Version May 2024
Nasal congestion: Intranasal: Instill 2 to 3 sprays into each nostril twice daily (maximum dose: 2 doses/24 hours).
Duration: Generally limit to 3 to 5 days of consecutive use due to risk of rhinitis medicamentosa (Ref). In patients with persistent symptoms despite use of first-line therapies, some guidelines suggest oxymetazoline may be offered in combination with an intranasal corticosteroid for up to 4 weeks with low risk of rhinitis medicamentosa (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in manufacturer’s labeling.
There are no dosage adjustments provided in manufacturer’s labeling.
Refer to adult dosing.
(For additional information see "Oxymetazoline (nasal): Pediatric drug information")
Nasal congestion: Children ≥6 years and Adolescents: 0.05% solution: Intranasal: Instill 2 to 3 sprays into each nostril twice daily; doses should be separated by 10 to 12 hours; maximum daily dose: 2 doses/24 hours; therapy should not exceed 3 days. Note: Intranasal not recommended for use in children <6 years of age (especially in infants) due to CNS depression.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in manufacturer's labeling.
There are no dosage adjustments provided in manufacturer's labeling.
There are no adverse reactions listed in the manufacturer's labeling.
Postmarketing:
Cardiovascular: Acute coronary syndrome (Montastruc 2014), acute myocardial infarction (Rajpal 2014), angina pectoris (Shah 2018), cardiac arrhythmia (Shah 2018), hypertension (including hypertensive crisis) (Shah 2018, Loewen 2004), hypotension (Shah 2018), palpitations (Loewen 2004), syncope (Shah 2018)
Nervous system: Cerebrovascular accident (Cantu 2003), headache (including severe headache [thunderclap]) (Loewen 2004), subarachnoid hemorrhage (Cantu 2003)
OTC labeling: When used for self-medication, do not use for more than 3 days.
Concerns related to adverse effects:
• Local nasal effects: Temporary discomfort such as burning, stinging, sneezing, or an increased nasal discharge may occur.
• Rebound nasal congestion: Frequent or prolonged use may cause nasal congestion to recur or worsen.
Disease-related concerns:
• Cardiovascular disease: Use with caution in patients with hypertension or heart disease.
• Diabetes: Use with caution in patients with diabetes mellitus.
• Thyroid disease: Use with caution in patients with thyroid disease.
• Prostatic hyperplasia/urinary obstruction: Use with caution in patients with prostatic hyperplasia and/or GU obstruction.
Dosage form specific issues:
• Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer’s labeling.
• Polysorbate 80: Some dosage forms may contain polysorbate 80 (also known as Tweens). Hypersensitivity reactions, usually a delayed reaction, have been reported following exposure to pharmaceutical products containing polysorbate 80 in certain individuals (Isaksson 2002; Lucente 2000; Shelley 1995). Thrombocytopenia, ascites, pulmonary deterioration, and renal and hepatic failure have been reported in premature neonates after receiving parenteral products containing polysorbate 80 (Alade 1986; CDC 1984). See manufacturer’s labeling.
Other warnings/precautions:
• Accidental ingestion: Accidental ingestion by children of over-the-counter (OTC) imidazoline-derivative eye drops and nasal sprays may result in serious harm. Serious adverse reactions (eg, coma, bradycardia, respiratory depression, sedation) requiring hospitalization have been reported in children ≤5 years of age who had ingested even small amounts (eg, 1 to 2 mL). Contact a poison control center and seek emergency medical care immediately for accidental ingestion (FDA Drug Safety Communication 2012).
• Self-medication (OTC use): When used for self-medication (OTC), do not exceed recommended dosages; use of this container by more than one person may spread infection.
Some dosage forms may contain propylene glycol; in neonates large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Shehab 2009).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, Nasal, as hydrochloride:
12 Hour Decongestant: 0.05% (30 mL) [contains benzalkonium chloride, edetate (edta) disodium dihydrate, polyethylene glycol (macrogol), propylene glycol]
12 Hour Nasal Decongestant: 0.05% (30 mL) [contains benzalkonium chloride, benzyl alcohol, edetate (edta) disodium, polyethylene glycol (macrogol)]
12 Hour Nasal Relief Spray: 0.05% (15 mL [DSC], 30 mL)
12 Hour Nasal Spray: 0.05% (30 mL) [contains benzalkonium chloride]
Afrin 12 Hour: 0.05% (30 mL) [contains benzalkonium chloride, disodium edta, polyethylene glycol (macrogol), propylene glycol]
Afrin Menthol Spray: 0.05% (15 mL)
Afrin Nasal Spray: 0.05% (15 mL [DSC])
Afrin Nasal Spray: 0.05% (15 mL [DSC], 20 mL [DSC], 30 mL [DSC]) [contains benzalkonium chloride, disodium edta]
Afrin NoDrip Extra Moisture: 0.05% (15 mL) [contains benzalkonium chloride]
Afrin NoDrip Original: 0.05% (15 mL) [contains benzalkonium chloride]
Afrin NoDrip Sinus: 0.05% (15 mL) [contains benzalkonium chloride, menthol]
Dristan Spray: 0.05% (15 mL [DSC]) [contains benzalkonium chloride, disodium edta]
FT Nasal Spray: 0.05% (30 mL) [contains benzalkonium chloride, edetate (edta) disodium, menthol, polysorbate 80]
Long Lasting Nasal Spray: 0.05% (30 mL) [contains benzalkonium chloride]
Mucinex Childrens Stuffy Nose: 0.05% (22 mL [DSC]) [contains benzalkonium chloride, disodium edta, menthol, polysorbate 80, propylene glycol]
Mucinex Sinus-Max Clear & Cool: 0.05% (22 mL) [contains benzalkonium chloride, edetate (edta) disodium, menthol, polyethylene glycol (macrogol), polysorbate 80, propylene glycol]
Mucinex Sinus-Max Sinus/Allrgy: 0.05% (22 mL) [contains benzalkonium chloride, disodium edta, propylene glycol]
Nasal Decongestant Spray: 0.05% (15 mL) [contains benzalkonium chloride, benzyl alcohol, edetate (edta) disodium, propylene glycol]
Nasal Decongestant Spray: 0.05% (15 mL, 30 mL) [contains benzalkonium chloride, edetate (edta) disodium, polyethylene glycol (macrogol), propylene glycol]
Nasal Spray Max Strength: 0.05% (30 mL) [gluten free; contains benzalkonium chloride, benzyl alcohol, disodium edta]
QlearQuil: 0.05% (15 mL) [contains benzalkonium chloride, disodium edta]
Vicks Sinex 12 Hour Decongest: 0.05% (15 mL) [contains benzalkonium chloride, disodium edta]
Vicks Sinex Moisturizing: 0.05% (15 mL) [contains benzalkonium chloride, benzyl alcohol, edetate (edta) disodium, polysorbate 80]
Vicks Sinex Severe Decongest: 0.05% (15 mL) [contains benzalkonium chloride, benzyl alcohol, edetate (edta) disodium, menthol, polysorbate 80]
Generic: 0.05% (30 mL)
Yes
Solution (Afrin Menthol Spray Nasal)
0.05% (per mL): $0.40
Solution (Afrin NoDrip Original Nasal)
0.05% (per mL): $0.38
Solution (Giltuss Severe Sinus Nasal)
0.05% (per mL): $0.49
Solution (Mucinex Sinus-Max Clear & Cool Nasal)
0.05% (per mL): $0.40
Solution (Mucinex Sinus-Max Sinus/Allrgy Nasal)
0.05% (per mL): $0.40
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Intranasal: For intranasal use only. Shake well before use (varies by product; also refer to manufacturer’s labeling). Before using for the first time, prime the pump by firmly depressing the rim several times. Keep head upright and insert nozzle into nostril, depress rim firmly, and inhale deeply.
Intranasal: For intranasal use only. Shake well before use. Before using for the first time, follow directions per labeling for any applicable priming. Keep head upright (do not tilt) during administration. Insert nozzle/applicator into nostril. Spray or apply drops into each nostril.
Nasal congestion: Temporary relief of nasal congestion (due to a cold, hay fever, or other upper respiratory allergies) and sinus congestion/pressure.
Topical vasoconstriction in nasal procedures
Oxymetazoline may be confused with oxymetholone
Afrin may be confused with aspirin
Afrin (oxymetazoline) may be confused with Afrin (saline)
Neo-Synephrine (oxymetazoline) may be confused with Neo-Synephrine (phenylephrine, nasal)
Accidental ingestion: Serious adverse reactions (eg, coma, bradycardia, respiratory depression, sedation) requiring hospitalization have been reported in children ≤5 years of age who have accidentally ingested even small amounts (eg, 1-2 mL) of imidazoline-derivative (ie, tetrahydrozoline, oxymetazoline, or naphazoline) eye drops or nasal sprays. Store these products out of reach of children at all times. Contact poison control or seek medical attention if accidental ingestion occurs.
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Alpha1-Blockers: May diminish the vasoconstricting effect of Alpha1-Agonists. Similarly, Alpha1-Agonists may antagonize Alpha1-Blocker vasodilation. Risk C: Monitor therapy
Atomoxetine: May enhance the hypertensive effect of Sympathomimetics. Atomoxetine may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy
Atropine (Systemic): May enhance the hypertensive effect of Alpha1-Agonists. Risk C: Monitor therapy
Bromocriptine: May enhance the hypertensive effect of Alpha1-Agonists. Management: Consider alternatives to this combination when possible. If combined, monitor for hypertension and tachycardia, and do not coadminister these agents for more than 10 days. Risk D: Consider therapy modification
Cannabinoid-Containing Products: May enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy
Cocaine (Topical): May enhance the hypertensive effect of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. Risk D: Consider therapy modification
Doxofylline: Sympathomimetics may enhance the adverse/toxic effect of Doxofylline. Risk C: Monitor therapy
Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates): May enhance the vasoconstricting effect of Alpha1-Agonists. Risk X: Avoid combination
Esketamine: Decongestants (Nasally Administered) may diminish the therapeutic effect of Esketamine. Management: Patients who require a nasal decongestant on an esketamine dosing day should administer the nasal decongestant at least 1 hour before esketamine. Risk D: Consider therapy modification
FentaNYL: Decongestants may decrease the serum concentration of FentaNYL. Risk C: Monitor therapy
Guanethidine: May enhance the arrhythmogenic effect of Sympathomimetics. Guanethidine may enhance the hypertensive effect of Sympathomimetics. Risk C: Monitor therapy
Iobenguane Radiopharmaceutical Products: Alpha1-Agonists may diminish the therapeutic effect of Iobenguane Radiopharmaceutical Products. Management: Discontinue all drugs that may inhibit or interfere with catecholamine transport or uptake for at least 5 biological half-lives before iobenguane administration. Do not administer these drugs until at least 7 days after each iobenguane dose. Risk X: Avoid combination
Kratom: May enhance the adverse/toxic effect of Sympathomimetics. Risk X: Avoid combination
Levothyroxine: May enhance the adverse/toxic effect of Sympathomimetics. Specifically, the risk of coronary insufficiency may be increased in patients with coronary artery disease. Levothyroxine may enhance the therapeutic effect of Sympathomimetics. Sympathomimetics may enhance the therapeutic effect of Levothyroxine. Risk C: Monitor therapy
Linezolid: May enhance the hypertensive effect of Sympathomimetics. Management: Consider initial dose reductions of sympathomimetic agents, and closely monitor for enhanced blood pressure elevations, in patients receiving linezolid. Risk D: Consider therapy modification
Lisuride: May enhance the hypertensive effect of Alpha1-Agonists. Risk X: Avoid combination
Monoamine Oxidase Inhibitors: May enhance the hypertensive effect of Alpha1-Agonists. While linezolid is expected to interact via this mechanism, management recommendations differ from other monoamine oxidase inhibitors. Refer to linezolid specific monographs for details. Risk X: Avoid combination
Ozanimod: May enhance the hypertensive effect of Sympathomimetics. Risk C: Monitor therapy
Pergolide: May enhance the hypertensive effect of Alpha1-Agonists. Risk C: Monitor therapy
Solriamfetol: Sympathomimetics may enhance the hypertensive effect of Solriamfetol. Sympathomimetics may enhance the tachycardic effect of Solriamfetol. Risk C: Monitor therapy
Sympathomimetics: May enhance the adverse/toxic effect of other Sympathomimetics. Risk C: Monitor therapy
Tedizolid: May enhance the hypertensive effect of Sympathomimetics. Tedizolid may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy
Tricyclic Antidepressants: May enhance the therapeutic effect of Alpha1-Agonists. Tricyclic Antidepressants may diminish the therapeutic effect of Alpha1-Agonists. Risk C: Monitor therapy
Zavegepant: Decongestants (Nasally Administered) may decrease the serum concentration of Zavegepant. Management: Avoid the concurrent administration of intranasal decongestants with zavegepant. If combined use is unavoidable, intranasal decongestants should be administered at least 1 hour after zavegepant administration. Risk D: Consider therapy modification
Adverse fetal/neonatal events have been noted in case reports following large doses or extended use of oxymetazoline nasal spray in the first trimester of pregnancy (Baxi 1985; Holm 1985; Menezes 2016). Fetal blood flow was not found to be affected by a one-time dose of oxymetazoline in noncomplicated, third trimester pregnancies (Rayburn 1990).
Decongestants are not recommended for the treatment of rhinitis during pregnancy (BSACI [Scadding 2017]). Use of oxymetazoline nasal spray can be considered if acute relief is needed (Mazzotta 1999).
If a decongestant is needed, nasal preparations may be preferred over systemic agents in nursing women (Anderson 2000).
Stimulates alpha-adrenergic receptors in the arterioles of the nasal mucosa to produce vasoconstriction
Onset of action: Within 10 minutes (Chua 1989)
Duration: Up to 12 hours (Chua 1989)
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