Rhinitis medicamentosa

Topical intranasal decongestants (e.g., oxymetolazine, xylome-tolazine, phenylephrine, and naphazoline) are OTC options that provide prompt relief of nasal congestion. Nasal decongestants are dosed multiple times daily.15 Tachyphylaxis, rebound congestion, and rhinitis medicamentosa may occur with chronic use therefore, use should be limited to 3 to 5 days.8,12 These may be used 5 to 10 minutes before administration of intranasal corticosteroids in patients with blocked nasal passages.15... 

Rhinitis medicamentosa Inflammation of nasal mucous membranes due to excessive use of topical medication. 

Pseudoephedrine (see Table 79-2) is an oral decongestant that has a slower onset of action than topical agents but may last longer and cause less local irritation. Also, rhinitis medicamentosa does not occur with oral decongestants. Doses up to 180 mg produce no measurable change in blood pressure... 

Oral agents are not as effective as topical products, especially on an immediate basis, but generally have a longer duration of action, cause less local irritation and are not associated with rebound congestion (rhinitis medicamentosa). 

Rebound congestion (rhinitis medicamentosa) May occur following topical application after the vasoconstriction subsides. Patients may increase the amount of drug and frequency of use, producing toxicity and perpetuating the rebound congestion. 

Benzalkonium chloride accentuated the severity of rhinitis medicamentosa and increased histamine sensitivity in a 30-day study with oxjmetazoline nasal spray in healthy volunteers (5,6). 

Graf P, HaUen H, Into JE. Benzalkonium chloride in a decongestant nasal spray aggravates rhinitis medicamentosa in healthy volunteers. Chn Exp Allergy 1995 25(5) 395-400. 

Patients should be counseled on the nse of topical decongestants to prevent rhinitis medicamentosa. Patients shonld be instructed to use as small a dose as possible as infrequently as possible and only when absolutely necessary (e.g., at bedtime to aid in falling asleep). Dnration of therapy always should be limited to 3 to 5 days. 

Also, rhinitis medicamentosa is not a problem with older agents. The most commonly used agent is psendoephedrine. Usnal doses for the regnlar and sustained-release version are given in Table 93-5. An oral form of phenylephrine is available by prescription only. 

Rhinitis medicamentosa—Nasal congestion associated with tolerance to and resulting overuse of topical decongestants. Also known as rebound vasodilation or rebound congestion. 

In the differential diagnosis of allergic rhinitis, one should include the following rhinitides vasomotor rhinitis, nonallergic rhinitis with eosinophilia syndrome (NARES) (49), atrophic rhinitis (52), occupational rhinitis, medication-induced rhinitis (especially rhinitis medicamentosa due to the overuse of topical sympa-thomimetics), hormonal rhinitis (pregnancy and hypothyroidism), infectious rhi-... 

Topical decongestants do not commonly cause systemic sympathomimetic effects but may lead to rebound congestion (rhinitis medicamentosa) after 5-7 days of therapy. 

Oral decongestants are not strongly associated with rhinitis medicamentosa but are associated with systemic adverse effects, e.g., blood pressure elevation, palpitations, tremor, appetite loss, and insomnia. Oral decongestants should be used with caution in patients with cardiac disease (arrhythmias, high blood pressure, coronary heart disease), hyperthyroidism, glaucoma, diabetes, and urinary dysfunction. Pseudoephedrine is less likely to elevate blood pressure than phenyl propanolamine (64). 

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