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Sodium chloride preparations (saline and oral salt tablets): Drug information

Sodium chloride preparations (saline and oral salt tablets): Drug information
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For additional information see "Sodium chloride preparations (saline and oral salt tablets): Patient drug information" and "Sodium chloride preparations (saline and oral salt tablets): Pediatric drug information"

For abbreviations, symbols, and age group definitions show table
Brand Names: US
  • 4-Way Saline [OTC];
  • Afrin Saline Nasal Mist [OTC];
  • Altachlore [OTC];
  • Altamist Spray [OTC];
  • Atrapro Dermal Spray;
  • Ayr Nasal Mist Allergy/Sinus [OTC];
  • Ayr Saline Nasal Drops [OTC];
  • Ayr Saline Nasal Gel [OTC];
  • Ayr Saline Nasal Neti Rinse [OTC];
  • Ayr Saline Nasal No-Drip [OTC];
  • AYR Saline Nasal Rinse [OTC];
  • Ayr Saline Nasal [OTC];
  • Ayr [OTC];
  • Baby Ayr Saline [OTC];
  • Deep Sea Nasal Spray [OTC];
  • DiaB Klenz [OTC] [DSC];
  • Entsol Nasal [OTC] [DSC];
  • HyperSal;
  • Liquivida Hydration [DSC];
  • MicroKlenz Wound Cleanser [OTC] [DSC];
  • Muro 128 [OTC];
  • Nasal Moist [OTC];
  • Nebusal;
  • Ocean Complete Sinus Rinse [OTC];
  • Ocean for Kids [OTC];
  • Ocean Nasal Spray [OTC];
  • Ocean Ultra Saline Mist [OTC];
  • Pretz Irrigation [OTC];
  • Pretz Natur Moist Nasal Spray [OTC];
  • Pretz [OTC];
  • PulmoSal;
  • RadiaKlenz [OTC] [DSC];
  • Remedy 4-in-1 Body Cleanser [OTC] [DSC];
  • Rhinaris [OTC] [DSC];
  • Safe Wash [OTC] [DSC];
  • Saline Flush ZR [DSC];
  • Saline Mist Spray [OTC];
  • Saljet Rinse [OTC];
  • Saljet [OTC];
  • SwabFlush Saline Flush [DSC];
  • True Nasal Moisturizing [OTC];
  • Ultra-Klenz [OTC];
  • Wound Wash Saline [OTC]
Brand Names: Canada
  • Addipak Sodium Chloride;
  • Aquapak;
  • Ballard Unit Dose
Pharmacologic Category
  • Electrolyte Supplement, Parenteral;
  • Genitourinary Irrigant;
  • Irrigant;
  • Lubricant, Ocular;
  • Sodium Salt
Dosing: Adult
Bronchodilator diluent

Bronchodilator diluent: Inhalation: 1 to 3 sprays (1 to 3 mL) to dilute bronchodilator solution in nebulizer before administration.

Corneal edema

Corneal edema:

Ointment: Ophthalmic: Apply a small amount (approximately one-fourth inch) of the ointment to the affected eye(s) every 3 or 4 hours.

Solution: Ophthalmic: Instill 1 to 2 drops into affected eye(s) every 3 to 4 hours.

Cystic fibrosis

Cystic fibrosis (off-label use): Inhalation: 7% hypertonic saline: 4 mL two times daily (Ref). Note: If patients cannot tolerate 7% hypertonic saline, 3% inhaled solution may be used; refer to institutional protocols. Pretreatment with an inhaled bronchodilator is recommended to prevent potential bronchospasm (Ref).

Diabetic ketoacidosis or hyperosmolar hyperglycemic state, fluid management

Diabetic ketoacidosis or hyperosmolar hyperglycemic state, fluid management (off-label use):

Note: Goal of fluid resuscitation is to replace fluid losses, when present, within 24 to 36 hours, with half of fluid losses being replaced within the first 8 to 12 hours (Ref). In patients with chronic kidney disease or congestive heart failure, replace fluids carefully and monitor closely for signs and symptoms of overreplacement (Ref). Refer to institutional protocols.

Initial fluid management: IV: Normal saline (0.9% NaCl): 15 to 20 mL/kg/hour for 1 to 2 hours (usual dose: 1 to 1.5 L/hour) (Ref). Note: In patients with hypovolemic shock, more aggressive fluid replacement may be required (Ref); in euvolemic patients (eg, mild diabetic ketoacidosis [DKA]), fluid replacement is less aggressive and is guided by clinical assessment (Ref). If initial serum glucose is <250 mg/dL, initiate dextrose-containing IV fluids when IV insulin is started (Ref).

Subsequent fluid management: IV: Choice of fluid (normal saline [0.9% NaCl] or half-normal saline [0.45% NaCl]) is based on corrected serum sodium. Individualize rate of replacement and refer to institutional protocols; an example fluid regimen after initial hydration is 4 to 14 mL/kg/hour (usual dose: 250 to 500 mL/hour). Modify fluid replacement rate based on patient-specific factors (Ref).

Note: Once serum glucose approaches 200 to 250 mg/dL (DKA) or 250 to 300 mg/dL (hyperosmolar hyperglycemic state [HHS]), administer dextrose-containing IV fluids at a reduced rate (eg, 150 to 250 mL/hour) until DKA or HHS has resolved (Ref).

Genitourinary irrigant

Genitourinary irrigant: Irrigation: 1 to 3 L/day by intermittent irrigation.

Hypercalcemia, volume replacement

Hypercalcemia, volume replacement (off-label use):

Note: For use with other treatments in patients with volume depletion to restore intravascular volume and to lower serum calcium; most patients with albumin-corrected serum calcium >14 mg/dL (>3.5 mmol/L) will require volume replacement (Ref).

IV: Normal saline (0.9% NaCl): Initial: 1 to 2 L bolus (optional), followed by 150 to 300 mL/hour for 24 to 48 hours or until euvolemic; dose is highly variable and must be guided by clinical assessment. In patients without heart failure or kidney impairment, the usual dose range is ~3 to 6 L of fluids in the first 24 to 48 hours (Ref). Note: In patients with heart failure or kidney impairment, monitor carefully while replacing fluids (Ref); cautious use of loop diuretics (after intravascular volume has been replaced) may be required to prevent fluid overload (Ref).

Hyponatremia

Hyponatremia:

Note: For the correction of acute (<48 hours) or chronic (≥48 hours or duration unknown) hyponatremia. Goal of initial therapy is to achieve a 24 hour increase in serum sodium concentration by 4 to 6 mEq/L (maximum serum sodium increase: 8 mEq/L in any 24-hour period), which is sufficient to improve most symptoms of hyponatremia. However, if patient is symptomatic (acute or chronic hyponatremia), it is recommended to increase serum sodium by 4 to 6 mEq/L within the first 6 hours, then maintain serum sodium at a constant level for the remainder of the 24-hour period. In chronic severe hyponatremia, overcorrection or too rapid correction increases the risk of iatrogenic osmotic demyelination syndrome (Ref). Choice of fluid concentration for sodium correction is dependent upon the severity of the hyponatremia; use hypertonic sodium solutions (eg, 3% NaCl) for symptomatic patients; monitor serum sodium closely during therapy (Ref). The following recommendations are based on use of 3% NaCl:

Acute hyponatremia (serum sodium <130 mEq/L):

Asymptomatic:

Hypertonic saline: 3% NaCl: IV: 50 mL bolus over 10 minutes; monitor serum sodium every 1 to 2 hours to assess need for additional treatment. For treatment goals, refer to "Hyponatremia: Note." Note: Some experts withhold hypertonic saline if hyponatremia is autocorrecting due to water diuresis (Ref).

