From the Guidelines
Oxymetazoline nasal spray is not recommended for children under 6 years old, including 2 and 3-year-olds, due to the risk of systemic effects and rebound congestion. The use of topical decongestants, such as oxymetazoline, in young children is cautioned against because of the narrow margin between the therapeutic and toxic dose, which increases the risk for cardiovascular and CNS side effects 1.
Key Considerations
- Topical decongestants can cause local stinging or burning, sneezing, and dryness of the nose and throat, and their use should be limited to short-term therapy to avoid the development of rhinitis medicamentosa 1.
- The package insert for oxymetazoline nasal spray recommends use for no more than 3 days to minimize the risk of rebound congestion 1.
- Alternative safer options for nasal congestion in toddlers include saline nasal sprays, nasal suctioning with a bulb syringe, humidifiers, and keeping the child well-hydrated.
Recommendations
- For 2 and 3-year-olds, oxymetazoline nasal spray should only be used if prescribed by a pediatrician, and parents should follow the exact dosing instructions, typically using the pediatric formulation (0.025% concentration rather than the adult 0.05%) 1.
- Limit use to no more than 3 consecutive days to avoid rebound congestion and minimize the risk of systemic effects.
- Always consult a pediatrician before giving any decongestant medication to children this young, as they can provide guidance on the safest and most effective treatment options.
From the FDA Drug Label
Directions: ... Children under six years of age: ask a doctor. The FDA drug label does not answer the question.
From the Research
Safety of Oxymetolazone Nasal Spray in Children
- The safety of oxymetolazone nasal spray in children under 6 years old is not well established, as the US Food and Drug Administration has only approved it for patients 6 years and older 2.
- However, medical professionals may use it off-label for younger children in certain clinical scenarios where the potential benefits outweigh the risks, such as active bleeding, acute respiratory distress, or improved surgical visualization 2.
- There have been reports of cardiac and respiratory complications related to the use of oxymetazoline in pediatric patients, highlighting the need for caution when administering the medication to children 2, 3.
- A study found that the method of drug delivery can lead to an unanticipated overdose, with the position of the bottle causing pronounced variation in the quantity of oxymetazoline dispensed 3.
Dosage and Administration
- To avoid excessive administration of the medication, medical professionals should use the spray bottle in an upright position with the child upright 2.
- The quantity of dosing and technique of administration should be carefully considered, as there have not been adequate pediatric pharmacokinetic studies of oxymetazoline 2.
- A study found that squeezing the bottle in the inverted position can result in a steady stream of fluid, leading to a significant increase in the volume administered 3.