Is your medication making you sick?

By Peter Jaret

updated 1:53 p.m. ET Nov. 23, 2009

You take pain medication for a headache... and it gets worse. Is this possible? The answer is yes. It's called the rebound effect, and researchers say this happens startlingly often. In some cases, a user takes too much of a drug or makes an incorrect self-diagnosis; in others, it's a quirk of the remedy itself. Whatever the reason, a vicious cycle develops, as patients go on using the offending medicine, hoping they'll soon see improvement if they take just a little more.

Some of the most widely used prescriptions and OTC drugs and products can cause the rebound effect. At any given time, 3 million Americans suffer headaches brought on by taking pain relievers, according to Stephen D. Silberstein, MD, a professor of neurology and director of the Jefferson Headache Center at Thomas Jefferson University. Other common remedies that may worsen the condition they're meant to help include decongestant sprays, sleeping pills, and teeth whiteners.

If you think you're experiencing rebound, bring this up with your physician. "Some doctors may not be aware that drugs they recommend are causing a problem, not solving it," says Silberstein. They may even tell patients to increase the dosage when the real solution is quitting the medication altogether, he says.

Here's a checklist of symptoms that may mean you're experiencing medication rebound effect and the best methods for getting rid of the problem, once and for all.

Perpetually stuffy nose

The culprit: OTC nasal sprays

The cause: These products, which contain the vasoconstrictor oxymetazoline, tighten tiny nasal blood vessels to clear out stuffiness. "Unfortunately, they can also exacerbate swelling and congestion," says Richard F. Lockey, MD, an allergy expert at the University of South Florida. After several days of use, your blood vessels can lose the ability to constrict on their own. Then, when you stop the spray, the nasal passages swell. In a study of 500 patients at an allergy clinic, 9 percent suffered from this problem.

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What to do: Use a spray containing oxymetazoline no more than 5 days in a row, and never exceed the recommended dosage. If you think you're suffering from rebound congestion, see your doctor. "For some patients, switching to a prescription nasal steroid drug can help restore blood vessel function and reduce congestion," says Lockey. If your congestion stems from allergies, you may need the steroid spray through allergy season. If you have mild congestion, however, relieve it with a saline spray or a neti pot.

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Skin flare-ups

The culprit: OTC and prescription corticosteroid (cortisone) creams

The cause: Although they offer powerful temporary relief from the itching and flaking of rashes, these preparations can also cause severe flare-ups of redness. With prescription creams, if your skin gets worse while using it or when you stop — and especially if the itching turns into burning — that could indicate rebound, according to UCLA dermatologist Marvin J. Rapaport, MD, who has treated 2,000 patients with steroid-rebound flare-ups over the past 20 years.

The steroids work by constricting the skin's blood vessels, thereby clearing up any redness and the accompanying irritation, explains Rapaport. But when you discontinue the steroids, the blood vessels can react by overdilating and getting stuck in the "open" position, causing a skin flare-up. If you medicate with yet more cream, you perpetuate the symptoms and the "rash," he says.

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What to do: Use an OTC cream for no more than 7 days, especially on the face and groin. If you've been using a steroid-based cream for longer and suffer persistent rashes, see your doctor. "The only solution is to stop the steroids completely," says Rapaport. That will allow blood vessels to function normally again. The downside: It can take a year or more for complete recovery. During that time, ease symptoms with nonsteroidal moisturizers and cool showers.

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