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Nasal decongestant — sympathomimetic (perioperative / ENT use) Pregnancy: Avoid if possible — systemic sympathomimetic effects; oxytocic potential. Saline alternatives preferred in pregnancy.

Ephedrine Hydrochloride 0.5% Nasal Drops

Brand names: Ephedrine nasal drops (generic — no UK branded preparation)

Adult dose

Dose: 1–2 drops into each nostril up to 3–4 times daily
Route: Intranasal (drops)
Frequency: Up to 3–4 times daily
Max: 3–4 times daily; maximum 7 days
Nasal decongestion: primarily used perioperatively (premedication for nasal intubation, endoscopy, or rhinological surgery) and for sphenopalatine ganglion block preparation. Acute nasal congestion in adults: 1–2 drops per nostril TDS-QDS, max 7 days. 0.5% formulation standard for adults (1% for surgical ENT use — specialist). Often used alongside cocaine paste or other vasoconstrictors perioperatively.

Paediatric dose

Route: Intranasal
Frequency: Up to 3 times daily
Max: 3 times daily; maximum 7 days
Children: use 0.5% drops with caution — specialist guidance. 0.5% drops 1 per nostril up to 3 times daily for short periods. Avoid in infants under 3 months. Xylometazoline 0.05% is generally preferred for paediatric nasal decongestion.

Dose adjustments

Renal

No dose adjustment required for intranasal use.

Hepatic

No dose adjustment required for intranasal use.

Clinical pearls

  • Largely replaced by xylometazoline OTC but still used perioperatively and by ENT surgeons for nasal surgery preparation
  • Perioperative use: applied as nasal packing / spray prior to nasendoscopy, nasotracheal intubation, or transnasal pituitary surgery for mucosal vasoconstriction
  • MAO inhibitor interaction is critical — severe, potentially fatal hypertensive crisis; always check medications before use
  • 7-day limit applies as with all topical nasal decongestants
  • In the anaesthetic context: IV ephedrine (3–6 mg IV bolus) is used to treat spinal anaesthesia hypotension — separate use from nasal drops

Contraindications

  • MAO inhibitor use (within 14 days) — risk of hypertensive crisis
  • Hyperthyroidism
  • Hypertension (use with caution)
  • Coronary artery disease / cardiac arrhythmias
  • Angle-closure glaucoma
  • Hypersensitivity to ephedrine

Side effects

  • Rebound congestion (rhinitis medicamentosa — with prolonged use >7 days)
  • Nasal dryness and stinging
  • Tachycardia and palpitations (systemic absorption)
  • Hypertension
  • Headache
  • Insomnia
  • Anxiety (systemic sympathomimetic)

Interactions

  • MAO inhibitors — severe hypertensive crisis; absolute contraindication within 14 days
  • Tricyclic antidepressants — potentiated pressor response
  • Beta-blockers — unopposed alpha-agonist effect causing hypertension
  • Halogenated anaesthetics — increased risk of cardiac arrhythmias
  • Other sympathomimetics — additive cardiovascular effects

Monitoring

  • BP and HR (perioperative use)
  • Duration of use (max 7 days)
  • Symptom response

Reference: BNFc; BNF; RCOphth / ENT-UK Perioperative Guidelines; British Journal of Anaesthesia Nasal Decongestants. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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