Symptomatic:

Hypertonic saline: 3% NaCl: IV: 100 mL over 10 minutes; if symptoms persist, may repeat up to a total of 3 doses over a period of 30 minutes; monitor serum sodium hourly to assess need for repeat treatment (Ref). Alternatively, some experts recommend 150 mL over 20 minutes up to a total of 2 doses while measuring serum sodium between infusions (Ref). For treatment goals, refer to "Hyponatremia: Note."

Chronic hyponatremia (serum sodium <130 mEq/L):

Asymptomatic or mild to moderate symptoms, moderate hyponatremia (serum sodium 120 to 129 mEq/L):

IV: Administration of 3% NaCl is generally not indicated; identify reason for hyponatremia and treat as appropriate (Ref). For treatment goals, refer to "Hyponatremia: Note."

Asymptomatic or mild to moderate symptoms, severe hyponatremia (serum sodium <120 mEq/L):

Hypertonic saline: 3% NaCl: IV: Initial: 15 to 30 mL/hour with frequent serum sodium monitoring (eg, every 2 to 6 hours, depending on risk of rapid correction and/or osmotic demyelination syndrome); or alternatively, 1 mL/kg bolus (maximum bolus: 100 mL) over 10 minutes every 6 hours as needed (Ref). For treatment goals, refer to "Hyponatremia: Note." Note: Consider combination therapy with desmopressin to prevent overcorrection in select patients (eg, high risk of developing osmotic demyelination syndrome) (Ref).

Severe symptoms (eg, seizures, obtundation, coma, respiratory arrest) or known intracranial pathology:

Hypertonic saline: 3% NaCl: IV: 100 mL over 10 minutes; if symptoms persist, may repeat up to a total of 3 doses over a period of 30 minutes (Ref). Alternatively, some experts recommend 150 mL over 20 minutes, up to a total of 2 doses while measuring serum sodium between infusions (Ref). For treatment goals, refer to "Hyponatremia: Note."

Intracranial hypertension due to various etiologies, transtentorial herniation syndromes

Intracranial hypertension (refractory) due to various etiologies (eg, subarachnoid hemorrhage, trauma, neoplasm), transtentorial herniation syndromes (off-label use):

IV (via central venous access only): Hypertonic saline: 23.4% NaCl: 15 to 60 mL administered over 2 to 20 minutes (Ref).

Intraosseous: Hypertonic saline: 23.4% NaCl: 30 mL administered over 3 to 5 minutes; remove intraosseous catheter after 24 hours due to the complication risk with prolonged use (Ref).

Intracranial hypertension due to traumatic brain injury

Intracranial hypertension due to traumatic brain injury (off-label use): Note: Optimal dose has not been established; due to insufficient evidence, the Brain Trauma Foundation guidelines do not make specific recommendations on the use of hypertonic saline for the treatment of traumatic intracranial hypertension (Ref). Clinical trials are small; few are prospective. Some concentrations may not be commercially available; protocols include:

Continuous infusion: IV: Hypertonic saline: 3% NaCl: Initial: 30 to 50 mL/hour; titrate to maintain serum sodium between 145 to 155 mEq/L (Ref). May administer 23.4% bolus infusions to treat acute intracranial pressure (ICP) elevations (Ref).

Intermittent bolus dosing: Hypertonic saline:

IV (via central venous access only): 23.4% NaCl: 30 mL administered over 2 to 10 minutes as needed to treat acute ICP elevations (Ref).

IV (via central venous access only): 7.5% NaCl: 2 mL/kg administered over 20 minutes when ICP values exceed 25 mm Hg (Ref).

Intraosseous: 23.4% NaCl: 30 mL administered over 3 to 5 minutes for <24 hours; may be administered prior to administering a 3% NaCl continuous infusion; remove intraosseous catheter after 24 hours due to the complication risk with prolonged use (Ref).

Nasal congestion

Nasal congestion: Intranasal: 2 to 3 sprays in each nostril as needed.

Parenteral nutrition

Parenteral nutrition:

Chloride maintenance electrolyte requirement: IV: As needed to maintain acid-base balance with parenteral nutrition; use equal amounts of chloride and acetate to maintain balance and adjust ratio based on individual patient needs (Ref).

Sodium maintenance electrolyte requirement: IV: 1 to 2 mEq/kg/24 hours; customize amounts based on individual patient needs (Ref).

Sclerotherapy, lower-extremity venous disease

Sclerotherapy, lower-extremity venous disease (off-label use):

Note: May mix with local anesthetic to reduce pain during injection. The following concentrations have been recommended based upon size of affected vein (Ref).

IV: Hypertonic saline:

11.7% to 15% NaCl:

Vessel diameter <0.5 mm: 0.25 mL per injection.

Vessel diameter 0.5 to 1 mm: 0.5 mL per injection.

15% to 23.4% NaCl:

Vessel diameter 1 to 3 mm: 0.5 to 1 mL per injection.

Septic shock or sepsis-induced hypoperfusion, fluid resuscitation

Septic shock or sepsis-induced hypoperfusion, fluid resuscitation (off-label use):

Note: Balanced crystalloids may be preferred over normal saline; however, fluid therapy should be individualized (Ref).

IV: Normal saline (0.9% NaCl): Initial resuscitation: Minimum of 30 mL/kg to be given within the first 3 hours for shock or hypoperfusion. Administer vasopressors during or after fluid resuscitation to maintain a mean arterial pressure ≥65 mmHg; following initial resuscitation, additional fluid administration guided by frequent reassessment of hemodynamic status may be necessary (Ref). Note: Some patients may require more rapid administration and/or greater amount of fluid for complete initial resuscitation (Ref).

Subarachnoid hemorrhage with hyponatremia

Subarachnoid hemorrhage with hyponatremia (ie, ≤133 mEq/L or a decrease by ≥ 6 mEq/L over 24 to 48 hours) (off-label use): IV: Hypertonic saline: 3% NaCl: Initial: 20 mL/hour; titrate by increasing rate by 10 to 20 mL/hour to maintain serum sodium between 136 to 140 mEq/L; may also administer concurrently with oral sodium chloride (Ref).

Wound irrigation

Wound irrigation: Spray affected area.

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Sodium chloride preparations (saline and oral salt tablets): Pediatric drug information")

Note: Systemic hypertonic solutions (>0.9%) should only be used for the initial treatment of acute serious symptomatic hyponatremia or increased intracranial pressure.

Normal daily maintenance sodium requirements (Ref):

Note: Consider all sources of sodium when calculating patient needs; daily maintenance sodium requirements can be met with a combination or enteral and parenteral sources (eg, enteral formulas, IV solutions, parenteral nutrition). Maintenance sodium should be incorporated into the patient's maintenance IV fluids; acid/base balance should be considered when selecting a sodium salt; individualize dose based on patient requirements.

