Rhinitis medicamentosa (RM), also known as rebound rhinitis, is a condition characterized by nasal congestion that is triggered by the overuse of topical vasoconstrictive medications, most notably intranasal decongestants; recreational use of intranasal cocaine may also cause a similar condition. [1, 2, 3] Underlying reasons for intranasal decongestant use can usually be identified, such as allergic or nonallergic rhinitis, acute or chronic rhinosinusitis, nasal polyps, night-time use of continuous positive airway pressure (CPAP), or upper respiratory tract infection. With regular daily use, some patients may develop rhinitis medicamentosa in 3 days, whereas others may not have evidence of rebound congestion after 4 to 6 weeks of use. [2] Management of rhinitis medicamentosa is focused on withdrawal of intranasal decongestants and treatment of congestion and underlying conditions with appropriate interventions.

Rhinitis medicamentosa is now generally considered a subset of drug-induced rhinitis that may include the development of congestion and other nasal symptoms from medications that are not administered by the intranasal route. [2] Examples of orally administered agents that may cause drug-induced rhinitis include ACE inhibitors, beta blockers, alpha adrenergic receptor antagonists used in the treatment of benign prostatic hypertrophy, and phosphodiesterase-5 selective inhibitors used to treat erectile dysfunction. [2, 4] Aspirin and other NSAIDs may also produce nasal symptoms in sensitive individuals, sometimes as part of a broader presentation of aspirin-exacerbated respiratory disease (AERD), formerly known as Samter’s Triad, that may include chronic rhinosinusitis with nasal polyps, asthma and aspirin/NSAID sensitivity.