A Closer Look at the Evidence Supporting Appropriate Use of Nasal Oxymetazoline HCl Spray and the Risk of Rebound Congestion: A Systematic Review
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oxymetazoline, rebound congestion, rhinitis, rhinitis medicamentosa, nasal decongestants, systematic review
Abstract
Purpose: Although intranasal decongestants provide rapid relief from nasal congestion—a major symptom in various upper respiratory disorders—their prolonged or excessive use may lead to rebound congestion (RC), a condition with poorly understood mechanisms. We reviewed published studies investigating the relationship between the use of oxymetazoline nasal sprays (as-directed versus prolonged) and the development of RC.
Methods: We conducted a literature search in PubMed, covering publications up until April 2024, to identify clinical trials investigating RC involving the use of oxymetazoline nasal spray. Two investigators screened articles and extracted data on study design, participant characteristics, interventions, and outcomes. We employed a narrative approach to integrate and summarize the findings on the duration of oxymetazoline treatment in managing nasal congestion with minimal RC.
Results: 17 studies were selected. In clinical trials assessing the as-directed use of oxymetazoline (up to 10 days), RC was not identified as a resulting complication. Conversely, some studies of oxymetazoline use beyond the recommended duration indicated an association with RC, though results varied. Some studies suggested that prolonged use symptoms could be mitigated with appropriate use of intranasal corticosteroids.
Conclusions: When used as directed, oxymetazoline nasal sprays provide an effective remedy for nasal congestion with minimal risk of RC. Healthcare practitioners can recommend short-term use of oxymetazoline for managing nasal congestion. Future research on the optimal duration and combination therapies is warranted to further minimize the risk of RC and enhance care for individuals with chronic nasal congestions.
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