Infants and Children ≤50 kg: Oral, IV: 2 to 5 mEq/kg/day.

Children >50 kg and Adolescents: Oral, IV: 1 to 2 mEq/kg/day.

Hyponatremia

Hyponatremia: Infants, Children, and Adolescents: IV: Note: The choice of saline preparation (eg, 0.9% isotonic solution or 3% hypertonic solution) is based on the presence and severity of symptoms. The use of 3% hypertonic solution is generally limited to symptomatic patients (severe hyponatremia) with neurologic findings (eg, seizures, altered mental status) (Ref).

Symptomatic (severe hyponatremia with severe neurologic symptoms): Limited data available; variable regimens reported: 3% hypertonic solution: Bolus IV infusion: 2 to 5 mL/kg over 20 minutes (maximum dose: 150 mL/dose); monitor serum sodium 20 minutes after dose. If necessary, may repeat up to 2 times if severe symptoms continue (Ref). Alternatively, dosing can be based on the estimation of the sodium deficit* needed to correct the serum sodium by 4 to 6 mEq/L in the initial 1 to 4 hours of symptom onset. Maximum correction rate: 0.5 mEq/L/hour or 10 mEq/L/24 hours (Ref). In cases in which the onset of hyponatremia has been sudden (<24 hours), the rate of correction can match the rate of onset without an mEq/L/hour limit. Note: Continuous infusion of hypertonic saline may be considered, consult institutional policy (Ref).

Asymptomatic or mild to moderate symptoms (mild to moderate hyponatremia): Limited data available: Note: Dosing based on estimation of the sodium deficit* with replacement using 0.9 % isotonic solution over 24 to 48 hours. In general, no more than 50% of sodium deficit should be replaced over 12 hours. Maximum correction rate: 8 mEq/24 hours (chronic hyponatremia duration >48 hours) or 10 mEq/24 hours (acute hyponatremia duration <48 hours) (Ref).

*Sodium deficit (mEq sodium) = [desired serum sodium (mEq/L) - actual serum sodium (mEq/L)] x 0.6 x wt (kg)

Hypovolemic shock

Hypovolemic shock: Infants, Children, and Adolescents: IV: 0.9% isotonic solution: 20 mL/kg/dose; may repeat until blood pressure and markers of cardiac output (eg, capillary refill, heart rate, peripheral pulses) improve or until signs of fluid overload occur; usual requirement is 40 to 60 mL/kg (Ref).

Septic shock

Septic shock: Limited data available: Infants, Children, and Adolescents: IV: 0.9% isotonic solution: 10 to 20 mL/kg/dose; maximum dose: 1,000 mL/dose; repeat every 15 minutes for up to 4 hours (Ref).

Cerebral edema, diabetic ketoacidosis

Cerebral edema, diabetic ketoacidosis: Limited data available: Infants, Children, and Adolescents: 3% hypertonic solution: IV: 2.5 to 5 mL/kg administered over 10 to 15 minutes, can be used as an alternative to mannitol or in those unresponsive to mannitol (Ref).

Increased intracranial pressure, traumatic brain injury

Increased intracranial pressure (ICP), traumatic brain injury (TBI):

Note: Monitor sodium concentration closely, avoid sustained (>72 hours) serum sodium concentrations >170 mEq/L to avoid thrombocytopenia and anemia and avoid serum sodium concentrations >160 mEq/L to avoid deep vein thrombosis (Ref).

Bolus: Limited data available; dosing regimens variable: Infants, Children, and Adolescents: 3% hypertonic solution: IV: 2 to 5 mL/kg administered over 10 to 20 minutes (Ref).

Continuous IV infusion: Infants, Children, and Adolescents: 3% hypertonic solution: IV infusion: 0.1 to 1 mL/kg/hour titrated to maintain ICP <20 mm Hg (Ref); monitor serum sodium concentration closely.

Refractory increased intracranial pressure, traumatic brain injury

Refractory increased intracranial pressure (ICP), traumatic brain injury (TBI): Limited data available: 23.4% hypertonic solution: Infants, Children, and Adolescents: IV: 0.5 mL/kg. Maximum dose: 30 mL/dose. Note: Therapy should not be administered to patients with a serum sodium >155 mEq/L (Ref).

Bronchiolitis, viral

Bronchiolitis, viral (mild to moderate, inpatient):

Note: Current bronchiolitis guidelines do not recommend hypertonic saline to treat infants in the emergency department; however, it may be administered to hospitalized infants and children (Ref).

Infants and Children <18 months: Limited data available, efficacy results variable, optimal dose not defined: Inhalation: 3% solution: 4 mL inhaled every 2 hours for 3 doses followed by every 4 hours for 5 doses and continued every 6 hours until discharge (Ref). Other trials using doses of 2 to 4 mL every 6 hours have shown no benefit (Ref).

Cystic fibrosis

Cystic fibrosis (CF): Children ≥2 years and Adolescents: 7 % solution: Inhalation: 4 mL inhaled twice daily; pretreatment with an inhaled bronchodilator is recommended to prevent potential bronchospasm (Ref). May be considered for use in symptomatic infants <2 years of age (Ref). Note: Clinically, some CF centers use 3% or 3.5% inhaled solutions if patients cannot tolerate 7%.

Nasal dryness/congestion

Nasal dryness/congestion: Note: Consult product-specific labeling for approved use in pediatric patients; available concentrations vary. Intranasal solution:

Infants, Children, and Adolescents: Intranasal: 2 to 6 drops per nostril as needed. Product concentrations vary; most are a 0.65% to 0.9% solution.

Corneal edema

Corneal edema: Infants, Children, and Adolescents: Ophthalmic:

Ophthalmic ointment (5%): Apply small amount (1/4 inch) every 3 to 4 hours as needed.

Ophthalmic solution (5%): Instill 1 to 2 drops into affected eye(s) every 3 to 4 hours as needed.

Adverse Reactions

The following adverse drug reactions are derived from product labeling unless otherwise specified. Reported adverse reactions are for IV (hypertonic, hypotonic, isotonic) solutions.

Postmarketing:

Endocrine & metabolic: Acid-base imbalance (including hyperchloremic metabolic acidosis, metabolic acidosis) (Finfer 2022, Lobo 2012, Semler 2016), electrolyte disorder (including hyperchloremia, hyperkalemia) (Finfer 2022, Lobo 2012, Semler 2016), hypernatremia (Van De Louw 2014), hyponatremia

Hematologic & oncologic: Disorder of hemostatic components of blood (Chang 2016)

Hypersensitivity: Infusion-related reaction (Meng 2018)

Local: Localized phlebitis (Meng 2018)

Renal: Acute kidney injury (Semler 2016), decreased estimated GFR (eGFR) (Semler 2016), decreased renal blood flow (Semler 2016), renal failure syndrome (Shaw 2012)

Miscellaneous: Inflammation (increased inflammatory markers) (Chang 2016)

Contraindications

Hypersensitivity to sodium chloride or any component of the formulation; hypernatremia and/or fluid retention (dosage form specific).

