From the Guidelines
In U.S. hospitals, the most commonly used nasal decongestants for inpatients are oxymetazoline (Afrin), phenylephrine (Neo-Synephrine), and pseudoephedrine (Sudafed), with phenylephrine often preferred for short-term use due to its rapid onset and minimal systemic effects 1.
Nasal Decongestant Options
- Oxymetazoline is typically administered as a 0.05% nasal spray with 2-3 sprays per nostril twice daily for no more than 3 days to avoid rebound congestion.
- Phenylephrine is available as a 0.25-1% nasal spray used every 4 hours as needed.
- Pseudoephedrine is given orally at 30-60mg every 4-6 hours or 120mg extended-release every 12 hours.
Mechanism of Action and Precautions
These medications work by stimulating alpha-adrenergic receptors in nasal blood vessels, causing vasoconstriction that reduces mucosal swelling and congestion 1. Patients with hypertension, cardiovascular disease, diabetes, or thyroid disorders should use these medications with caution, and drug interactions should be considered when administering decongestants alongside other medications in the hospital setting 1.
Important Considerations
- Oral decongestants, such as pseudoephedrine and phenylephrine, can reduce nasal congestion but may result in side effects such as insomnia, irritability, and palpitations 1.
- Topical decongestants can cause local stinging or burning, sneezing, and dryness of the nose and throat, and should be used with caution in patients with certain conditions, such as cerebrovascular or cardiovascular disease, hyperthyroidism, closed-angle glaucoma, and bladder neck obstruction 1.
From the FDA Drug Label
Purpose: Nasal Decongestant The available nasal decongestant in an inpatient hospital in the USA is oxymetazoline (IN) 2.
- Key points:
- Drug Name: oxymetazoline
- Administration: Intranasal (IN)
- Use: Nasal Decongestant
From the Research
Nasal Decongestants Available in Inpatient Hospital Settings in the USA
- The use of nasal decongestants in inpatient hospital settings in the USA is supported by several studies, including one on oxymetazoline 3, which is used in the pediatric population for various conditions, including active bleeding, acute respiratory distress, and improved surgical visualization.
- Oxymetazoline is a topical nasal decongestant that provides fast symptom relief, with studies showing its effectiveness in relieving nasal congestion for up to 12 hours 4.
- Another study found that long-acting decongestants like oxymetazoline may be safely used for longer than the recommended 3 to 5 days without adverse effects if used once nightly 5.
- A systematic review of nasal decongestants in monotherapy for the common cold found that they may have a small positive effect on subjective measures of nasal congestion in adults, but the clinical relevance of this effect is unknown 6.
- Nasal congestion can be caused by various factors, including allergic rhinitis, vasomotor rhinitis, chronic sinusitis, and upper respiratory viral infections, and can lead to sequelae such as sinusitis and sleep disturbances 7.
Types of Nasal Decongestants
- Oxymetazoline is a widely used intranasal decongestant that offers fast symptom relief 4.
- Pseudoephedrine, phenylpropanolamine, and xylometazoline are other types of decongestants that have been studied, although some are no longer available on the market 6.
- Topical and oral decongestants are available, with topical decongestants like oxymetazoline providing relief for up to 12 hours 4.
Safety and Efficacy
- The safety and efficacy of nasal decongestants in children are not well established, and further studies are needed to understand their effects in this population 3.
- Nasal decongestants do not seem to increase the risk of adverse events in adults in the short term, but the clinical relevance of their small effect on subjective measures of nasal congestion is unknown 6.
- Caution should be exercised when using nasal decongestants, especially in pediatric patients, due to the potential for cardiovascular adverse effects and rebound swelling (rhinitis medicamentosa) 3, 5.