‘Do not use for more than three days’: Afrin use has drawbacks

Q. Several years ago, I was hooked on Afrin. I could not breathe through my nose unless I used it.

My doctor prescribed a tapering dose of prednisone, and I could breathe freely within one day. I didn’t like the prednisone because it made me very agitated and prevented sleep. On the other hand, it did take care of the addiction.

I don’t plan on using Afrin for more than three days again. I don’t want to have to deal with prednisone anymore, as there are problems with that, too.

A. Nasal decongestant sprays like Afrin (oxymetazoline) have a clear warning: “Do not use for more than three days. Use only as directed. Frequent or prolonged use may cause nasal congestion to recur or worsen.”

The official name for rebound nasal congestion is “rhinitis medicamentosa.” That means a stuffy nose triggered by medication overuse.

When people use topical decongestants such as naphazoline, oxymetazoline, phenylephrine and xylometazoline for more than few days, their noses adapt to the vasoconstriction. When the medicine is stopped, blood vessels dilate and create congestion that can be challenging. Because allergies last longer than three or four days, decongestant nose sprays are inappropriate to treat the resulting congestion and runny noses.

Another reader found a different solution: “I have always been plagued with nighttime congestion, but I’ve had great success with NasalCrom. If I forget to use it, the congestion comes right back. When I start to use it again, my congestion is gone!”

Cromolyn sodium (NasalCrom) stabilizes mast cells in the nasal passages. These cells discharge histamine and other inflammatory compounds, but this spray prevents their release. It does not lead to rebound congestion.

Q. I was on brand-name Lasix for over 30 years to treat lymphedema. Now that I can get only generic furosemide, I have found that the generic does nothing to reduce swelling. It only causes allergic skin outbreaks. The generic is not even close to the brand name based on how my body reacts.

Years ago, my parents traveled frequently to Mexico, where they purchased brand-name Lasix over the counter. It was less expensive than in the U.S., but it worked just as well.

Alas, those days are gone. I am 65, and I fear I will not be able to manage my condition in the future because the generic is ineffective. Can you advise me how I could find brand-name Lasix?

A. You are not the first reader to report problems with generic furosemide. We have even heard from a cardiologist who found that some furosemide formulations did not work well to control edema.

With a prescription from your doctor, you should be able to purchase brand-name Lasix from a legitimate online Canadian pharmacy for about one-third as much as it would cost in the U.S.

For more information about evaluating reputable Canadian pharmacies and other tips on using generic drugs wisely, you may wish to consult our eGuide to Saving Money on Medicines. This online resource is available at PeoplesPharmacy.com.

Q. What’s the most effective bug spray to keep ticks off? We walk our dogs in the woods almost every day and would like to avoid tick-borne diseases.

A. According to Consumer Reports (July 2019), either putting DEET-containing bug repellent on your skin or wearing permethrin-treated clothing can help. Even with such precautions, however, you must perform tick checks whenever you come inside from your walks.