As the cold and flu season sweeps across the UK, a surprising health warning has emerged: millions of Britons are unknowingly putting themselves at risk by misusing over-the-counter nasal decongestant sprays. With high levels of flu, colds, and adenovirus circulating, these sprays have become a go-to remedy for blocked noses. But medical experts and health authorities are sounding the alarm about a growing problem: addiction and physical dependence on these seemingly harmless products, which can lead to lasting—and sometimes irreversible—damage.
According to a recent survey conducted by the Royal Pharmaceutical Society (RPS) and reported by several outlets including Cosmopolitan UK, Daily Mail, and International Business Times, nearly 60% of community pharmacists believe patients are unaware of the risks and strict time limits for using nasal decongestant sprays. Out of more than 300 pharmacists surveyed, 59% said that people often don’t realize there’s a recommended maximum duration for these medicines. What’s more, 63% of pharmacists have personally intervened to refuse sales to customers they suspect of overusing the sprays, and almost three-quarters think that warning labels should be made much clearer on packaging.
So what exactly is the danger? The crux of the issue is a phenomenon called rebound congestion, or rhinitis medicamentosa. As explained by Ian Budd, Lead Prescribing Pharmacist at Chemist4U and cited by Cosmopolitan UK, "Most decongestant nasal sprays should only be used for up to five to seven days." Budd points out that, while these sprays can be highly effective when used properly, many people are unaware that they’re designed for short-term use only. "The biggest risk is something called rebound congestion, where overuse actually causes your nasal passages to swell more once the spray wears off. This can lead to a cycle where people feel they need to keep using the spray just to breathe normally."
Phil Day, Superintendent Pharmacist at Pharmacy2U, agrees, emphasizing that sprays containing ingredients like oxymetazoline or xylometazoline should not be used for more than seven days in a row. "If patients find themselves reaching for the spray every day just to breathe, it’s a sign that the problem may be a rebound effect rather than a new infection or allergy flare and it’s time to talk to a healthcare provider about safer alternatives," Day said.
It’s not just a theoretical risk. Recent research by ITV and Ipsos, reported by Daily Mail, found that over 20% of adults who have used these sprays have done so for longer than a week. That means an estimated 5.5 million people in the UK have put themselves at risk of developing a dependence on nasal sprays. The consequences can be severe: chronic swelling, irritation of the nasal lining, and damage to blood vessels, sometimes resulting in breathing problems or even facial disfigurement. In the worst cases, patients have required surgery to address the damage caused by long-term misuse.
One such patient is Charlotte Johnstone, a 30-year-old woman whose story has brought national attention to the issue. As reported by ITV, Daily Mail, and IBTimes, Charlotte started using nasal sprays at the age of seven and, at the height of her dependency, was reaching for the spray up to eight times a day. "I can't sleep without having it, I wake up and the first thing I do is have my nasal spray," she told ITV. Her reliance on the medication has shaped her daily life, causing her to avoid situations where she might not have access to the spray, and costing her around £30 per month. "I go through stages of losing my sense of smell. I know it's doing something but I don't know what. But for the sake of having a clear nose, and avoiding feeling claustrophobic, I'll just take it," she admitted. The anxiety and fear of being without the spray have even invaded her dreams.
Charlotte’s experience is far from unique. Pharmacists and health chiefs say that many people become trapped in a similar cycle, often unaware that their worsening symptoms are actually a result of the very medication they’re using for relief. Professor Amira Guirguis, chief scientist at the RPS, emphasized the scale of the problem, saying, "Our research shows that many people are unaware of this risk, which means they may continue using these sprays without realising they could be prolonging their symptoms. We’d like to see clearer warnings on the packaging which you can’t miss and greater awareness of the seven-day limit."
Medical professionals stress that rebound congestion is caused only by overuse of decongestant sprays containing oxymetazoline or xylometazoline—not by saline or steroid nasal sprays. The latter are often recommended as safer alternatives, especially for people with allergies, as they do not carry the same risk of dependence or rebound congestion. Budd recommends saline sprays, steam inhalation, and steroid nasal sprays for those needing longer-term relief. "Many people assume that because nasal sprays are available over the counter, they’re completely risk-free, which isn’t the case," he said. "Better labelling around the seven-day limit could prevent a lot of unnecessary discomfort and prolonged symptoms."
Symptoms of nasal spray dependence can sneak up gradually. According to IBTimes, users may notice they need the spray several times a day or feel severe congestion if they miss a dose. Anxiety or even panic without the spray is common, alongside physical symptoms like persistent blocked or runny noses, sneezing, sinus pressure, and headaches. Some patients, like Charlotte, have even reported a reduced sense of smell. Short-term side effects include burning sensations, dryness in the nose, dizziness, and difficulty sleeping. In severe cases, chronic nasal inflammation can develop, and surgery may be necessary.
Despite these sobering facts, most patients can successfully wean themselves off decongestant sprays without suffering long-term damage, experts say. For those struggling, doctors may prescribe steroid-based sprays to help manage symptoms during withdrawal. However, as Charlotte told ITV, "Going cold turkey is very scary to think about. You've got to be really brave for that and I'd have to book a lot of time off work."
Manufacturers and regulatory agencies maintain that proper instructions are already included with these medicines. A spokesperson for the consumer healthcare association PAGB said, "As an over-the-counter medicine, nasal decongestants are indicated for short-term relief of symptoms and the products state on the packaging and patient information leaflet that they should not be used continuously for more than seven days." The Medicines and Healthcare products Regulatory Agency added, "We advise patients to read the information provided with their medicine and adhere to the recommended dose and duration."
Still, with millions at risk and stories like Charlotte’s making headlines, the call for clearer warnings and better public education is growing louder. As Professor Guirguis put it, the immediate step is to "clarify the message and the health advice with a warning on the front of the packaging that this product should not be used beyond the seven-day limit."
For now, the message from health experts is simple: nasal decongestant sprays are safe and effective—when used correctly. But more is definitely not better, and understanding the risks could spare countless people from unnecessary suffering.
