Combined Oxymetazoline and Budesonide Relieves Nasal Obstruction: JAMA

To test whether the addition of a high-dose corticosteroid prevents topical decongestant-induced rebound and tachyphylaxis, a study of double-blind, single-center, randomized control trials took place between October 2024 to July 2025 at Washington University in St. Louis and Barnes-Jewish Hospital. Among the 87 patients who were screened, 61 gave informed consent and 60 adults (mean age 47.5 ± 17.5 years; 23 [76.7%] female) that have been diagnosed with nasal obstruction (who were not previously able to get relief from topical steroid monotherapy but without chronic sinusitis).

They were randomized into the group receiving two doses daily of oxymetazoline combined with budesonide spray (n=31; mean age 46.0 ± 18.7 years; 18 [58.1%] female) or budesonide alone (n=29; mean age 51.2 ± 17.1 years; 17 [58.6%] female). The patients received active therapy for 4 weeks and then 3 weeks of a weaning schedule. Ten patients received paired pretreatment and posttreatment biopsy of inferior turbinate mucosa for histopathological validation. The end point was responder rate (≥moderate on the CGI-I).

Key findings:

• The primary and secondary statistical analyses performed among the 60 randomized patients showed definite advantages of the combination treatment arm on the clinical level.
• By the end of 4 weeks of active therapy, 24 out of 29 patients (83%) in the oxymetazoline/budesonide combination therapy group were considered treatment responders, whereas only 10 out of 28 patients (36%) in the budesonide monotherapy group received this designation.
• This was accompanied by an absolute risk difference of 47 percentage points (95% confidence interval, 25 to 70 percentage points; p < .001).
• No patient in the oxymetazoline/budesonide combination therapy arm experienced an increase in nasal airway resistance or deterioration of the Clinical Global Impression–Severity score suggesting the development of rhinitis medicamentosa during the active 4-week period.
• All patients in the combination therapy group managed to discontinue oxymetazoline in 3 weeks of tapering without rebound congestion or withdrawal symptoms.

In summary, results from a 4-week randomized trial support that the use of oxymetazoline combined with budesonide nasal spray provides better decongestion effects than monotherapy with steroids in chronic rhinitis patients. The findings from the study demonstrate that using both agents allows for avoidance of oxymetazoline-induced rhinitis medicamentosa and helps in weaning successfully.

Reference:

Cruz L, Rammell J, Kallogjeri D, et al. Nasal Obstruction and Treatment With Oxymetazoline and Corticosteroids: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg. Published online October 29, 2026. doi:10.1001/jamaoto.2026.3297