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Nasal decongestant (alpha-2 adrenergic agonist — topical) Pregnancy: UK SPC section 4.6: no foetal toxicity or fertility studies have been carried out in animals. In view of its potential systemic vasoconstrictor effect, it is advisable to take the precaution of not using Otrivine during pregnancy. Breast-feeding: no evidence of any adverse effect on the breast-fed infant; however, it is not known if xylometazoline is excreted in breast milk, therefore caution should be exercised and Otrivine should be used only on the advice of a doctor whilst breastfeeding.

Xylometazoline Hydrochloride 0.1% Nasal Spray (Otrivine)

Brand names: Otrivine, Sudafed Blocked Nose Spray

Xylometazoline nasal spray (Otrivine) is a topical decongestant used for short-term relief of nasal congestion, including that associated with colds, sinusitis and allergic rhinitis.

Adult dose

Dose: Symptomatic relief of nasal congestion, perennial and allergic rhinitis (including hay fever) and sinusitis: one application (spray) in each nostril up to 3 times daily (adults and the elderly). Not for more than seven consecutive days
Route: Intranasal (application to the nasal passages) - metered-dose nasal spray, solution
Frequency: Up to 3 times daily
Max: 3 applications daily into each nostril (SPC: do not exceed)
INDICATION (section 4.1, verbatim): 'For the symptomatic relief of nasal congestion, perennial and allergic rhinitis (including hay fever), sinusitis.' POSOLOGY (section 4.2, verbatim): 'Adults and elderly: One application in each nostril up to 3 times daily. Do not exceed 3 applications daily into each nostril. Not suitable for children under 12 years.' 'The recommended dose should not be exceeded, especially in children and the elderly.' DURATION (section 4.4, verbatim): 'Patients are advised not to take decongestants for more than seven consecutive days, prolonged or excessive use may cause rebound congestion and/or atrophy of the nasal mucosa.' PRIMING (section 4.2): laterally actuated pump (Khone) - prime 5 actuations before first use, re-prime with 2 actuations if the spray is not ejected on the full stroke or the product has not been used for longer than 7 days; vertically actuated pump (Freepod) - prime 4 actuations before first use, re-prime with 4 actuations in the same circumstances. CHILDREN: no paediatric regimen is printed; 'Not suitable for children under 12 years' and 'Otrivine 0.1% is contraindicated in children aged less than 12 years' (section 4.3). The 0.05% strength named elsewhere is not covered by this SPC. Contains benzalkonium chloride, which may cause irritation of the nasal mucosa.

Dose adjustments

Renal

No renal dose adjustment is stated in the UK SPC sections retrieved (section 4.2 gives one adult regimen only).

Hepatic

No hepatic dose adjustment is stated in the UK SPC sections retrieved (section 4.2 gives one adult regimen only).

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

Contraindications

  • Known hypersensitivity to xylometazoline
  • 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 (Otrivine 0.1% is contraindicated)
  • Phaeochromocytoma
  • Prostatic hypertrophy
  • Patients receiving monoamine oxidase inhibitors (MAOI) treatment or who have received them in the last two weeks

Side effects

  • Common (>=1/100 to <1/10): headache; nasal dryness; nasal discomfort; nausea; application site burning
  • Uncommon (>=1/1,000 to <1/100): epistaxis
  • Very rare (<1/10,000): hypersensitivity reaction (angioedema, rash, pruritus); transient visual impairment; heart rate irregular; heart rate increased
  • Other: a burning sensation in the nose and throat

Interactions

  • Concomitant use of xylometazoline with monoamine oxidase (MAO) inhibitors or tri- and tetra-cyclic antidepressants may cause an increase in blood pressure due to the cardiovascular effects of these substances (SPC section 4.5; see Contraindications for MAOIs)

Monitoring

  • Advise patients not to take decongestants for more than seven consecutive days - prolonged or excessive use may cause rebound congestion and/or atrophy of the nasal mucosa
  • Use only with caution in patients showing a strong reaction to sympathomimetic agents, as evidenced by signs of insomnia, dizziness, tremor, cardiac arrhythmias or elevated blood pressure
  • Caution in hypertension, cardiovascular disease, hyperthyroidism, diabetes mellitus, or tri- and tetra-cyclic antidepressant treatment
  • Patients with long QT syndrome treated with xylometazoline may be at increased risk of serious ventricular arrhythmias
  • Contains benzalkonium chloride, which may cause irritation of the nasal mucosa

Clinical monograph

How it works

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

Prescribing in practice

  • Limit use to a few consecutive days only, as prolonged use causes rebound congestion (rhinitis medicamentosa) and tolerance.
  • Avoid sharing the device between people to prevent cross-infection, and use cautiously in patients with cardiovascular disease, hypertension, hyperthyroidism or those on certain antidepressants.
  • The higher-strength preparation is intended for adults and older children, and a lower-strength product should be used for younger children per a children's formulary.

Monitoring

No formal monitoring is needed for short-term use; review if congestion persists or recurs after stopping.

Counselling the patient

  • Use it for only a few days in a row to avoid worsening, rebound stuffiness.
  • Do not exceed the recommended frequency on the label.
  • Keep the spray for your own use only.

Evidence & guidelines

Topical decongestants give effective short-term symptomatic relief of nasal congestion but are limited by rebound congestion with prolonged use.

Reference: NICE CKS Common Cold; Otrivine SPC; 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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