Xylometazoline

Brand Names: Otrivin, Metarivin

Drug Class: Imidazoline derivative nasal decongestant

Overview

Xylometazoline is a topical nasal decongestant that provides rapid relief from nasal congestion associated with allergic rhinitis, common cold, and sinusitis. It works by constricting blood vessels in the nasal passages, reducing swelling and congestion. The medication is available over-the-counter for short-term symptomatic relief.

Mechanism of Action

Xylometazoline is a direct-acting sympathomimetic amine that selectively stimulates alpha-2 adrenergic receptors in the nasal mucosa. This causes vasoconstriction of dilated arterioles, reducing blood flow to nasal tissues, decreasing edema, and relieving nasal congestion without significant systemic absorption.

Indications

  • Temporary relief of nasal congestion due to the common cold
  • Symptomatic relief of nasal congestion associated with allergic rhinitis
  • Relief of sinus congestion and pressure

Common Doses

  • 0.1% solution (1 mg/mL)
  • 0.05% pediatric solution

Dosage

For adults and children 7 years and older: Spray 1-2 times into each nostril up to 3 times daily. Do not exceed 3 days of continuous use without medical supervision to avoid rebound congestion.

Contraindications

  • Hypersensitivity to xylometazoline or any component of the formulation
  • Concurrent use with monoamine oxidase inhibitors (MAOIs)
  • Severe hypertension or coronary artery disease
  • Thyrotoxicosis

Side Effects

  • Local burning, stinging, or dryness of nasal mucosa
  • Sneezing
  • Headache
  • Nervousness
  • Dizziness
  • Insomnia
  • Palpitations
  • Rebound congestion with prolonged use

Interactions

  • Monoamine oxidase inhibitors (MAOIs) - may potentiate pressor effects
  • Tricyclic antidepressants - may enhance sympathomimetic effects
  • Other sympathomimetic agents - additive cardiovascular effects

Counseling Points

  • Use only as directed, not exceeding 3 days of continuous use
  • Prime pump before first use if using spray
  • Blow nose gently before administration
  • Do not share bottle to prevent contamination
  • Seek medical attention if symptoms worsen or persist beyond 7 days
  • Store at room temperature away from direct sunlight