Warnings/Precautions

Concerns related to adverse effects:

• Extravasation: Concentrated solutions of IV sodium chloride (>1%) are irritants (with vesicant-like properties at higher osmolarities); depends on osmolarity; higher osmolarity is associated with a higher risk. Ensure proper needle or catheter placement prior to and during infusion. Avoid extravasation.

• Hemolysis: The use of hypotonic saline solutions (eg, sodium chloride 0.225%) may result in hemolysis if administered rapidly and for prolonged periods. If hypotonic saline solutions become necessary, administration as D5W/NaCl 0.2% or NaCl 0.45% is recommended for most patients (eg, those without hyperglycemia).

Disease-related concerns:

• Cirrhosis: Use with caution in patients with cirrhosis.

• Edema: Use with caution in patients with edema.

• Heart failure: Use with caution in patients with heart failure.

• Hypertension: Use with caution in patients with hypertension.

• Kidney impairment: Use with caution in patients with kidney impairment; may cause sodium retention.

Dosage form specific issues:

• Benzyl alcohol and derivatives: Bacteriostatic sodium chloride contains 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.

• Intravenous: Use caution when choosing from the available parenteral preparations; errors have occurred with choosing the wrong concentration and significant patient harm has occurred upon administration.

• Irrigants: For external use only; not for parenteral use. Do not use during electrosurgical procedures. Irrigating fluids may be absorbed into systemic circulation; monitor for fluid or solute overload.

• Wound Wash Saline: For single-patient use only.

Warnings: Additional Pediatric Considerations

In neonates, maximum serum concentration correction rate should generally not exceed 10 mEq/L/day; in infants, children, adolescents, and adults, do not exceed a maximum serum concentration correction rate of 12 mEq/L/day. Administration of low sodium or sodium free IV solutions may result in significant hyponatremia or water intoxication in pediatric patients; monitor serum sodium concentration.

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).

Dosage Forms Considerations

1 g sodium chloride = elemental sodium 393.3 mg = 17.1 mEq sodium = sodium 17.1 mmol

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Aerosol Solution, Nasal:

Ocean Complete Sinus Rinse: (177 mL)

Aerosol Solution, Nasal [preservative free]:

Ocean Complete Sinus Rinse: (177 mL) [drug free]

Gel, Nasal:

Ayr Saline Nasal: (14.1 g) [contains aloe barbadensis miller, fd&c blue #1 (brilliant blue), methylparaben, propylparaben, soybean oil]

Ayr Saline Nasal No-Drip: (22 mL) [contains aloe barbadensis miller, benzalkonium chloride, benzyl alcohol, soybean oil]

Kit, Intravenous:

Liquivida Hydration: 0.9% [DSC]

Liquid, External:

Atrapro Dermal Spray: (236 mL)

DiaB Klenz: (240 mL [DSC])

MicroKlenz Wound Cleanser: (240 mL [DSC])

RadiaKlenz: (240 mL [DSC])

Remedy 4-in-1 Body Cleanser: 0.5% (236 mL [DSC])

Ultra-Klenz: (240 mL, 360 mL)

Nebulization Solution, Inhalation:

Generic: 0.9% (3 mL); 3% (4 mL); 7% (4 mL)

Nebulization Solution, Inhalation [preservative free]:

HyperSal: 3.5% (4 mL) [latex free]

HyperSal: 7% (4 mL)

Nebusal: 3% (4 mL); 6% (4 mL)

PulmoSal: 7% (4 mL)

Generic: 0.9% (3 mL, 5 mL, 15 mL); 3% (4 mL, 15 mL); 7% (4 mL); 10% (4 mL, 15 mL)

Ointment, Ophthalmic:

Altachlore: 5% (3.5 g)

Muro 128: 5% (3.5 g)

Generic: 5% (3.5 g)

Packet, Nasal [preservative free]:

Ayr Saline Nasal Neti Rinse: Sodium chloride and sodium bicarbonate (40 ea) [iodine free]

AYR Saline Nasal Rinse: Sodium chloride and sodium bicarbonate (50 ea, 51 ea, 100 ea) [iodine free]

Solution, External:

Saljet: 0.9% (30 mL)

Wound Wash Saline: 0.9% (210 mL)

Solution, External [preservative free]:

Safe Wash: 0.9% (210 mL [DSC]) [drug free, latex free]

Saljet Rinse: 0.9% (30 mL)

Solution, Injection:

Generic: 0.9% (2 mL, 10 mL, 20 mL, 30 mL, 100 mL); 14.6% (20 mL, 40 mL)

Solution, Injection [preservative free]:

Generic: 0.9% (2 mL, 3 mL [DSC], 5 mL [DSC], 10 mL, 20 mL, 50 mL)

Solution, Intravenous:

SwabFlush Saline Flush: 0.9% (10 mL [DSC])

Generic: 0.45% (50 mL, 100 mL, 250 mL, 500 mL, 1000 mL); 0.9% (10 mL [DSC], 25 mL, 50 mL, 100 mL, 250 mL, 500 mL, 1000 mL); 3% (500 mL); 5% (500 mL); 23.4% (30 mL, 100 mL, 200 mL [DSC])

Solution, Intravenous [preservative free]:

Saline Flush ZR: 0.9% (2.5 mL [DSC], 5 mL [DSC], 10 mL [DSC]) [latex free]

Generic: 0.45% (50 mL, 100 mL, 250 mL, 500 mL, 1000 mL); 0.9% (1 mL, 2 mL, 2.5 mL, 3 mL, 5 mL, 10 mL, 25 mL, 50 mL, 100 mL, 125 mL, 150 mL, 250 mL, 500 mL, 1000 mL); 3% (500 mL); 23.4% (30 mL [DSC], 200 mL)

Solution, Irrigation:

Generic: 0.9% (100 mL [DSC], 120 mL [DSC], 250 mL, 500 mL, 1000 mL, 1500 mL, 2000 mL, 3000 mL, 4000 mL [DSC], 5000 mL)

Solution, Nasal:

4-Way Saline: (29.6 mL)

Afrin Saline Nasal Mist: 0.65% (30 mL, 45 mL)

Altamist Spray: 0.65% (45 mL, 60 mL)

Ayr: 0.65% (50 mL)

Ayr Nasal Mist Allergy/Sinus: 2.65% (50 mL) [contains benzalkonium chloride]

Ayr Saline Nasal Drops: 0.65% (50 mL)

Baby Ayr Saline: 0.65% (30 mL)

Deep Sea Nasal Spray: 0.65% (44 mL) [contains benzalkonium chloride]

Nasal Moist: 0.65% (15 mL, 45 mL) [contains benzyl alcohol]

Ocean for Kids: 0.65% (37.5 mL) [alcohol free, drug free; contains benzalkonium chloride]

Ocean for Kids: 0.65% (37.5 mL) [drug free; contains benzalkonium chloride]

Ocean Nasal Spray: 0.65% (44 mL, 45 mL, 66 mL, 104 mL, 480 mL) [contains benzalkonium chloride]

Pretz: (50 mL, 946 mL)

Pretz Irrigation: (237 mL)

Rhinaris: 0.2% (30 mL [DSC]) [contains benzalkonium chloride, propylene glycol]

