Alpha-adrenoceptor agonist (nasal decongestant) Pregnancy: In view of its potential systemic vasoconstrictor effect, advisable not to use during pregnancy. During breastfeeding, use only on the advice of a doctor (it is not known if xylometazoline is excreted in breast milk).

Xylometazoline hydrochloride

Brand names: Otrivin, Sudafed Blocked Nose, Sinex

Xylometazoline is a topical imidazoline sympathomimetic decongestant applied intranasally to relieve nasal congestion in conditions such as the common cold, rhinitis and sinusitis.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 2 or 3 drops in each nostril

Route: Nasal

Frequency: Up to 3 times daily

Max: Do not exceed 3 applications daily into each nostril

Adults and elderly (all indications). Based on Otrivine Adult Nasal Drops 0.1%. Suitable for children over 12 years of age; the recommended dose should not be exceeded, especially in children and the elderly. Do not take decongestants for more than 7 consecutive days - prolonged or excessive use may cause rebound congestion and/or atrophy of the nasal mucosa. The 0.1% strength is contraindicated in children aged less than 12 years.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Known hypersensitivity to the product
Patients with trans-sphenoidal hypophysectomy or surgery exposing the dura mater
Narrow-angle glaucoma
Rhinitis sicca or atrophic rhinitis
Children aged less than 12 years (0.1% strength)
Phaeochromocytoma
Prostatic hypertrophy
Receiving monoamine oxidase inhibitors (MAOI), or having received them in the last two weeks

Side effects

Headache (common)
Nasal dryness and nasal discomfort (common)
Nausea (common)
Application site burning (common)
Epistaxis (uncommon)
Hypersensitivity reaction, transient visual impairment, irregular/increased heart rate (very rare)

Interactions

Monoamine oxidase (MAO) inhibitors - concomitant use may cause an increase in blood pressure
Tri- and tetra-cyclic antidepressants - concomitant use may cause an increase in blood pressure

Clinical monograph

How it works

It is an alpha-adrenoceptor agonist that constricts dilated nasal blood vessels, reducing mucosal swelling and oedema to improve airflow.

Prescribing in practice

Limit continuous use to a short course only, as prolonged use causes rebound congestion (rhinitis medicamentosa).
Avoid or use with caution in patients with cardiovascular disease, hypertension, hyperthyroidism, diabetes or those taking monoamine oxidase inhibitors.
Paediatric formulations of lower strength exist; check a children's formulary for age-appropriate use and avoid in very young children unless specifically indicated.

Monitoring

Routine laboratory monitoring is not required; review symptomatic response and discourage prolonged or excessive use.

Counselling the patient

Use for only a few days at a time to avoid worsening congestion when you stop.
Do not share the nasal device with others to prevent spreading infection.
Seek advice if symptoms persist or worsen.

Evidence & guidelines

Topical nasal decongestants are well established for short-term symptomatic relief of nasal congestion as reflected in the SPC and current prescribing references.

Reference: NICE CKS; 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).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways