Could you please tell me the effects of long-term use of nasal sprays, if any? I have a friend who uses them very often, possibly 10 times a day. Recently her moods have become unpredictable. She is at the 40-year-old mark, and being a woman myself I know what that could mean. She doesn't feel that there is anything wrong, so she will not see a physician. Her marriage is at stake at this point, and we are trying desperately to figure out if there is anything beside menopause that could be affecting her.

M.

There are two common types of over-the-counter nose sprays. One contains the drug oxymetazoline, the other contains the drug phenylephrine. There are many different brand names for these sprays, but almost all of them contain one or the other of these two drugs.

Both types of spray are meant to be used only for short periods of time -- once or twice a day for a maximum of four or five days. If they are used for longer periods of time, "rebound" nasal swelling occurs. In other words, the nasal tissues swell not from a cold or allergy, but from withdrawal from the spray. The nose is, in a very real sense, addicted to the spray, and congestion is the main symptom of drug withdrawal. This problem has a name: "rhinitis medicamentosa," which means "nasal inflammation due to medications."

The only successful treatment for rhinitis medicamentosa is to stop using the drug. Cold turkey, in other words. We often try to put these patients on alternative nonaddictive sprays, such as nasal steroid sprays, to ease the withdrawal symptoms. Nevertheless, withdrawal is unpleasant and can last for several days. Since these patients know what will relieve their symptoms, they seek relief from, you guessed it, more spray.

Excessive use of these sprays can cause high blood pressure. The tissue that lines the nasal cavities, called mucosa, can also be very irritated in these patients. Can excessive use of the spray cause personality changes? Not to my knowledge. You touched on one good possibility (hormonal shifts due to menopause), but the list of possible problems is extremely long. She needs to be evaluated by a caring internist, one who will take the time to consider all of the possible explanations for her behavior and then act accordingly.

Unfortunately, you say "she doesn't feel that there is anything wrong, so she will not see a physician." If she is firm in this position, then you should not waste any more effort. All that you can do is let her know that you care about her and are willing to listen to her at any time, if she needs a kind ear. If she takes you up on this offer, then LISTEN (few friends know how to do this -- they would much rather nag and lecture), be nonjudgmental, and if she asks for advice, THEN you can give it.