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Antihistamine + Sympathomimetic (Topical Ophthalmic) Pregnancy: UK SPC §4.6: 'In line with common practice, the use of medication during pregnancy is not recommended unless considered essential. It is not known whether the active ingredients are distributed in human milk. It should therefore not be administered to nursing mothers or breast feeding should be interrupted for 48 hours after administration.'

Antazoline with Xylometazoline

Brand names: Otrivine-Antistin

Antazoline with xylometazoline is a topical ocular preparation combining an antihistamine with a sympathomimetic vasoconstrictor, used for short-term relief of allergic conjunctivitis.

Adult dose

Dose: Otrivine-Antistin Eye Drops (antazoline with xylometazoline), topical ocular use in adults: 1 or 2 drops instilled 2–3 times a day
Route: Topical ophthalmic — for local administration to the eye. Patients must avoid allowing the tip of the dispensing container to contact the eye or surrounding structures, as this may contaminate the solution
Frequency: 2 to 3 times a day; not for more than seven consecutive days
Max: 2 drops per instillation, 3 times a day — the upper end of the SPC's stated range — and the SPC states 'Otrivine-Antistin Eye Drops should not be used for more than seven consecutive days'
ELDERLY: '1 drop instilled 2 to 3 times a day.' MULTIPLE EYE DROPS: 'If more than one medication needs to be instilled in the eye, an interval of at least 5 minutes between application of the different medicinal products must be allowed.' DURATION AND REBOUND: 'Rebound hyperaemia may follow prolonged frequent use. Otrivine-Antistin should not be used without supervision over a long period of time.' 'If the symptoms do not improve after 2 days, medical advice should be sought to rule out the possibility of a bacterial infection.' EXCIPIENTS: 'This medicine contains 2.8 micrograms benzalkonium chloride in each drop, which is equivalent to 0.1 mg/ml. Benzalkonium chloride may cause eye irritation, especially with dry eyes or disorders of the cornea.' 'This medicine contains boric acid. This medicine should not be given to a child younger than 2 years without medical advice, as it contains boron and may impair fertility in the future.' NOT SUITABLE for patients suffering from dry eyes without first seeking medical advice. Eye drops are not for injection — 'They should never be injected subconjunctivally, nor should they be directly introduced into the anterior chamber of the eye.' INDICATION WORDING: §4.1 (therapeutic indications) was not part of this fetch, so the page's indication text (symptomatic allergic conjunctivitis) is not quoted from this bundle; the dose above is scoped to the product rather than asserted against an unfetched indication statement.

Paediatric dose

Route: Topical ophthalmic
Frequency: 2 to 3 times a day (children aged 12 years and over only)
Max: 1 drop instilled 2 to 3 times a day; not for more than seven consecutive days
NOT WEIGHT-BASED — dosePerKg is deliberately null because this SPC expresses the paediatric dose as a number of drops, not per kilogram; do not derive a per-kg figure. UK SPC §4.2, verbatim: 'Paediatric population Children aged 12 years and over: 1 drop instilled 2 to 3 times a day. No specific studies are available in this patient group. Due to possible systemic effects, Otrivine-Antistin is not recommended for use in children younger than 12 years of age.' No dose is available for children under 12 from this source. §4.4 adds that the product contains boric acid and 'should not be given to a child younger than 2 years without medical advice, as it contains boron and may impair fertility in the future', and that systemic effects including tachycardia may occur 'especially in small children'.

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

  • Hypersensitivity to the active substances or to any of the excipients listed in section 6.1
  • Presence of narrow angle glaucoma
  • Use with contact lenses
  • Use in patients receiving monoamine oxidase inhibitors or within 14 days of stopping such treatment

Side effects

  • Eye disorders: stinging sensation in eyes; blurred vision; mydriasis; eye irritation; ocular hyperaemia
  • Nervous system: headache; drowsiness
  • Cardiac: tachycardia; palpitation; arrhythmia
  • Vascular: hypertension; pallor
  • Gastrointestinal: nausea
  • Skin: sweating; local allergic reactions (e.g. rash, oedema, pruritus) reported post-marketing
  • Immune system: hypersensitivity
  • Respiratory: epistaxis
  • Systemic sympathomimetic effects despite the topical route — 'tachycardia (especially in small children), palpitations, arrhythmia, hypertension, occipital headache, nausea, paleness and sweating'
  • Rebound hyperaemia may follow prolonged frequent use

Monitoring

  • Duration of use — do not exceed seven consecutive days; the product should not be used without supervision over a long period of time
  • Review at 2 days — 'If the symptoms do not improve after 2 days, medical advice should be sought to rule out the possibility of a bacterial infection.' Inflammation arising from infection should receive appropriate anti-bacterial therapy
  • Cardiovascular status in the elderly and in severe cardiovascular disease, including arrhythmia and poorly controlled hypertension; caution in hypertension, cardiac irregularities, hyperthyroidism, diabetes mellitus and phaeochromocytoma
  • QT interval — 'Patients with long QT syndrome treated with xylometazoline may be at increased risk of serious ventricular arrhythmias'
  • Urinary retention risk — caution in conditions such as prostatic hypertrophy, and in patients currently receiving other sympathomimetic drugs
  • Ocular symptoms attributable to benzalkonium chloride — advise patients to talk to a doctor if they feel abnormal eye sensation, stinging or pain in the eye after using the medicine

Clinical monograph

How it works

Antazoline blocks histamine H1 receptors to reduce itch and inflammation, while xylometazoline stimulates alpha-adrenergic receptors to constrict conjunctival vessels and reduce redness.

Prescribing in practice

  • Avoid in untreated angle-closure (narrow-angle) glaucoma, as the sympathomimetic component can precipitate an acute attack.
  • Limit to short-term use, as prolonged application of the vasoconstrictor can cause rebound conjunctival hyperaemia.
  • Use with caution in patients with cardiovascular disease, hypertension or hyperthyroidism.

Monitoring

Monitor symptomatically for resolution of allergic signs and for rebound redness with continued or prolonged use.

Counselling the patient

  • Use for only a few days; if symptoms persist, seek further review.
  • Remove contact lenses before instilling drops.
  • Transient stinging and pupil changes can occur after instillation.

Evidence & guidelines

Combined antihistamine-decongestant eye drops provide established short-term symptomatic relief in allergic conjunctivitis as reflected in current prescribing references.

Reference: NICE CKS Conjunctivitis — allergic (2023); RCOphth patient information; 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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