What Drugs Cause a Stuffy Nose? A Comprehensive Guide to Drug-Induced Rhinitis

October 6, 2025 •

4 min read

According to a 2022 review, drug-induced rhinitis is a form of non-allergic rhinitis that can be caused by numerous medications, with an estimated prevalence of about 1%. Understanding what drugs cause a stuffy nose is crucial for identifying the root cause of persistent nasal congestion that isn't due to allergies or infection. This article provides an in-depth look at the various pharmaceutical agents responsible for causing a stuffy nose and offers insight into effective management strategies.

Quick Summary

Drug-induced rhinitis manifests as nasal congestion resulting from certain systemic and topical medications. Common culprits include the overuse of nasal decongestant sprays leading to rebound congestion, certain blood pressure medications, erectile dysfunction drugs, hormonal agents, and nonsteroidal anti-inflammatory drugs. The condition often resolves upon discontinuation or substitution of the problematic medication.

Key Points

Rhinitis Medicamentosa: Overusing topical nasal decongestant sprays is a frequent cause of rebound congestion.
Hypertension Medications: ACE inhibitors, beta-blockers, and calcium channel blockers can cause nasal congestion due to vasodilation.
Erectile Dysfunction Drugs: PDE5 inhibitors like sildenafil cause systemic vasodilation that includes the nasal mucosa.
Psychotropic Medications: Some antidepressants and antipsychotics can cause rhinitis by affecting the autonomic nervous system.
Treatment Requires Identification: Resolving drug-induced rhinitis involves identifying and stopping or substituting the problematic medication under medical guidance.
Symptomatic Relief Options: Nasal saline, intranasal corticosteroids, and temporary oral steroids can help manage symptoms during treatment.

Understanding Drug-Induced Rhinitis

Drug-induced rhinitis is a non-allergic inflammation of the nasal mucous membranes caused by certain medications. It differs from allergic rhinitis as it doesn't involve an immune response to an allergen. Instead, medications can impact nasal passages by affecting the autonomic nervous system's control over blood vessels, leading to vasodilation and congestion. Recognizing this side effect is important, as it's often mistaken for other conditions like chronic sinusitis or allergies. Reviewing a patient's medication history is key to proper diagnosis and treatment.

Rhinitis Medicamentosa: The Rebound Effect

A frequent cause of drug-induced nasal congestion is rhinitis medicamentosa, which results from the overuse of topical decongestant sprays. These sprays contain vasoconstrictors like oxymetazoline or phenylephrine that temporarily shrink nasal blood vessels. However, exceeding the recommended use of 3 to 5 days can lead to dependency and a cycle of worsening congestion when the spray wears off—known as rebound congestion. This overuse can potentially cause long-term nasal damage.

Common Prescription Medications That Cause Congestion

Various oral medications can also cause rhinitis systemically. Key classes include:

Cardiovascular Medications

Drugs for high blood pressure and heart issues are significant contributors to drug-induced rhinitis.

Angiotensin-Converting Enzyme (ACE) Inhibitors: Medications such as lisinopril and captopril can induce nasal congestion, similar to their known cough side effect, potentially due to the buildup of inflammatory substances.
Beta-Blockers: Drugs like propranolol and metoprolol may cause congestion by reducing sympathetic nerve activity, leading to vasodilation in the nasal mucosa.
Calcium Channel Blockers (CCBs): CCBs such as amlodipine and diltiazem can cause nasal congestion by inhibiting calcium influx into vascular smooth muscle, promoting vasodilation and mucosal edema.
Alpha-Adrenergic Blockers: Used for conditions like hypertension, these medications (e.g., doxazosin) can cause congestion by lowering sympathetic tone in nasal passages.

Erectile Dysfunction (ED) Drugs

Phosphodiesterase Type 5 (PDE5) Inhibitors: Medications like sildenafil and tadalafil used for ED cause widespread vasodilation, including in nasal blood vessels, leading to congestion.

Psychotropic Drugs

Antidepressants: Both older tricyclic antidepressants and newer SSRIs (like escitalopram) may cause nasal congestion, possibly due to their impact on neurotransmitters that regulate the autonomic nervous system.
Antipsychotics and Tranquilizers: Certain medications, such as chlorpromazine, can induce rhinitis by affecting autonomic control, leading to vasodilation.

Other Culprits and Illicit Substances

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): In some sensitive individuals, NSAIDs like aspirin can trigger non-allergic rhinitis, sometimes as part of aspirin-exacerbated respiratory disease (AERD).
Oral Contraceptives and Hormonal Therapies: Hormonal changes from sources like oral contraceptives or hormone therapy can cause nasal congestion, potentially due to the effect of estrogen receptors in the nasal lining.
Cocaine: Snorting cocaine, a strong vasoconstrictor, can damage the nasal lining over time, resulting in chronic rhinitis, inflammation, and tissue destruction.

