Intranasal corticosteroids may reverse rhinitis medicamentosa

Chronic use of intranasal decongestants like oxymetazoline leads to tachyphylaxis of response and rebound congestion, due to alpha-adrenoceptor mediated down-regulation and desensitization of response

In a randomized, double-blind, placebo-controlled trial 19 healthy subjects received intranasal oxymetazoline tid for 14 days, followed by addition of fluticasone bid for a further 3 days.

Oxymetazoline-induced tachyphylaxis and rebound congestion was reversed by intranasal fluticasone.

References:
Fluticasone Reverses Oxymetazoline Induced Tachyphylaxis of Response and Rebound Congestion. Vaidyanathan S, Williamson P, Clearie K, Khan F, Lipworth B. Am J Respir Crit Care Med. 2010 Mar 4. Link via @wheezemd

Pseudoephedrine used in allergic rhinitis improved stuffy nose but decreased sexual activity http://goo.gl/1uLxb

Oxymetazoline for 1 month adds to nasal steroid effect in perennial allergic rhinitis, without development of rhinitis medicamentosa. JACI, 2011.
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