oxymetazoline hydrochloride
Afrin, Allerest 12 Hour Nasal Spray, Benzedrex 12-hour Nasal Spray, Ceracol Nasal Spray, Dristan Long Lasting, Duramist Plus, Duration, 4-Way Long Lasting Spray, Genasal Decongestant Spray, Neo-Synephrine 12 Hour Nasal Spray, Nostrilla Long Acting Nasal Decongestant, NTZ Long Acting Decongestant Nasal Spray, OcuClear, Oxymeta-12 Spray, Sinarest 12 Hour Nasal Spray, Vicks Sinex Long-Acting, Visine L.R.

Available forms
Available without a prescription
Nasal drops or spray: 0.05%
Nasal solution: 0.025% (drops) for children
Ophthalmic solution: 0.025%

Indications and dosages
 Nasal congestion. Adults and children older than age 6: 2 to 3 drops or sprays of 0.05% solution in each nostril q 10 to 12 hours for no longer than 3 to 5 days. Dosage for younger children hasn’t been established.
 Relief of minor eye redness. Adults and children older than age 6: 1 to 2 drops in the conjunctival sac up to q.i.d. (spaced at least 6 hours apart).

Pharmacodynamics
Decongestant action: Oxymetazoline produces local vasoconstriction of arterioles through alpha receptors to reduce blood flow and nasal congestion.

Pharmacokinetics
Absorption: Occasional systemic absorption may occur.
Distribution: Unknown.
Metabolism: Unknown.
Excretion: Unknown.

Contraindications and precautions
Contraindicated in patients hypersensitive to drug. Ophthalmic form contraindicated in patients with angle-closure glaucoma.
 Use cautiously in patients with hyperthyroidism, cardiac disease, or hypertension and in those receiving MAO inhibitors. Use nasal solution cautiously in patients with diabetes mellitus. Use ophthalmic form cautiously in those with eye disease, infection, or injury.

Interactions
Drug-drug. Beta blockers: May increase systemic adverse effects. Monitor patient carefully.
Local anesthetics: May increase absorption of ophthalmic form. Monitor patient closely.
Tricyclic antidepressants: May potentiate pressor effects from significant systemic absorption of the decongestant. Monitor patient carefully.

Adverse reactions
CNS: headache; insomnia; drowsiness, dizziness, and possible sedation from nasal form; light-headedness and nervousness from ophthalmic form.
CV: palpitations; CV collapse and hypertension with nasal form; tachycardia, bradycardia, and irregular heartbeat with ophthalmic form.
EENT: rebound nasal congestion or irritation with excessive or long-term use, dryness of nose and throat, increased nasal discharge, stinging, sneezing (with nasal form); transient stinging upon instillation, blurred vision, reactive hyperemia, keratitis, lacrimation, increased intraocular pressure (with ophthalmic form).
Other: systemic effects in children (with excessive or long-term use of nasal form); trembling (with ophthalmic form).

Effects on lab test results
None reported.

Overdose and treatment
Signs and symptoms of overdose include somnolence, sedation, sweating, CNS depression with hypertension, bradycardia, decreased cardiac output, rebound hypertension, CV collapse, depressed respirations, and coma.
 If drug is ingested, emesis isn’t recommended (unless given early) because of rapid onset of sedation. Activated charcoal or gastric lavage may be used initially. Monitor vital signs and ECG. Treat seizures with I.V. diazepam.

Special considerations
• Excessive dosing may irritate nasal mucosa and cause rebound congestion (nasal) or rebound hyperemia (ophthalmic).
• Watch for adverse reactions in patients with CV disease, diabetes mellitus, or prostatic hypertrophy because systemic absorption can occur.
Pediatric patients
• Children may exhibit increased adverse effects from systemic absorption; 0.05% nasal solution is contraindicated in children younger than age 6; 0.025% nasal solution should be used in children younger than age 2 only under medical direction and supervision.
Geriatric patients
• Use drug cautiously in elderly patients with cardiac disease, poorly controlled hypertension, or diabetes mellitus.

Patient education
• Emphasize that only one person should use dropper bottle or nasal spray.
• Advise patient not to exceed recommended dosage and to use drug only when needed.
• Tell patient to stop drug and report symptoms that persist after 3 days of self-medication.
• Tell patient that nasal mucosa may sting, burn, or become dry.
• Warn patient that excessive use may cause bradycardia, hypotension, dizziness, and weakness.
• Show patient how to apply drug. Have him bend head forward and sniff spray briskly or apply light pressure on lacrimal sac after instillation of eyedrop.

Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE THREATENING.
◆ Canada only
◇ Unlabeled clinical use