XYLOMETAZOLINE HYDROCHLORIDE

XYLOMETAZOLINE HYDROCHLORIDe
(zye-loe-met-az'oh-leen)
Otrivin
Classifications: nasal decongestant; vasoconstrictor;
Therapeutic: nasal decongestant

Prototype: Naphazoline
Pregnancy Category: C

Availability

0.05%, 0.1% nasal solution

Action

Markedly constricts dilated arterioles of nasal membrane. Has little or no beta-adrenergic activity.

Therapeutic Effect

Decreases fluid exudate and mucosal engorgement associated with rhinitis and may open up obstructed eustachian tubes.

Uses

Temporary relief of nasal congestion associated with common cold, sinusitis, acute and chronic rhinitis, and hay fever and other allergies.

Contraindications

Sensitivity to adrenergic substances; angle-closure glaucoma; concurrent therapy with MAO inhibitors or tricyclic antidepressants; lactation, and infants; pregnancy (category C).

Cautious Use

Hypertension; hyperthyroidism; heart disease, including angina; advanced arteriosclerosis, older adults, and children.

Route & Dosage

Nasal Congestion
Adult/Child (≥12 y): Nasal 1–2 sprays or 1–2 drops of 0.1% solution in each nostril q8–10h (max: 3 doses/d)
Child (2 –12 y): Nasal 1 spray or 2–3 drops of 0.05% solution in each nostril q8–10h (max: 3 doses/d)

Administration

Instillation
  • Have patient clear each nostril gently before administering spray or drops.
  • Spray: Do not shake container. Hold tube vertically (spray end up) so that solution is delivered in a fine spray. Head should be erect; spray into each nostril; 3–5 min later, clear (blow) nose thoroughly.
  • Drops: Patient should be in a lateral, head-low position to permit application of drops to lower nostril surface. Have patient remain in this position for 5 min, then apply drops to opposite nostril surface in same manner; or drops may be instilled with patient in reclining position with head tilted back as far as possible.
  • Store at 15°–30° C (59°–86° F) in a tight, light-resistant container.

Adverse Effects (≥1%)

All: Usually mild and infrequent; local stinging, burning, dryness and ulceration, sneezing, headache, insomnia, drowsiness. With excessive use: Rebound nasal congestion and vasodilation, tremulousness, hypertension, palpitations, tachycardia, arrhythmia, somnolence, sedation, coma.

Interactions

Drug: May cause increase BP with guanethidine, methyldopa, mao inhibitors; phenothiazines may decrease effectiveness of nasal decongestant.

Pharmacokinetics

Onset: 5–10 min. Duration: 5–6 h.

Nursing Implications

Assessment & Drug Effects

  • Evaluate for development of rebound congestion (see ADVERSE EFFECTS).

Patient & Family Education

  • Prevent contamination of nasal solution and spread of infection by rinsing dropper and tip of nasal spray in hot water after each use; restrict use to the individual patient.
  • Note: Prolonged use can cause rebound congestion and chemical rhinitis. Do NOT exceed prescribed dosage and report to physician if drug fails to provide relief within 3–4 d.
  • Do NOT self-medicate with OTC drugs, sprays, or drops without physician's approval.
  • Note: Excessive use by a child may lead to CNS depression.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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