Afrin rebound effect?

[kelly7552]

I'm going on a dive boat in Belize with my two kids and I spoke with DAN about a separate issue and they suggested a shot of AFRIN would help a specific situation before a dive. Given that there will be 5-6 days of diving with 3-4 dives a day, my ENT told me to only use AFRIN for 3 days. Why? What's the rebound effect? If AFRIN helps, can you use it every other day without consequences?

 

[erparamedic]

If I were you, I'd trust what you ENT told you. I'm a Paramedic in an ER, and though, not common, I have seen several patients that have been or are addicted to Afrin.

I believe the "rebound" effect is that of an "addictive" effect. In other words, once you use it for so long, you feel "stuffy" or like you can't "breathe" without it... and it progresses to excessively frequent usage to maintain the "desired" effect. Does that make sense to you? I'm not good at putting some things into words.

 

[DocVikingo]

Hi kelly7552,

Rebound congestion, known in the med biz as rhinitis medicamentosa, results from abnormal swelling and enlargement of the lining of the nasal cavity secondary to the extended use (on the order of 3-5 days) of Afrin (oxymetazoline) and certain other decongestant nasal sprays (e.g., ephedrine, phenylephrine). This swelling blocks the nasal airway and causes discomfort.

Then the sufferer is caught in a vicious cycle---->the spray must used to reduce the rebound congestion--->the congestion is temporarily relieved---->once the effect of the last dose of the spray wears off, the nasal mucosa swell again---->another dose of spray is required to provide relief. Worse, response to the spray rapidly decreases and more frequent doses are needed to provide adequate decongestion.

This can be very bad business and a difficult cycle to break.

Use such nasal spays only as directed and if you think you've developed rebound decongestion, see an ENT pronto.

Also, be aware there are more effective and safer steroid nasal sprays available by prescription.

Regards,

DocVikingo

 

[fisherdvm]

My residency director, a well respected army colonel and physician, say that you can use Afrin everyday - as he does. I met another diver who said he uses it every day, no problem.

I DISAGREE WITH BOTH. AFRIN IS NOT SAFE TO USE DAILY. I noted a rebound effect after only 6 daily use prior to my dives. Rebound is simply congestion, which resolved in about 3 days.

I quoted a study that noted no improvement in passengers of airlines with ear squeeze (but psudafed did well). Afrin was no better than placebo. But likely this is if you followed the labeled instruction.

Labeled instruction said not to tilt your neck back. But this would limit the effect of the decongestant only on your nasal turbinates, and perhaps your maxillary sinuses. To try to get Afrin back where it counts - the eustachian tube - you really do need to tilt your neck back.

However, tilting your neck back, you will aspirate the nasty wicked stuff which burns your pharynx, irritate your throat, and make your day uncomfortable.

I'd try claritin or allegra first. If afrin is no better than placebo for simple airplane flights (with fluctuation of cabin pressure of plus or minus 30% of atmospheric pressure), can you imagine your scuba ranges (1 to 3 times atmospheric pressure), I am doubtful if used as directed, Afrin will help you.

 

[letterboy]

HMM I like that explanation. . . it makes sense, is that the same thing with over use of psydofed (SP)?

 

[oxyhacker]

Afrin is real bad stuff for regular use, according the an ENT doctor and diver I spoke with. Use it too long, and when you stop using it, the nasal passages congest even worse than they were before you started. So you start using more and more of it, and getting less and less relief. This can develop, as erparamedic says, into a genuine addiction.
Also, the rebound effect can cause serious, and unpredictable congestion when diving. This may manifest in the normal way, by difficulty equalizing on descent, but it can also take the form of inability to equalize on ascent, which leaves on in the difficult position of having to decide between blowing your eardrums or drowning.

He felt even 3 days is too long and recommended not using it for more than two, and even then only at the end of a trip, when one would have a few non-diving days to get over it.

 

[DocVikingo]

Hi jhbryaniv,

Thank you.

Overuse of an oral pseudoephrine-based decongestant, such as Sudafed 12 Hour/24 Hour/Maximum Strength, can cause problems but rebound congestion would not be expected.

However, overuse of Sudafed Decongestant Nasal Spray (xylometazoline), indeed will court rebound problems.

Regards,

DocVikingo

 

[letterboy]

Your welcome Doc

Thanks for your well thought out posts as well