Saline Mist Spray: 0.65% (44 mL) [contains benzalkonium chloride]

True Nasal Moisturizing: 0.65% (50 mL) [contains benzalkonium chloride]

Generic: 0.65% (44 mL, 88 mL [DSC])

Solution, Nasal [preservative free]:

Entsol Nasal: 3% (100 mL [DSC]) [drug free]

Ocean Ultra Saline Mist: (90 mL) [drug free]

Pretz Natur Moist Nasal Spray: (20 mL) [cfc free]

Solution, Ophthalmic:

Altachlore: 5% (15 mL, 30 mL)

Muro 128: 2% (15 mL); 5% (15 mL, 30 mL [DSC])

Generic: 5% (15 mL)

Solution, Oral:

Generic: 4 mEq/mL (23.4%) (473 mL)

Swab, Nasal:

Ayr Saline Nasal Gel: (20 ea) [contains methylparaben, propylparaben, soybean oil, trolamine (triethanolamine)]

Tablet, Oral:

Generic: 1 g

Generic Equivalent Available: US

May be product dependent

Pricing: US

Nebulization (HyperSal Inhalation)

3.5% (per mL): $0.22

7% (per mL): $0.22

Nebulization (Nebusal Inhalation)

3% (per mL): $0.19

6% (per mL): $0.20

Nebulization (PulmoSal Inhalation)

7% (per mL): $0.20

Nebulization (Sodium Chloride Inhalation)

0.9% (per mL): $0.10 - $0.14

3% (per mL): $0.20 - $0.21

7% (per mL): $0.08 - $0.21

10% (per mL): $0.10

Ointment (Altachlore Ophthalmic)

5% (per gram): $3.89

Ointment (Muro 128 Ophthalmic)

5% (per gram): $4.22

Ointment (Sodium Chloride (Hypertonic) Ophthalmic)

5% (per gram): $3.09 - $3.52

Pack (Ayr Saline Nasal Neti Rinse Nasal)

1.57 g (per each): $0.20

Pack (AYR Saline Nasal Rinse Nasal)

1.57 g (per each): $0.08

Solution (Afrin Saline Nasal Mist Nasal)

0.65% (per mL): $0.09

Solution (Altachlore Ophthalmic)

5% (per mL): $1.16

Solution (Ayr Nasal)

0.65% (per mL): $0.05

Solution (Ayr Nasal Mist Allergy/Sinus Nasal)

2.65% (per mL): $0.07

Solution (Ayr Saline Nasal Drops Nasal)

0.65% (per mL): $0.05

Solution (Baby Ayr Saline Nasal)

0.65% (per mL): $0.08

Solution (Muro 128 Ophthalmic)

2% (per mL): $1.21

5% (per mL): $1.28

Solution (Nasal Moist Nasal)

0.65% (per mL): $0.16

Solution (Ocean for Kids Nasal)

0.65% (per mL): $0.08

Solution (Ocean Nasal Spray Nasal)

0.65% (per mL): $0.07

Solution (Saline Bacteriostatic Injection)

0.9% (per mL): $0.11

Solution (Saline Nasal Spray Nasal)

0.65% (per mL): $0.04

Solution (Saljet External)

0.9% (per mL): $0.02

Solution (Saljet Rinse External)

0.9% (per mL): $0.02

Solution (Sodium Chloride (Hypertonic) Ophthalmic)

5% (per mL): $0.35 - $0.70

Solution (Sodium Chloride (PF) Injection)

0.9% (per mL): $0.11 - $4.70

Solution (Sodium Chloride Flush Intravenous)

0.9% (per mL): $0.06 - $0.15

Solution (Sodium Chloride Injection)

2.5 mEq/mL (per mL): $0.11 - $0.26

Solution (Sodium Chloride Intravenous)

0.45% (per mL): $0.01 - $0.02

0.9% (per mL): $0.03 - $0.57

3% (per mL): $0.01 - $0.02

4 mEq/mL (per mL): $0.09 - $0.18

5% (per mL): $0.01 - $0.02

Solution (Sodium Chloride Irrigation)

0.9% (per mL): $0.00 - $0.12

Solution (Sodium Chloride Oral)

4 mEq/mL (per mL): $0.12 - $0.15

Solution (Wound Wash Saline External)

0.9% (per mL): $0.02

Tablets (Sodium Chloride Oral)

1 g (per each): $0.03 - $0.29

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.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Nebulization Solution, Inhalation:

Addipak Sodium Chloride: 0.9% (3 mL, 5 mL, 15 mL)

Aquapak: 0.9% (150 mL, 760 mL, 1070 mL, 2200 mL)

Generic: 0.9% (15 mL)

Solution, Injection:

Generic: 0.9% (10 mL, 20 mL, 30 mL, 50 mL, 100 mL, 250 mL, 500 mL, 1000 mL)

Solution, Intravenous:

Generic: 0.45% (500 mL, 1000 mL); 0.9% (10 mL, 20 mL, 25 mL, 50 mL, 100 mL, 150 mL, 250 mL, 500 mL, 1000 mL); 3% (250 mL, 500 mL); 5% (500 mL); 20% (500 mL); 23.4% (5 mL, 30 mL, 50 mL, 100 mL, 200 mL)

Solution, Irrigation:

Generic: 0.9% (500 mL, 1000 mL, 3000 mL)

Administration: Adult

Ophthalmic: Ophthalmic solution, ointment: Do not touch tip of container to any surface to avoid contamination. Replace cap after use. Do not use solution if the solution color changes or becomes cloudy. Do not use ointment if it is difficult to dispense or if particles are seen in the product. Apply ointment to the inside of the eyelid by first pulling down the lower lid of the affected eye.

Oral inhalation: Nebulization solution: Compatibility with other medications (eg, budesonide) in nebulizer has been reported; also refer to institution-specific policies (Ref). Refer to manufacturer's labeling for additional administration information.

Topical: Irrigation solution: Do not warm >66°C (150°F); not for IV use. Wound Wash Saline: Before use, expel a short stream into air to clear nozzle.

Intraosseous: >2% solutions: Based on data in adult patients, intraosseous administration is a reasonable alternative when quick IV access is not feasible (Ref).

IV:

>2% solutions: Administration through a central venous line is recommended due to high osmolarity and tonicity (Ref). In the absence of a central line and when urgent administration is necessary, 3% solutions may be safely administered through a peripheral venous line (Ref). Concentrations >3% should be administered via central venous line only (Ref). Consult individual institutional policies and procedures.

3% solution: Osmolarity: 1027 mOsm/L; sodium content: 513 mEq/L.

Higher concentrations (>1%) are irritants (with vesicant-like properties at higher osmolarities); higher osmolarity is associated with a higher risk. Ensure proper needle or catheter placement prior to and during infusion; avoid extravasation.

Extravasation management: If extravasation occurs, stop infusion immediately; leave cannula/needle in place temporarily but do NOT flush the line; gently aspirate extravasated solution, then remove needle/cannula; elevate extremity; apply dry warm compresses; initiate hyaluronidase antidote (if indicated) (Ref).

