Antihistamine + Sympathomimetic (Topical Ophthalmic)

Antazoline with Xylometazoline

Brand names: Otrivine-Antistin

Adult dose

Dose: 1–2 drops into the affected eye(s) 2–3 times daily

Route: Topical ophthalmic (eye drops)

Frequency: 2–3 times daily; maximum 4 times daily

Clinical pearls

OTC product for symptomatic relief of allergic conjunctivitis (itching and redness)
Antazoline is an H1-antihistamine; xylometazoline is an alpha-adrenergic vasoconstrictor
Not recommended for more than 2 weeks continuous use — rebound hyperaemia may occur
For persistent or severe allergic conjunctivitis: prefer topical sodium cromoglicate, nedocromil, or olopatadine
Always check for angle-closure glaucoma risk before dispensing (check IOP, narrow angles)
NICE CKS Allergic conjunctivitis: topical antihistamines and mast cell stabilisers preferred; combination products appropriate for short-term use

Contraindications

Narrow-angle glaucoma (xylometazoline component — risk of precipitating acute angle closure)
Hypersensitivity to either component
Soft contact lenses (remove before instilling; reinsert after 15 minutes)

Side effects

Transient stinging or burning on instillation
Rebound conjunctival congestion with prolonged use (vasoconstrictor rebound)
Pupil dilation (mydriasis — risk in susceptible eyes)
Systemic effects with prolonged use (very rare): tachycardia, hypertension

Interactions

MAOIs — avoid (xylometazoline component; risk of hypertensive crisis)
Tricyclic antidepressants — additive sympathomimetic effects

Monitoring

Duration of use (should not exceed 2 weeks without review)
Intraocular pressure if used long-term or in glaucoma-risk patients

Reference: BNF; NICE CKS Conjunctivitis — allergic (2023); RCOphth patient information; https://bnf.nice.org.uk/drugs/antazoline-with-xylometazoline/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways