Dependence on drops in the nose

There are drops that for several minutes eliminate nasal congestion with respiratory diseases, as well as allergic and vasomotor rhinitis: dripped two drops into each nasal passage - and you can breathe freely with your nose. It is these intranasal anticongestive (decongestant) drugs that cause dependence on drops in the nose.

Causes of the dependence on drops in the nose

With a cold, nasal congestion, which hampers nasal breathing, is caused by the expansion of capillaries, small arterioles and other blood vessels of the nose. Because of this, the mucosal edema develops, and the respiratory passages are blocked. The anticongestive agents facilitate breathing through the nose, but the reasons for the dependence on drops in the nose lie in their long-term use. When such drops are used longer than recommended, tachyphylaxis occurs - a sudden rapid decrease in response to a drug after its administration. In this case, as experts note, an increase in the dose of the drug can restore its effect; that's why many people who use such means - to breathe normally - are buried by the nose again and again. And get addiction from drops in the nose. But why does tachyphylaxis arise?

It should be recalled that the pharmacological group of anticongestant drugs that cause persistent addiction includes such nasal stuff as naphthazine (other trade names are Nafazolin, Rinazin, Imidine, Privin), Nazivin (Nazole, Noxprey), Galazolin (Eucazolin, , Rinorus, Otrivin, Suprima-NOZ) and others.

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

Pathogenesis

It is assumed that the pathogenesis of tachyphylaxis using these nasal drops is associated with the rapid release of the neurotransmitter norepinephrine from the nerve endings due to the increase in blood pressure: an increase in blood pressure is a systemic side effect of all anticongestant drugs. And this testifies to the activation of the adrenal catecholamine synthesis system after absorption of the active substances of the nasal mucosa and getting them into the bloodstream.

In addition, the constant instillation of the nose with vasoconstrictors (longer than prescribed according to the instructions 3-5 days) contributes to the dryness of the mucous membranes, which should be moist. And here the "ricochet" effect works: the compensatory reaction of parasympathetic nerve fibers begins to manifest itself. In response to prolonged compulsory vasoconstriction, the physiology of the body tries to restore the system back to normal, and the blood vessels expand to maintain mucosal nutrition. This is expressed in an increase in the production of mucin (mucous secretion), edema and nasal congestion ...

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

[1], [2], [3], [4]

Symptoms of the dependence on drops in the nose

In most cases, the symptoms of droplet dependence in the nose are expressed in the form of drug rhinitis.

Its first signs are manifested in the fact that it is practically impossible to breathe normally through the nose without the burial of the nose with Naphthyzine, Nazivin, Galazolin and other intranasal anticongestants. According to the otolaryngologists, all patients in such a situation complain that the nose is blocked. And this is an obvious proof of obstruction of the sinuses of the sinuses of the nose.

In addition, the symptoms of medical rhinitis are manifested by itching and a burning sensation in the nasal passages; increased secretion and secretion of fluid exudate from the nasal passages (not because of inflammation, but due to the dominance of parasympathetic activity and vasodilation of blood vessels); a change in the resonance of the voice and the appearance of nasal voices in conversation; deterioration of perception of smells (that is, a decrease in smell).

Sufferers of drug-induced rhinitis often snore in sleep, and breathing through the mouth leads to dry mouth and sore throat.

In this case, patients often try to "break through" the stuffiness of the nose, increasing both the dose of vasoconstrictive drops, and the frequency of their use. And this only worsens the situation: the swelling of the nasal passages, caused by the above-mentioned "bounce" effect, can eventually cause complications such as atrophic rhinitis and sinusitis, as well as atrophy of the nasal mucosa. Atrophy, mucosal scarring occurs, often accompanied by nasal bleeding.

[5], [6], [7], [8]

Complications and consequences

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

[9]

Diagnostics of the dependence on drops in the nose

General diagnosis of the dependence on drops in the nose is based on a carefully collected history of the patient. In all cases, otolaryngologists perform a rhinoscopy examination that identifies the presence of anatomical abnormalities (for example, curvature of the nasal septum) or polyps in the nose.

Since medical rhinitis usually coexists with other diseases that initially caused the need for decongestants, the diagnosis may be helpful in the diagnosis: a smear from the nose mucosa, a blood test for IgE and ESR, a skin test for allergy (for patients with a history of allergic rhinitis and asthma) , CT of the sinuses of the nose.

[10], [11], [12], [13]

Differential diagnosis

The goal, which should be carried out differential diagnosis - identified according to nasal drops, and not on any other medication because the trigger rhinitis are some antihypertensives, drugs beta-blockers group, antidepressants and antipsychotic drugs, exogenous hormones (in including, as part of oral contraceptives), etc.

For example, almost a fifth of pregnant women have rhinitis due to a high level of estrogen and a gradual increase in the synthesis of the neurotransmitter acetylcholine, especially in the third trimester of pregnancy.

Treatment of the dependence on drops in the nose

To overcome dependence on drops in the nose, it is necessary to go to the ENT doctor who will diagnose and prescribe the appropriate treatment.

Some doctors use the method of gradually reducing the doses used by the patient for two to three weeks. At the same time, it is recommended twice a day to wash the nose with a solution of table salt (a teaspoon of a glass of warm boiled water).

Drugs for topical use may also be prescribed. Aerosol Fluticasone (Fliksotid nebulus, Nasofan Teva) containing synthetic analogues of glucocorticoids. It is used twice a day for two injections in each nasal passage; the maximum daily dose is 400 mcg. This drug is contraindicated in cases of respiratory diseases of viral and fungal origin, as well as during pregnancy and lactation. Its use can cause a headache, an unpleasant taste in the mouth, bleeding from the nose.

The preparation Budesonide (Rinocort, Tafen) in the form of a nasal spray (also based on GSK); appointed by two injections (morning and evening) into each nostril; the course of treatment lasts a minimum of a week (the duration of therapy is determined by the doctor after examination of the nasal mucosa). Budesonide has the same contraindications and side effects as Fluticasone.

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

Dragee Sinupret forte or drops for oral administration Sinupret help with inflammation of the upper respiratory tract, therefore some otolaryngologists recommend taking them with a medicinal cold: adults - two pills three times a day; children 6-14 years - 25 drops three times a day, children 2-6 years - 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 macro elements (iron, calcium, potassium, magnesium, zinc).

Physiotherapeutic treatment is carried out by the methods of ozonotherapy and ultraviolet radiation of the mucous membranes of the nose, electrophoresis with corticosteroids, tubus quartz movement of the nasal passages.

And homeopathy offers a spray of mineral-vegetative composition - Euforbium compositum Nazentropfen S, which helps restore atrophied mucous nasal and helps improve nasal breathing. This homeopathic remedy should be injected into each nasal passage (two times per dispenser dispenser) up to five times during the day. Allowed treatment of children from 12 months, pregnant and lactating women.

Alternative treatment of the drug-induced rhinitis due to drops consists in irrigation of the nasal cavity with an aqueous solution of propolis (0.2 g per 200 ml of boiled water at room temperature). This procedure is useful to spend before bed, but for convenience, you can use a children's syringe or a syringe without a needle. It is also good to "postpone" the nose every night warm foot baths (with a water temperature of not higher than + 50 ° C) for 10-15 minutes. It is necessary to ventilate the room, which is intended for night rest, and make sure that the air of 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, eclipse, pine buds (200-250 ml of water, a tablespoon of dry raw material). And if dry crusts are formed in the nose, then lubrication of the nasal passages with vegetable oils facilitates their softening.

Surgical treatment is performed in case of atrophy and erosion of the nasal mucosa by electrosurgical vasotomy (electrocoagulation) of the submucosal tissue layer, and in case of hyperplasia of the nasal concha by the method of radiosurgical tissue reduction. With hyperplastic changes in the inferior nasal concha, a persistent positive effect and a significant improvement in nasal breathing gives a diode laser treatment or the use of cryotherapy.

Prevention

Prevention of the development of tachyphylaxis and the emergence of drug rhinitis - the use of anticonvulsant drugs only with short-term nasal congestion, in other cases it is better to abandon them. In general, the treatment of this dependence has a positive prognosis, although studies have shown that those who once again used such drops (even a year later) very quickly felt the effect of their "rebound" again.

Dependence on drops in the nose can occur in just three days of use, but the risk increases significantly after a 10-day application.

[14], [15]