Hyaluronidase: Intradermal or SUBQ: Inject a total of 1 mL (15 units/mL) as 5 separate 0.2 mL injections (using a tuberculin syringe) around the site of extravasation; if IV catheter remains in place, administer IV through the infiltrated catheter; may repeat in 30 to 60 minutes if no resolution (Ref).

Administration: Pediatric

Inhalation: For nebulization, not for IV administration; studies administering hypertonic saline utilized varying types of nebulizers, including jet and ultrasonic.

Nasal: Spray into 1 nostril while gently occluding other.

Ophthalmic: Apply to affected eye(s); avoid contact of bottle tip with eye or skin.

Oral: Administer with full glass of water.

Parenteral: Central-line administration is preferred for hypertonic saline (>0.9%) if available and/or if infusion is to be continued; peripheral administration may be necessary for initiation of treatment in critical patients; use of peripheral administration should be limited; intraosseous administration may be used if unable to obtain intravenous access (Ref).

Rate of administration:

0.9% isotonic solution: Hypotension, shock:

Neonates: Published data not available; consider slower administration to avoid IVH (Ref).

Infants, Children, and Adolescents: Administer boluses by IV push or via rapid infusion device (Ref).

3% hypertonic solution:

>2% solutions: Administration through a central venous line is recommended due to high osmolarity and tonicity (Ref). In the absence of a central line and when urgent administration is necessary, 3% solutions may be safely administered through a peripheral venous line (Ref). Consult individual institutional policies and procedures.

Cerebral edema, diabetic ketoacidosis (DKA): Bolus doses typically administered over 10 to 15 minutes. Longer infusions of 30 minutes have also been described in patients DKA (Ref).

Increased intracranial pressure (ICP), traumatic brain injury (TBI): Bolus doses typically administered over 10 to 20 minutes (Ref).

Symptomatic hyponatremia, severe: Bolus doses typically administered over 20 minutes (Ref).

23.4% hypertonic saline: Increased ICP, TBI: Bolus doses typically administered over 10 minutes (Ref). Note: Concentrations >3% should be administered via central venous line only (Ref).

Higher sodium chloride concentrations (>1%) are irritants (with vesicant-like properties at higher osmolarities [eg, concentrations ≥3%]); higher osmolarity is associated with a higher risk. Ensure proper needle or catheter placement prior to and during infusion; avoid extravasation. If extravasation occurs, stop infusion immediately; leave cannula/needle in place temporarily but do NOT flush the line; gently aspirate extravasated solution, then remove needle/cannula unless needed for IV antidote; elevate extremity; apply dry warm compresses; initiate hyaluronidase antidote if indicated (Ref).

Use: Labeled Indications

Inhalation: Restores moisture to pulmonary system; loosens and thins congestion caused by colds or allergies; diluent for bronchodilator solutions that require dilution before inhalation

Intranasal: Restores moisture to nasal membranes

Irrigation: Wound cleansing, irrigation, and flushing

Ophthalmic: Temporary reduction of corneal edema.

Parenteral: Restores sodium ion in patients with restricted oral intake (especially hyponatremia states or low salt syndrome).

Concentrated sodium chloride: Additive for parenteral fluid therapy

Hypertonic sodium chloride: For severe hyponatremia and hypochloremia

Hypotonic sodium chloride: Hydrating solution

Normal saline: Restores water/sodium losses

Use: Off-Label: Adult

Cystic fibrosis; Diabetic ketoacidosis or hyperosmolar hyperglycemic state, fluid management; Hypercalcemia, volume replacement; Refractory elevated intracranial pressure; Sclerotherapy, lower-extremity venous disease; Septic shock or sepsis-induced hypoperfusion, fluid resuscitation; Subarachnoid hemorrhage; Transtentorial herniation syndrome; Traumatic brain injury with elevated intracranial pressure

Medication Safety Issues
Sound-alike/look-alike issues:

Afrin (saline) may be confused with Afrin (oxymetazoline)

High alert medication:

The Institute for Safe Medication Practices (ISMP) includes this medication (IV, hypertonic >0.9% concentration) among its list of drugs which have a heightened risk of causing significant patient harm when used in error (High-Alert Medications in Acute Care Settings).

Other safety concerns:

Per The Joint Commission (TJC) recommendations, concentrated electrolyte solutions (eg, NaCl >0.9%) should not be available in patient care areas.

Inappropriate use of low sodium or sodium-free intravenous fluids (eg, D5W, hypotonic saline) in pediatric patients can lead to significant morbidity and mortality due to hyponatremia (ISMP 2009).

Metabolism/Transport Effects

None known.

Drug Interactions

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 drug interactions program by clicking on the “Launch drug interactions program” link above.

Lithium: Sodium Chloride may increase the excretion of Lithium. Risk C: Monitor therapy

Tolvaptan: Sodium Chloride may enhance the adverse/toxic effect of Tolvaptan. Specifically, Hypertonic Saline may increase the risk for too rapid of an increase in serum sodium concentrations. Management: This interaction is specific to hypertonic saline. Avoid concurrent use of hypertonic saline with tolvaptan. Risk X: Avoid combination

Pregnancy Considerations

Sodium and chloride requirements do not change during pregnancy (IOM 2005; NAS 2019).

Nasal saline may be used for the treatment of pregnancy rhinitis (Dykewicz 2020) and to clear nasal secretions in pregnant patients with cystic fibrosis (Edenborough 2008).

Breastfeeding Considerations

Sodium and chloride are present in breast milk.

Sodium and chloride requirements do not change during lactation (IOM 2005; NAS 2019).

Monitoring Parameters

Serum sodium, potassium, chloride, bicarbonate concentrations, and osmolarity; intake and output, weight. Monitor infusion site (during IV administration of hypertonic solutions).

Diabetic ketoacidosis or hyperosmolar hyperglycemic state: Frequent monitoring (eg, every 1 to 4 hours) of serum electrolytes (eg, sodium, potassium, bicarbonate, phosphate), serum glucose, anion gap, venous pH, serum BUN, serum creatinine, serum osmolality, fluid status (eg, blood pressure, fluid intake/output, signs/symptoms of dehydration or fluid overload), anion gap, and mental status. Refer also to institutional protocols (Hirsch 2022; Kitabchi 2009).

Reference Range

Note: Reference ranges may vary depending on the laboratory.

Serum/plasma sodium concentration: 136 to 145 mEq/L (SI: 136 to 145 mmol/L).

