Sep 17, 2012

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

I like the new toonit. I was watching Myth Busters on TV. I was not really paying attention to my 7 year old son Eric when he made this announcement. Later as we were having lunch he said, Black is a good color for the toonit. I still ignored him. Finally as I was tearing him away from the TV and trying to tuck him in he said, It was fun when Emily and I helped build the toonit. I still hadnt clued in, so I finally had to ask what he was talking about. So he pointed to the thing under the TV. It was the entertainment unit. He had just shortened the words entertainment unit down to toonit. In retrospect, toonit is a very quick way of saying entertainment unit. Eric would argue toonit is better because it is faster. But faster isnt better if its communication value is lost. When else is faster not always better?


Your nose is stuffed up. You cant breathe. There is a constant drip down your face. You just want it to stop. So you reach for a decongestant spray because they are fast. These are effective products, but maybe you should know a little about them first.


There are lots of reasons why your nose and sinuses get plugged up. The cause can be anything from allergies to cold viruses. The mucus in your nose serves to protect your nasal lining from dust, allergens, microbes, and other particles that you inhale all the time. Mucus has lots of different components in it but its main component is water. Where does this water come from? It comes from the fantastic water circulating system that brings fluids to all parts of the body, the blood vessels. Blood comes into the lining of the nose through narrower and narrower vessels until it reaches the smallest blood vessels, the capillaries. Cells get fed food and oxygen across the thin walls of the capillaries while waste products and carbon dioxide are removed. During this nutrient transfer some of the water leaves the blood plasma and eventually becomes mucus.


So, if a medication could cause less blood to flow into the capillaries, there would be less water available to make mucus. So less blood flow could lead to less mucus, right? That is exactly what decongestants do. There are switches in the lining of the nose that usually respond to adrenaline. The switches are like little locks and only the right key can fit into them and turn them on. Adrenaline is the right shaped key, and when it fits into the lock-switch it causes a valve called the subepithelial precapillary sphincter to close and less blood to go into the capillaries. This means less mucus, less nasal congestion, less nasal swelling, and the nasal lining changes from a red to white-ish color (blanching). This reaction to adrenaline makes sense. If you are being chased by an angry bear, adrenaline will cause your nose to clear, you will breathe better and hopefully get away from the bear.


Medications in nasal decongestants like xylometazoline are designed to look like adrenaline on the molecular level. So they can trigger the adrenaline lock-switches and clear the nose. No angry bear required! So spraying these decongestants in the nose does work! There is a problem though. They dont work for very long. Just like if you had a bear chase you every day, you would be less scared everytime, the lock-switches in the nose lining dont react to the decongestants as strongly if they are used everyday. In fact, if you spray a nasal decongestant into your nose for a week or more, you will get rebound rhinitis.


Rebound rhinitis is when those lock-switches in the nose are so comfortable having decongestant sprayed on them that they think having the decongestant around is normal. So when the decongestant is sprayed on them they dont close the valves that reduce the blood flow into the capillaries. The valves stay open, and mucus is still produced at a regular rate. Then if the person stops using the decongestant, the lock-switches panic. They are so comfortable having decongestant sprayed on them that when the decongestant goes away they throw the valves all the way open, and even more blood goes into the capillaries. Now even more mucus is produced than normal. So now what you have is a person who is quite congested even if they use the spray decongestants every day, and get really congested if they stop the spray decongestants. This is rebound rhinitis.


What do you do about rebound rhinitis? Unfortunately the answer is to stop the spray decongestant, and suffer through the congestion. It will take several days, but it usually goes away on its own. How do you avoid getting rebound rhinitis? Avoid using the spray type decongestants for more than 3-7 days in a row. Or try using the pill type decongestant. It doesnt work as fast, but rebound rhinitis doesnt happen. There are people who shouldnt take decongestants at all, like those with uncontrolled high blood pressure. Always check with your pharmacist when you are considering a new medication.


Toonit is a perfectly good short, fast word for an entertainment unit. But if only Eric knows what toonit means it loses its communication valve. The same goes for spray decongestants. They are very good, fast treatments for a runny nose, but if they are used more than 3-7 days in a row they will cause your nose to be more stuffed up than when you started.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.


We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at


As always if you have any questions or concerns about these or other products, ask your pharmacist.


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