Topical Alpha-Adrenergic Agonist (Nasal Decongestant) Pregnancy: Avoid — potential vasoconstrictive effects on placenta; minimal data

Oxymetazoline (Nasal Decongestant)

Brand names: Sudafed Nasal Spray, Afrin

Adult dose

Dose: 0.05% solution: 2–3 sprays per nostril every 8–12h as needed. Maximum duration: 3–5 days.

Route: Intranasal

Frequency: Every 8–12h PRN

Max: 3–5 days continuous use

For acute nasal congestion. STRICTLY maximum 3–5 days — rebound congestion (rhinitis medicamentosa) if used longer. Do not use in children <6 years (risk of CNS toxicity — profound drowsiness).

Paediatric dose

Route: Intranasal

Frequency: Every 8–12h

Max: Maximum 3 days use

Concentration: 0.025% (children 6–12); 0.05% (adults/children >12) drops/sprays/ml

Children 6–12 years: 0.025% solution (lower concentration) 1–2 sprays per nostril every 8–12h, max 3 days. NEVER use in children <6 years — CNS toxicity reported (profound somnolence, hypothermia, bradycardia).

Dose adjustments

Renal

N/A

Hepatic

N/A

Clinical pearls

Rhinitis medicamentosa: dependence and rebound congestion if used >5 days — treatment involves gradual cessation, intranasal steroids, and reassurance
Paediatric toxicity: children <6 years are at risk of severe CNS depression from topical decongestants — associated fatalities reported; absolute contraindication
Pregnancy: avoid — limited data; intranasal steroid preferred for chronic congestion in pregnancy

Contraindications

Age <6 years
Narrow-angle glaucoma
Coronary artery disease (relative)

Side effects

Rebound congestion (rhinitis medicamentosa) with use >5 days
Burning/stinging
Dryness
Hypertension (systemic absorption at high doses)
Bradycardia (rare)

Interactions

MAOIs — hypertensive crisis
Tricyclics — enhanced pressor response

Monitoring

Duration of use (<5 days)
Rebound congestion symptoms
Blood pressure (if extensive use)

Reference: BNFc; BNF; MHRA OTC Decongestant Safety; EMA Paediatric Decongestant Review. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways