Nasal decongestant (alpha-2 adrenergic agonist — topical) Pregnancy: Avoid — vasoconstriction may reduce uteroplacental blood flow. Saline preferred in pregnancy.

Xylometazoline Hydrochloride 0.1% Nasal Spray (Otrivine)

Brand names: Otrivine, Sudafed Blocked Nose Spray

Adult dose

Dose: 2–3 sprays (or drops) into each nostril up to 3 times daily

Route: Intranasal

Frequency: Up to 3 times daily (not more than every 8–10 hours)

Max: 3 times daily; use for maximum 7 days only

Nasal congestion (colds, allergic rhinitis acute relief, acute sinusitis): 2–3 sprays per nostril up to 3 times daily for maximum 7 days. Do NOT exceed 7 days — rhinitis medicamentosa (rebound congestion) develops with prolonged use. 0.05% formulation for children 2–12 years.

Paediatric dose

Route: Intranasal

Frequency: Up to 2 times daily

Max: 2 times daily; max 7 days

2–12 years: 0.05% solution only — 1–2 sprays per nostril twice daily (max 7 days). Under 2 years: not recommended. ≥12 years: adult 0.1% formulation. The 0.1% adult formulation must NOT be used in children under 12 years.

Dose adjustments

Renal

No dose adjustment required.

Hepatic

No dose adjustment required.

Clinical pearls

Strict 7-day maximum — rhinitis medicamentosa (drug-induced rebound congestion) is a common reason patients present to ENT
For rhinitis medicamentosa management: abrupt cessation plus intranasal steroid (mometasone) — steroid reduces withdrawal rebound
Better acute decongestion than intranasal steroids but lacks anti-inflammatory effect
Contraindicated with MAOIs — a critical drug interaction check before prescribing
OTC availability does not mean prolonged safety — counsel patient explicitly on 7-day limit

Contraindications

Rhinitis medicamentosa (rebound — current condition from overuse)
Atrophic rhinitis
Post-transsphenoidal hypophysectomy
Hypersensitivity to xylometazoline
Children under 2 years
Use with MAOIs (within 14 days) — risk of hypertensive crisis

Side effects

Rebound nasal congestion (rhinitis medicamentosa — with >7 days use)
Nasal dryness, stinging, and sneezing
Headache
Systemic sympathomimetic effects: palpitations, tachycardia, hypertension (rare at recommended doses)
Insomnia (if systemic absorption)

Interactions

MAO inhibitors — severe hypertensive crisis; avoid within 14 days
Tricyclic antidepressants — enhanced vasopressor effect
Other sympathomimetics — additive cardiovascular effects

Monitoring

Duration of use (not >7 days)
BP in hypertensive patients

Reference: BNFc; BNF; NICE CKS Common Cold; Otrivine SPC. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways