Adult: For the symptomatic relief of congestion associated with common cold, hay fever, sinusitis or other respiratory allergies: As 0.05% nasal spray: 1-2 sprays into each nostril bid or tid. Alternatively, 2-3 sprays into each nostril bid (Max: 2 doses/24 hours). As 0.05% nasal drops: Instil 1-2 drops into each nostril bid or tid. Dosing recommendations may vary among individual products and between countries (refer to specific product guidelines). Child: As 0.025% nasal drops: 1-<6 years Instil 1-2 drops into each nostril bid or tid. As 0.05% nasal drops: ≥6 years Same as adult dose. As 0.05% nasal spray: ≥6 years 2-3 sprays into each nostril bid. Treatment and dosing recommendations may vary among individual products and between countries (refer to specific product guidelines).
Ophthalmic Acquired blepharoptosis
Adult: As 0.1% solution: Instil 1 drop into the affected eye(s) once daily.
Topical/Cutaneous Persistent facial erythema associated with rosacea
Adult: As 1% cream: Apply a pea-sized amount to the entire face once daily.
What are the brands available for Oxymetazoline in Hong Kong?
Nasal: Angle-closure glaucoma; phaeochromocytoma; inflammation or lesions of the skin around the nostrils or nasal mucosa, rhinitis sicca; acute coronary disease, cardiac asthma; transsphenoidal hypophysectomy or nasal surgery exposing the dura mater. Concomitant use or within 2 weeks of discontinuing MAOIs.
Special Precautions
Patient with diabetes mellitus, thyroid disease; CV disease (e.g. hypertension), angina; prostatic hypertrophy, genitourinary obstruction; occlusive vascular disease, thromboangiitis obliterans, scleroderma, cerebral or coronary insufficiency, Raynaud's phenomenon, Sjogren's syndrome; angle-closure glaucoma (ophthalmic or topical). Renal and hepatic impairment. Children. Pregnancy and lactation.
Adverse Reactions
Significant: Rebound nasal congestion (frequent or prolonged use); local nasal effects (e.g. burning, stinging, sneezing, increased nasal discharge); ptosis associated with neurologic or orbital disease (ophthalmic). Cardiac disorders: Rarely, tachycardia, palpitations. Eye disorders: Punctate keratitis, conjunctival hyperaemia, blurred vision (ophthalmic). Rarely, eye irritation, dryness, discomfort or redness. Gastrointestinal disorders: Rarely, nausea. General disorders and administration site conditions: Application site dermatitis, erythema or pain (topical). Nervous system disorders: Headache. Psychiatric disorders: Rarely, insomnia, nervousness, anxiety, irritability. Respiratory, thoracic and mediastinal disorders: Rarely, nasal discomfort, nasal irritation or dryness. Skin and subcutaneous tissue disorders: Worsening inflammatory lesions of rosacea (topical).
Patient Counseling Information
Ophthalmic: Remove contact lenses before administration and reinsert after 15 minutes.
Overdosage
Symptoms: Nausea, fever, lowering of the body temperature, mydriasis, cyanosis, dyspnoea, apnoea, psychic disturbance, somnolence, bradycardia, tachycardia, cardiac arrhythmia, hypotension, hypertension, loss of consciousness. Management: Symptomatic and supportive treatment. May perform gastric lavage or administer activated charcoal and cathartic in case of moderate or severe inadvertent oral ingestion. May give nonselective α-blockers (e.g. phentolamine) for high blood pressure. Cardiorespiratory resuscitation (e.g. tracheal intubation, mechanical ventilation) may be required in serious cases.
Drug Interactions
Increased risk of hypertension with MAOIs. Additive effect with other sympathomimetics (e.g. ephedrine, pseudoephedrine). May increase the risk of hypertension and arrhythmias with TCAs, appetite suppressants, amphetamine-like psychostimulants. Increased risk of dysrhythmias with cardiac glycosides. May antagonise the effects of β-blockers and other antihypertensive agents (e.g. methyldopa, bethanidine, debrisoquine, guanethidine). Increased risk of ergotism with ergotamine and methysergide. May cause an additive CV toxicity with antiparkinsonian agents (e.g. bromocriptine). May enhance the adverse effect with levothyroxine.
Action
Description: Mechanism of Action: Oxymetazoline is a direct-acting sympathomimetic amine. It stimulates α-adrenergic receptors in the arterioles of the nasal mucosa, thereby producing vasoconstriction and decongestion. Additionally, it stimulates the tarsal muscle of the eyelid. Furthermore, topical application decreases erythema through direct vasoconstriction. Onset: Local vasoconstriction: Within 10 minutes (nasal); within minutes (ophthalmic). Duration: Local vasoconstriction: Up to 12 hours (nasal); up to 6 hours (ophthalmic). Pharmacokinetics: Absorption: Ophthalmic: Time to peak plasma concentration: Median: 2 hours (range: 0.5-12 hours). Distribution: Plasma protein binding: 56.7-57.5%. Metabolism: Minimally metabolised in the liver into mono-oxygenated and dehydrogenated products of oxymetazoline. Excretion: Ophthalmic: Terminal elimination half-life: 8.3 hours (range: 5.6-13.9 hours).
Chemical Structure
Oxymetazoline Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 4636, Oxymetazoline. https://pubchem.ncbi.nlm.nih.gov/compound/Oxymetazoline. Accessed Sept. 25, 2024.
S01GA04 - oxymetazoline ; Belongs to the class of sympathomimetics used as ophthalmologic decongestants. D11AX27 - oxymetazoline ; Belongs to the class of other dermatologicals. R01AA05 - oxymetazoline ; Belongs to the class of topical sympathomimetic agents used as nasal decongestants.
References
Afrin No Drip Severe Congestion Spray, Metered (Bayer HealthCare LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 19/07/2024.Anon. Oxymetazoline Hydrochloride (EENT). AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 19/07/2024.Anon. Oxymetazoline Hydrochloride (Topical). AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 19/07/2024.Brayfield A, Cadart C (eds). Oxymetazoline Hydrochloride. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 19/07/2024.ClariClear Nasal Spray 0.05% (Bayer Co. [Malaysia] Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 19/07/2024.Equaline Nasal Spray (United Natural Foods, Inc. dba UNFI). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 19/07/2024.Oxymetazoline (Nasal). UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 19/07/2024.Oxymetazoline (Ophthalmic). UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 19/07/2024.Oxymetazoline (Topical). UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 19/07/2024.Rhofade Cream (EPI Health, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 19/07/2024.Upneeq Ophthalmic Solution/Drops (RVL Pharmaceuticals, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 19/07/2024.Vicks Sinex Micromist (Procter & Gamble [Health & Beauty Care] Limited). MHRA. https://products.mhra.gov.uk. Accessed 19/07/2024.Vicks Sinex Soother Nasal Spray (Procter & Gamble [Health & Beauty Care] Limited). MHRA. https://products.mhra.gov.uk. Accessed 19/07/2024.Xylocon 0.025% and 0.05% Nasal Drops (Medispec [M] Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 19/07/2024.
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