Mechanism of Action

Principal extracellular cation; functions in fluid and electrolyte balance, osmotic pressure control, and water distribution

Pharmacokinetics (Adult Data Unless Noted)

Absorption: Oral: Rapid

Distribution: Widely distributed

Excretion: Primarily urine; also sweat, tears, saliva

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Apisal | Apisal stuffy nose | Clear mist | Fess | Fess little noses | Nasomist plus | Normaline | Salinex | Salinose;
  • (AR) Argentina: Arlyt fill | Clorhyp atom | Cloruro de sodio norgreen | Larmabak | Mar v | Muro 128 | Naclor | Oftalook | Refenax salino | Relente | Respisol | Solucion Fisiologica | Solucion fisiologica de cloruro de sodio | Solucion fisiologica jayor | Solucion isotonica de cloruro de sodio | Totalatlas;
  • (AU) Australia: Apohealth saline | Aqafy | Chemists' Own saline | Cipla saline | Crystawash | Dimetapp infants nasal relief | Fess little noses | Flo baby saline | Metagenics nasoclear | Muro 128 | Narium natural mist | NeilMed NasaDrops | Otrivin saline | Pharmacy choice saline | Terry white chemists saline | Toppin salt | Trust for kids saline infant drops | Trust saline nasal spray | Zepclear;
  • (BD) Bangladesh: Happysol | Hypersol | I sol | N sol | Ncl | Normal saline | Nosomist | Saloride | Sodiclor | Solo | Xenosol;
  • (BE) Belgium: Chlorure de sodium | Naaprep | Physiorhine;
  • (BF) Burkina Faso: Chlorure de sodium | Chlorure de sodium b. braun;
  • (BR) Brazil: Adnasal | Bem care | Blusoro jet | Clinaris | Cloreto de sodio | Cloreto de sodio baxter | Cloreto de sodio jp fisiologico | Conidrin | Conidrin baby | Deltasoro | Eflua | Fluinasal | Fluzap | Hipertonic | Maresis | Maresis ht | Maxidrate | Multisoro jet | Naridrin aqua | Naridrin bebe | Naridrin h | Naridrin jet | Narilivre | Narisoro | Narix jet | Nasalfree | Nasoclean | Nasofar | Nasofar ad | Nasojet | Nasojet 3h | Nasojet maris | Nasolac | Nasonew | Nasonew aires | Nasonew infantil | Nazosoro | Neosoro h | Novosoro h | Rinoar | Rinosoft | Rinosoft baby | Rinosoft s | Rinosoro jet xt | Rinosoro Sic | Rinospray | Salsep | Salsep jet | Salsep jet kids | Sanoclear | Sinurest | Snif | Snif sc | Snouse | So-Soro Infantil | Solucao de cloreto de sodio b.braun | Solucao fisiologica | Solucao fisiologica a 0,9% | Solucao fisiologica de cloreto de sodio | Solucao fisiologica de cloreto de sodio equiplex | Solucion Fisiologica | Solusam | Sonarin infantil | Soridrat | Sorine | Sorine h | Sorisma e | Soro fisiologico | Sorofar | Sorofar H | Soroliv hipertonico | Soroneo | Triane soro fisiologico;
  • (CH) Switzerland: Hydrabak | NaCl | NaCl b.braun | NaCl Bioren | NaCl Fresenius | Nacl sintetica | Otrivin natural | Physiologic gifrer | Siccoral;
  • (CI) Côte d'Ivoire: Axaline ns | Chlorure de sodium | Sodium chlorure nirma | Steriline | Steriline plus;
  • (CL) Chile: Fisiolimp | Larmabak | Mokit off | Mokit off kids | Nasakid | Nasalub max | Nasamist | Nasitral;
  • (CN) China: Ai na duo | Concentrated sodium chloride | Sodium chloride physiological;
  • (CO) Colombia: Afrisal | Allerzitina | Bio nasal | Cloruro de sodio | Efrimel nasal | Fisioline | Fluimucil Aqua | Frekaflex | Humenas | Humenas gl | Na trol | Nasaler | Nasalub adultos | Nasivin aqua | Natrum mur | Physiocean | Rhifisol | Sinuphis | Sodio cloruro | Solucion cs pisa | Solucion fisiologica de cloruro de sodio | Solucion salina | Solucion salina normal | Suero fisiologico | Suero fisiologico nasalin;
  • (CZ) Czech Republic: Ardeaelytosol conc. natriumchlorid | Ardeaelytosol f 1/1 | Fyziologicky roztok viaflo;
  • (DE) Germany: Abtei meersalz | Biochemie pfluger nr 8 | Broncholind nasen | Coldamaris | Hysan salinspray | Kochsalz | NaCl b.braun | Nasendusche | Omni sorb | Schwedentabletten | Siccoral | Sm;
  • (DO) Dominican Republic: Cloruro de sodio | Clorusod | Hiperton | Hypersol | Sanalimp | Solucion cs pisa;
  • (EC) Ecuador: Afrisal | Bioglo tear | Cloruro de sodio | Cloruro de sodio sanderson | Estericlean cloruro de sodio | Fisiol ub | Fisionasal | Mar v | Nasitral | Nasoclean | Nasoxy | Physiodose | Retaine NaCl | Rinokid | Sodio cloruro | Soletrol na | Soludial | Suero fisiologico;
  • (EE) Estonia: Coldamaris | Edenorm | Hydrabak | Miwana | Muro 128 | Sodium chloride kabi;
  • (EG) Egypt: Salinex | Salinol;
  • (ES) Spain: Bucalsone | Hidrathea | Meinvenil fisiologico | Salina fisiologica grifols;
  • (ET) Ethiopia: Abnal | Normal saline | Ns;
  • (FI) Finland: Natriumklorid abboxia | Natriumklorid abcur | Otrimer;
  • (FR) France: Larmabak | Multilarm | Unilarm;
  • (GB) United Kingdom: Calpol Saline Nasal Drops | Calpol Saline Nasal Spray | Easyflex n iso nacl | Irriclens | Mucoclear | Nasosal | Natklor | Optiflo s | Pf drops sodium chloride | Sodiclor | Sterile mandanol | Sterowash | Syrisal | Tixylix;
  • (GR) Greece: Sodium chlorid/baxter | Sodium chloride demo | Sodium chloride/bradex;
  • (HK) Hong Kong: Larmabak;
  • (HN) Honduras: Nostrila;
  • (HR) Croatia: Natrii chloridi infundibile | Natrijev klorid | Natrijev klorid viaflo;
  • (HU) Hungary: Salsol;
  • (ID) Indonesia: Iliadin moist | Sanbreth;
  • (IE) Ireland: Sodium chloride braun | Stericlens | Syrisal | Tixylix;
  • (IL) Israel: Tipotaf;
  • (IN) India: Acolate saline | Acusalt | Addna | Clarivion | Clearnoz ns | Cliarway | Easnoze | Ecoflac plus ns | Hafnor | Hitsol | I rinse | Isol | Karvol clear | Lcz ns | Maxtra s | Moistwin | More Na | Musing | Nasalt | Naseon | Nasivion s | Nasoclear | Nasoclear plus | Nasokid | Nasoline | Nasomist | Nazalin s | Nazodrop | Nazone | Nazosis | Nesobest s | Noseon | Nozeclear | Nozuka nasal spray | Nusodium | Osmogel | Osolin | Revosal | Rhinoset s | Salin | Saline | Salinex | Saltnase | Sane ns | Sinomet s | Socl | Sodeem | Soline | Solspre | Solvin | Vilco nasal drops s | Vitrinal | Zoamet s;
