What is the difference between oxymetazoline and xylometazoline for relieving nasal congestion?

From the Guidelines

Oxymetazoline is preferred over xylometazoline for relieving nasal congestion due to its longer-lasting relief and potential to prevent rebound congestion when combined with nasal corticosteroids, as shown in a study published in 2020 1.

Key Differences

• Oxymetazoline typically provides longer-lasting relief, working for up to 12 hours, while xylometazoline generally lasts 8-10 hours.
• Both medications work by constricting blood vessels in the nasal passages to reduce swelling and congestion.
• Oxymetazoline is often considered slightly more potent, which may provide better relief for severe congestion but could potentially cause more rebound congestion with prolonged use.

Usage and Side Effects

• Both are available as over-the-counter nasal sprays in similar concentrations (0.05% for oxymetazoline and 0.1% for xylometazoline) and should be used no more than 3 days consecutively to avoid rebound congestion, as recommended by the package insert for oxymetazoline nasal spray 1.
• The typical dosage for either medication is 2-3 sprays in each nostril twice daily.
• Side effects are similar for both and may include burning, stinging, dryness, or increased blood pressure.
• People with high blood pressure, heart disease, diabetes, or thyroid disorders should consult a healthcare provider before using either medication.

Clinical Considerations

• The combination of oxymetazoline with nasal corticosteroids may prevent rebound congestion, as shown in a study published in 2020 1.
• The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 suggests that adding a nasal decongestant to intranasal corticosteroids may improve symptomatology in CRS, but the risk of rebound swelling should be considered 1.

From the Research

Comparison of Oxymetazoline and Xylometazoline

• Oxymetazoline and xylometazoline are both topical decongestants used to relieve nasal congestion, with studies showing their efficacy in providing fast and effective relief 2, 3.
• A comparative analysis of the decongestive effect of oxymetazoline and xylometazoline in healthy subjects found that both drugs have similar decongestive effects, with no statistically significant difference in nasal resistance, nasal airflow, and cross-sectional areas of the nasal cavity 4.
• Xylometazoline has been shown to provide relief of nasal congestion for up to 10 hours, with a clinically relevant decongestant effect that is significantly superior to placebo 3.
• Oxymetazoline, on the other hand, has been shown to provide relief of nasal congestion for up to 12 hours, with a statistically significant change from baseline in subjective nasal congestion and objective measures of nasal patency 2.

Efficacy and Tolerability

• A study comparing the efficacy and tolerability of oxymetazoline plus dexpanthenol versus xylometazoline found that the combination of oxymetazoline and dexpanthenol had better efficacy, shorter recovery time, and lesser rebound congestion than xylometazoline 5.
• The study also found that the combination of oxymetazoline and dexpanthenol had better tolerability than xylometazoline, with significantly less nasal irritation and rebound congestion 5.
• Another study found that xylometazoline was well tolerated, with generally mild to moderate nasal-related side effects, and no cases of sedation or rhinitis medicamentosa were reported 3.

Concentration and Formulation

• A study investigating the decongestant activity of a new formulation of xylometazoline nasal spray found that the 0.05% concentration of xylometazoline seemed to achieve maximal decongestant activity, and was statistically equivalent to the reference formulation and the aqueous solution of xylometazoline 0.1% 6.
• The study also found that hyaluronic acid seemed to act as an enhancer/carrier of the active principle, xylometazoline, as already demonstrated for other drugs 6.