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Topical Alpha-Adrenergic Agonist (Nasal Decongestant) Pregnancy: 'The safety of use in pregnancy has not fully been established and administration of oxymetazoline hydrochloride during pregnancy should be avoided unless absolutely essential. Animal studies do not indicate direct or indirect harmful effects with respect pregnancy, embryonal/foetal development, parturition or postnatal development. The recommended dose should not be exceeded because overdosing can decrease placental blood flow. Caution should be exercised during pregnancy and lactation as oxymetazoline may be systemically absorbed.' Lactation: 'It is not known if oxymetazoline hydrochloride is excreted into breast milk. The recommended dose should not be exceeded because overdosing can reduce milk production. A risk to the infants cannot be excluded.' Fertility: 'There are no known effects of oxymetazoline treatment on fertility.'

Oxymetazoline (Nasal Decongestant)

Brand names: Sudafed Nasal Spray, Afrin

Oxymetazoline is a topical nasal decongestant applied as drops or spray for short-term relief of nasal congestion in colds, sinusitis and allergic rhinitis.

Adult dose

Dose: Relief of nasal congestion in conditions such as the common cold, catarrh and hayfever - oxymetazoline hydrochloride 0.05% w/v nasal spray: while holding upright, insert the spray nozzle into each nostril in turn and squeeze lightly twice while breathing in (adults and the elderly)
Route: Intranasal (nasal spray)
Frequency: The application may be repeated up to 2 times a day, or used at bedtime to give relief through the night; not for more than 7 consecutive days
UK SPC section 4.2, Adults and Elderly: 'While holding upright the spray nozzle should be inserted into each nostril in turn and squeezed lightly twice while breathing in. The application may be repeated up to 2 times a day, or used at bedtime to give relief through the night.' 'Oxymetazoline hydrochloride 0.05% Nasal Spray should not be used for more than 7 consecutive days.' 'The recommended daily dosage or the specified number of doses should not be exceeded.' Strength (section 2): the nasal solution contains oxymetazoline hydrochloride 0.05% w/v. Section 4.4: if symptoms persist or do not improve after 7 days, a doctor should be consulted; use for no more than 7 consecutive days avoids rebound effect and drug-induced rhinitis (rhinitis medicamentosa). Keep away from eyes. Stop using the medicine if hallucinations, restlessness or sleep disturbances occur. Children: 'Do not give to children under 12 years of age' - contraindicated under 12 years. Scope: this card covers only the pinned 0.05% w/v nasal spray (UK own-brand decongestant sprays under one licence); other oxymetazoline products, strengths and regimens (including the brands named on this page) differ and are not covered by this SPC.

Dose adjustments

Renal

No dose adjustment is stated in the SPC. Section 4.4: consult a doctor before using this medicine in patients with hepatic and renal disorders.

Hepatic

No dose adjustment is stated in the SPC. Section 4.4: consult a doctor before using this medicine in patients with hepatic and renal disorders.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via MHRA Products — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to oxymetazoline or to any of the excipients (section 4.3)
  • Phaeochromocytoma; patients who have had trans-sphenoidal hypophysectomy (removal of the pituitary gland); patients who have recently had nasal or sinus surgery (section 4.3)
  • Concomitant use of other sympathomimetic decongestants (section 4.3)
  • Inflamed skin or mucous membranes of the nostrils, or scabs in the nose; atrophic rhinitis or rhinitis sicca (section 4.3)
  • Cardiovascular disease (including hypertension); diabetes mellitus; hyperthyroidism; closed-angle glaucoma (section 4.3)
  • Currently taking monoamine oxidase inhibitors (MAOIs), or within 14 days of stopping treatment; patients taking beta-blockers (section 4.3)
  • Children under 12 years of age (section 4.3)