  • (IQ) Iraq: Baby nose;
  • (IT) Italy: Edenorm | Sodio cloruro baxter s.p.a. | Sodio cloruro Gambro Dasco | Sodio cloruro panpharma;
  • (JO) Jordan: Apisal | Drossa Nose | Edenorm | Hynasal | Nasosal | Nazex;
  • (KE) Kenya: Abnal | Nasosal | Normal saline | Novorin | Ns | Rinz normal saline | Saline;
  • (KR) Korea, Republic of: B. braun sodium chloride | Binex isotonic sodium chloride | Cleancle | Conafresh | Daihan isotonic sodium chloride | Daihan sodium chloride | Daihan sodium chloride 40 | Encle | Fess natural | Genuone isotonic sodium chloride | Huons sodium chloride | Hypertonicity ophthalmic | Inno.n 0.45% sodium chloride | Inno.n 0.9% sodium chloride | Inno.n 0.9% sodium chloride irrigation | Jw 0.45% sodium chloride | Jw ns | Klenzo | Metarivin nasal wash | Mg normal saline | Muro 128 | Nasaline plus | Otrisal | Otrivin baby natural | Samjin normal saline | Sodium chlorid | Uk sodium chloride;
  • (KW) Kuwait: Antiedema | Fess eucalyptus | Fess little noses | Fess original | Nasosal | Nisita;
  • (LB) Lebanon: Physiosol | Salinose | Serum physiologique;
  • (LT) Lithuania: Edenorm;
  • (LV) Latvia: Coldamaris | Edenorm | Hydrabak | Natrii chloridum | Normgel | Tetrisoft e;
  • (MA) Morocco: Larmabak | Ocusalin | Rhina care;
  • (MX) Mexico: Biogalenic ele | Brisamar | Clorurosodica alpha | Ecf ns | Hiperton | Misalati | Nasalub adultos | Salt claire | Sodiamsa | Solucion cs c 17.7% pisa | Solucion cs pisa | Solucion isotonica de cloruro de sodio al 0.9% pisa | Solucion isotonica de cloruro de sodio cryopharma | Ssb pisa;
  • (MY) Malaysia: Cleaq | Infusol hs | Infusol S3;
  • (NG) Nigeria: Bioflex sodium chloride | Normal saline | Salacyn | Unisal | Vitadium;
  • (NL) Netherlands: Natriumchloride;
  • (NO) Norway: Muro 128 | Natriumklor naf | Natriumklorid abboxia | Natriumklorid abcur | Natriumklorid apl | Sodium chloride akorn;
  • (NZ) New Zealand: Apohealth saline | Fess original | Medco sinus clear | Muro 128 | Pharmacy health saline | Schuessler tissue salts fluid balance nat mur | Trust saline nasal spray;
  • (OM) Oman: Apisal;
  • (PE) Peru: Cloruro de sodio | Rhino bb | Rhino clo | Rinokid;
  • (PH) Philippines: Euro Med Sodium Chloride | Hyperton opta | Nasalden | Nasoclear | Salinase | Sydenase;
  • (PK) Pakistan: Celine | Gee sol ns | Immuasol ns | Macsol ns | Medisol ns | Nadosaline | Normal saline | Norsaline p | Nsline | Revasol ns | Safesol ns | Salub | Searle ns | Unisol ns | Visoline | Zeesol ns;
  • (PL) Poland: Natrium chloratum baxter | Nebu dose hipertonic | Ocusalin;
  • (PR) Puerto Rico: Atrapro dermal | Nasamist | Neilmed pediamist;
  • (PT) Portugal: Cloreto de sodio | Salina fisiologica grifols;
  • (PY) Paraguay: Baby rhinol | Bonair | Cloruro de sodio 3 molar catedral | Cloruro de sodio 3 molar dutriec | Cloruro de sodio 3 molar lasca | Cloruro de sodio bergamo | Cloruro de sodio prosalud | Cloruro de sodio sanderson | Hypersol | Nasoplus | Nicorin | Parsol | Rhino mar | Silimar | Solucion fisiologica de cloruro de sodio b braun | Solucion fisiologica de cloruro de sodio baxter | Solucion fisiologica de cloruro de sodio demotek | Solucion fisiologica de cloruro de sodio roux ocefa | Solucion fisiologica diproan | Solucion fisiologica isotonica imeg | Suero fisiologico | Suero fisiologico icu vita | Xylisol cassara;
  • (QA) Qatar: Apisal | Apisal Jet Dead Sea Adult & Children | Apisal Jet Dead Sea Baby | Baby Nadif (Hypertonic) | Baby Nadif (Isotonic) | Nisita | Norsalin | Otrisalin | Physiodose | Rinomist Spray | Sinomarin Cold & Flu Relief | Slow Sodium | Snufflebabe Nasal Drops | Sterimar Baby Hypertonic | Sterimar Baby Isotonic | Sterimar Congestion Relief | Sterimar Copper | Sterimar Hygiene | Sterimar Nasal Hygiene | Steripod UD | Tonimer Lab | Tonimer Lab Normal | Tonimer Saline Baby Spray;
  • (RO) Romania: Larmabak;
  • (RU) Russian Federation: Aqua rinosol | Aquamaster | Natrium chloridum | Nazol aqua | Physiodose | Rizosin | Salin | Sodium chlorid;
  • (SA) Saudi Arabia: Apisal | Drossa Nose | Edenorm | Nasosal | Normaline | Salinex | Salinose hypertonic;
  • (SE) Sweden: Addex-natriumklorid | Natriumklorid abboxia | Natriumklorid abcur | Natriumklorid braun;
  • (SG) Singapore: Hypergel | Larmabak | Naspira | Normlgel | Otrivin saline | Rinz normal saline;
  • (SI) Slovenia: Fizioloska raztopina za nos;
  • (SK) Slovakia: Chlorid sodny 0,9 % Imuna envibag | Infusio natrii chlorati isotonica imuna;
  • (SL) Sierra Leone: Ns;
  • (TH) Thailand: Hashi baby drop gentle formula | Soride | Virx nasal spray;
  • (TN) Tunisia: Chlorure de sodium | Chlorure sodium | Nasoclean | Rhina care | Tonimer Baby;
  • (TR) Turkey: Hipertonik sodyum klorur | Izotonik sodyum klorur bfs | Lafleks izotonik sodyum klorur | Larmabak | Neofleks izotonik sodyum klorur sudaki solusyonu | Polifleks %0,9 izotonik sodyum klorur | Pro fleks izotonik sodyum klorur | Sodyum klorur | Turkfleks izotonik sodyum klorur;
  • (UA) Ukraine: Aquamax | Natrium chloratum | No sol | Nosalen | Solutio Natrii chloridi;
  • (UG) Uganda: Abnal | Ns;
  • (UY) Uruguay: Beltears | Cloruro de sodio | Narixol | Nasal | Nasitral | Saline | Saline hipertonico | Snif | Snif sc | Xylisol | Xylisol cassara;
  • (VE) Venezuela, Bolivarian Republic of: Fisiolin | Larmabak | Salafrin;
  • (VN) Viet Nam: Natri clorid | Osla | Salnor;
  • (ZA) South Africa: Aquamist | Autoststeril sodium chloride | Bennetts Saline Nose Spray | Euro Med Sodium Chloride | Flamirins | Iliadin saline nose drops | Just saline | Kleer Naze | Kuraflo | Linctagon | Linctomed | Sabax pour saline | Saline spray;
  • (ZM) Zambia: Abnal | Sabax sodium chloride;
  • (ZW) Zimbabwe: Sodium chloride b.braun | Sodium chloride fresenius | Sodium chloride iv
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