drug-induced rhinitis caused by drops consists of irrigating the nasal cavity with an aqueous solution of propolis (0.2 g per 200 ml of boiled water at room temperature). It is useful to carry out such a procedure before going to bed, and for convenience, you can use a baby syringe or a syringe without a needle. Warm foot baths every evening (with a water temperature of no higher than +50 ° C) for 10-15 minutes also help to “put aside” the nose. You should ventilate the room intended for night rest more often and ensure that the air in the house is not too dry.

You can try herbal treatment, that is, irrigate the nasal passages with decoctions of calendula flowers, chamomile, peppermint leaves, sage, eucalyptus, pine buds (a tablespoon of dry raw materials per 200-250 ml of water). And if dry crusts form in the nose, then lubricating the nasal passages with vegetable oils helps to soften them.

Surgical treatment is performed in case of atrophy and erosion of the mucous membrane of the nasal cavity by the method of electrosurgical vasotomy (electrocoagulation) of the submucosal layer of tissue, and in case of hyperplasia of the nasal turbinates – by the method of radiosurgical tissue reduction. In case of hyperplastic changes of the inferior nasal turbinate, a stable positive effect and significant improvement of nasal breathing are achieved by treatment with a diode laser or the use of cryotherapy.

Prevention

Prevention of tachyphylaxis and drug-induced rhinitis is the use of decongestants only for short-term nasal congestion; in other cases, it is better to refuse them. In general, treatment of this addiction has a positive prognosis, although studies have shown that those who used such drops again (even a year later) very quickly felt the effect of their "rebound".

Addiction to nasal drops can occur in as little as three days of use, but the risk increases significantly after 10 days of use.

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