Products
Numerous nasal sprays containing vasoconstrictive agents are commercially available. Among the best known are xylometazoline (Otrivin, generic) and oxymetazoline (Nasivin). In addition to sprays, nasal drops and nasal gels are also available. Decongestants for the nose have been available since the early 20th century (Sneader, 2005). As early as the 1940s, rhinitis medicamentosa was reported in association with the use of naphazoline (Privin, Ciba) and similar drugs.
Structure and properties
The active ingredients are sympathomimetics that are structurally related to the endogenous catecholamines epinephrine and norepinephrine. The imidazolines – they are derivatives of imidazole – are the most commonly used today.
Effects
The nasal sprays (ATC R01AA) have sympathomimetic, vasoconstrictor, decongestant, and antisecretory properties. They reduce nasal running and facilitate breathing. Furthermore, they open the excretory ducts of the sinuses and keep the auditory tube clear. The active ingredients contained are direct or indirect sympathomimetics, which lead to a constriction of the nasal vessels by stimulating alpha-adrenoceptors. The effects occur immediately or after a few minutes and last up to 12 hours for both oxymetazoline and xylometazoline.
Indications
Decongestant nasal sprays are mainly used for the treatment of a rhinitis and for nasal congestion of various causes. Other indications include:
- Sinusitis (acute sinusitis).
- Otitis media
- To facilitate rhinoscopy
- Lack of pressure equalization in the ears, tubal catarrh.
- Nosebleeds
In the case of allergic rhinitis, specific anti-allergic nasal sprays such as antihistamine nasal sprays or glucocorticoid nasal sprays should preferably be used, as they can be used for a longer period of time.
Dosage
According to package insert. Adults usually give one spray into the nostrils about three times daily. Different guidelines apply to infants and children. Medicines should not be used for more than a maximum of 5 to 7 days. Sprays without preservatives should be preferred.
- Clean the nose before use.
- Remove the protective cap.
- Pump several times before the first application until the spray comes out.
- Insert the spray into the nostril and press down once.
- Inhale lightly while spraying.
- Repeat the procedure with the second nostril.
- Clean the front of the spray with a paper tissue.
- After use, replace the protective cap.
For hygienic reasons and to prevent infection, each spray should be used by only one person.
Medication overuse
With prolonged use, decongestant nasal sprays can lead to a condition called rhinitis medicamentosa. It manifests as chronic swelling of the mucosa. Patients develop a dependence on the nasal spray, which is needed again and again to clear the nose. See also under medication overuse.
Active ingredients
Medications containing the following substances are available in many countries:
- Oxymetazoline (Nasivin).
- Phenylephrine (Vibrocil)
- Tuaminoheptane (Rinofluimucil)
- Xylometazoline (e.g., Otrivin, Triofan, generics).
Other active ingredients exist, such as naphazoline and tramazoline.
Contraindications
- Hypersensitivity
- Dry nasal mucosa (rhinitis sicca).
- Atrophic rhinitis
- Narrow-angle glaucoma
- After transnasal or transoral surgical procedures.
Refer to the drug label for complete precautions.
Interactions
Drug-drug interactions have been described with MAO inhibitors, tricyclic antidepressants, and bleeding-increasing drugs.
Adverse effects
The most common possible adverse effects include:
- Dry nose, burning sensation, rhinitis medicamentosa.
- Headache
- Nausea
Decongestant nasal sprays can cause rhinitis medicamentosa if used improperly.