Comparison of Medications Causing Stuffy Nose


Drug Class	Examples	Mechanism of Action	Common Symptoms	Potential Severity	Patient Action
Topical Decongestants	Oxymetazoline, Phenylephrine	Overuse leads to rebound vasodilation and swelling	Worsening congestion, dependency	Moderate to severe, especially with prolonged use	Stop use (can be challenging), consult doctor for weaning strategy
ACE Inhibitors	Lisinopril, Captopril	Accumulation of bradykinin leads to vasodilation	Nasal congestion, dry cough	Mild to moderate	Discuss switching to an ARB with your doctor
PDE5 Inhibitors	Sildenafil, Tadalafil	Systemic vasodilation affects nasal blood vessels	Stuffy/runny nose, headache	Mild to moderate	Use nasal saline or consult doctor if persistent
Beta-Blockers	Propranolol, Metoprolol	Decreased sympathetic nerve activity leads to vasodilation	Nasal congestion, fatigue	Mild to moderate	Discuss alternative medication options with your doctor
NSAIDs	Aspirin, Ibuprofen	Inhibition of COX-1 in sensitive individuals	Nasal inflammation, congestion	Varies, can be part of broader AERD	Avoid NSAIDs if sensitive, use alternatives like acetaminophen
Oral Contraceptives	Combined hormonal pills	Hormonal fluctuations affect nasal mucosa receptors	Nasal stuffiness, especially during cycles	Mild to moderate	Discuss potential alternatives with your healthcare provider

Management and Treatment Options

Treating drug-induced rhinitis primarily involves identifying and stopping the problematic medication, always under medical supervision. If the medication is essential, a doctor might suggest an alternative without the same side effect. Symptomatic treatments can help manage congestion:

Cessation of Topical Decongestants: For rhinitis medicamentosa, stopping the spray is necessary. Short-term oral or intranasal corticosteroids and saline sprays can help manage withdrawal symptoms.
Intranasal Corticosteroids: Sprays like fluticasone effectively reduce nasal inflammation and can be used long-term.
Saline Nasal Sprays and Rinses: Saltwater solutions help moisturize nasal passages and clear irritants, providing relief.
Intranasal Antihistamines: These can be beneficial for reducing symptoms in some cases of non-allergic rhinitis.
Humidification: Using a humidifier can help keep nasal passages moist and comfortable.

Conclusion

While colds and allergies are common causes of a stuffy nose, various medications can also be responsible, from over-the-counter decongestants causing rebound congestion to prescription drugs for conditions like hypertension or erectile dysfunction. It's important not to overlook persistent congestion, especially if it starts after beginning a new medication. Consulting a healthcare provider is essential to identify the cause and find effective, long-term relief without compromising overall health. For further information on non-allergic rhinitis, consult resources like the American Academy of Family Physicians.

Frequently Asked Questions

Yes, several types of blood pressure medications can cause nasal congestion. These include ACE inhibitors (like lisinopril), beta-blockers, and calcium channel blockers. They primarily work by affecting the blood vessels, which can lead to vasodilation and swelling in the nasal passages.

Rebound congestion, or rhinitis medicamentosa, is a cycle of worsening nasal stuffiness caused by the overuse of topical decongestant nasal sprays like oxymetazoline (Afrin) or phenylephrine. After using them for more than 3-5 days, the nasal tissues become dependent, and swelling returns more severely once the medication wears off.

Yes, erectile dysfunction drugs, known as PDE5 inhibitors (e.g., sildenafil, tadalafil), commonly cause nasal congestion. This is because they promote vasodilation throughout the body, including the blood vessels within the nose.

Some antidepressants, including SSRIs (like escitalopram) and tricyclic antidepressants, have been reported to cause nasal congestion. This side effect is often linked to their influence on the autonomic nervous system.

You should never stop a prescription medication without first consulting a healthcare provider. They can help identify if your medication is the cause and recommend a safe plan, which may include discontinuing, tapering the dose, or switching to an alternative treatment.

Yes, oral contraceptives and other hormonal therapies can sometimes cause nasal congestion, or hormonal rhinitis. This is thought to be due to hormonal fluctuations affecting the estrogen receptors in the nasal mucosa.

The most effective treatment for rebound congestion is to stop using the topical decongestant spray completely. Your doctor may prescribe a short course of oral or intranasal steroids and recommend using saline sprays to help manage symptoms during the withdrawal period.