Side effects

  • Well tolerated in normal use (section 4.8). Nasal and throat effects (frequency not known): drug-induced rhinitis / rhinitis medicamentosa, sneezing, nasal dryness, dry throat, nasal and throat irritation, stinging or burning of the nose, nasal or pharyngeal oedema, dyspnoea; bronchospasm (the product contains benzalkonium chloride)
  • Cardiovascular (frequency not known): arrhythmias, tachycardia, palpitations, vasoconstriction with hypertension, cold extremities, reactive hyperaemia, increased blood pressure
  • Nervous system and psychiatric: nervousness (very rare); anxiety, fear, confusion, restlessness, insomnia, psychotic state, sleep disorders in children, tremor, headache, dizziness, sedation (frequency not known)
  • Eye irritation, dryness, discomfort or redness (rare); visual disturbances (frequency not known)
  • Allergic reaction / hypersensitivity, allergic dermatitis (the product contains thiomersal), local skin reactions, skin discolouration, rash, pruritus, dry or irritated mouth, nausea, vomiting, swelling of the lips or tongue (frequency not known)
  • General (frequency not known): irritability, tolerance with diminished effect, rebound congestion (vasodilation), weakness, pain, anorexia.
  • This side-effect list may be incomplete — check the full SPC.

Interactions

  • Other sympathomimetic products (e.g. ephedrine, pseudoephedrine): should not be used together because of additive effects (section 4.5)
  • MAOIs and/or RIMAs, including moclobemide and rasagiline: should not be given within 14 days of stopping treatment - risk of hypertension (section 4.5)
  • Tricyclic antidepressants: known to interact (section 4.5; section 4.4 advises consulting a doctor before use)
  • Bethanidine, debrisoquine and guanethidine: effects may be antagonised; possible additive cardiovascular toxicity with sympathomimetics given with antiparkinsonian drugs such as bromocriptine (section 4.5)
  • Because oxymetazoline is absorbed through the mucosa, sympathomimetic interactions may follow topical use: antagonism of antihypertensives (including adrenergic neurone blockers and beta-blockers); increased risk of hypertension with oxytocin, appetite suppressants and amphetamine-like psychostimulants; increased risk of ergotism with ergotamine and methysergide; increased risk of dysrhythmias with cardiac glycosides; caution with thyroid hormones (section 4.5)

Monitoring

  • Reassess if symptoms persist or do not improve after 7 days - consult a doctor (section 4.4)
  • Limit use to no more than 7 consecutive days to avoid rebound effect and rhinitis medicamentosa (sections 4.2 and 4.4)
  • Stop the medicine if hallucinations, restlessness or sleep disturbances occur (section 4.4)
  • Caution in prostatic hypertrophy (risk of acute urinary retention), in the elderly and in occlusive vascular disease (section 4.4)
  • Benzalkonium chloride preservative may cause swelling of the nasal mucosa (persistent nasal congestion), especially in long-term use, and may cause bronchospasm; thiomersal preservative may cause sensitisation reactions (section 4.4)

Clinical monograph

How it works

It is a sympathomimetic alpha-adrenoceptor agonist that constricts the nasal blood vessels, reducing mucosal swelling and improving nasal airflow.

Prescribing in practice

  • It should only be used for a short course because prolonged use causes rebound nasal congestion (rhinitis medicamentosa).
  • Local effects such as nasal dryness, stinging or sneezing may occur.
  • Caution is advised in patients with cardiovascular disease, hyperthyroidism or those taking interacting sympathomimetic medicines.

Monitoring

No laboratory monitoring is required; review if congestion persists or worsens after the recommended short course.

Counselling the patient

  • Use this spray only for a few days to avoid worsening rebound congestion.
  • Do not exceed the recommended frequency of use.
  • Seek advice if your symptoms continue beyond the short recommended period.

Evidence & guidelines

Short-term use reflects standard guidance to avoid rebound congestion; refer to current prescribing references.

Reference: MHRA OTC Decongestant Safety; EMA Paediatric Decongestant Review; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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