From the Guidelines
Oxymetazoline can cause several side effects, including rebound congestion, nasal dryness, and systemic effects like headache and increased blood pressure, especially with prolonged use beyond 3-5 days. When used as a nasal decongestant, common side effects include nasal dryness, burning, stinging, sneezing, or increased nasal discharge [ 1 ]. Some people experience rebound congestion (rhinitis medicamentosa) with prolonged use, where congestion worsens when the medication wears off, leading to dependency [ 1 ]. Systemic side effects, though rare with normal use, can include headache, dizziness, nervousness, increased blood pressure, and heart palpitations [ 1 ]. These occur more commonly with excessive use or if the medication is swallowed.
Side Effects and Precautions
- Nasal dryness
- Burning or stinging sensation in the nose
- Sneezing or increased nasal discharge
- Rebound congestion (rhinitis medicamentosa)
- Systemic effects like headache, dizziness, nervousness, increased blood pressure, and heart palpitations
- Eye irritation, redness, or blurred vision when used as eye drops
Recommendations for Use
To minimize side effects, use oxymetazoline exactly as directed, typically no more than 2-3 times daily for no longer than 3-5 consecutive days for nasal sprays [ 1 ]. The medication works by constricting blood vessels in the nasal passages or eyes, reducing swelling and congestion, but this same mechanism can lead to the rebound effect and other side effects when overused [ 1 ]. It is essential to follow the recommended dosage and duration of use to avoid these side effects and ensure safe and effective use of oxymetazoline [ 1 ].
From the FDA Drug Label
When using this product Frequent or prolonged use may cause nasal congestion to recur or worsen temporary discomfort such as burning, stinging, sneezing or an increase in nasal discharge may occur The side effects of oxymetazoline include:
- Nasal congestion that may recur or worsen with frequent or prolonged use
- Temporary discomfort such as
- Burning
- Stinging
- Sneezing
- Increase in nasal discharge 2
From the Research
Side Effects of Oxymetazoline
The side effects of oxymetazoline can be categorized into several areas, including:
- Cardiovascular adverse effects, such as cardiac and respiratory complications, when systemically absorbed 3
- Rebound congestion, also known as rhinitis medicamentosa (RM), which can lead to nasal hyperreactivity, tolerance, and histologic changes of the nasal mucosa 4, 5, 6
- Substance use disorder, as reported in a case study of a patient who developed an oxymetazoline use disorder lasting 20 years 4
- Histopathological changes, including ischemic changes, congestion, arterial thrombosis, and necrosis, as observed in animal studies 7
- Damage to the end organ, which may occur with long-term use of oxymetazoline nasal spray 7
Specific Side Effects
Some specific side effects of oxymetazoline include:
- Rhinitis medicamentosa, which can be defined as a condition of nasal hyperreactivity, mucosal swelling, and tolerance induced by the overuse of topical vasoconstrictors 6
- Rebound swelling, which can occur after 30 days of use of oxymetazoline nasal spray 5
- Tachyphylaxis, which can result from long-term use of topical vasoconstrictors 5
- Nasal hyperreactivity, which can be induced by the overuse of topical vasoconstrictors 6
Patient Considerations
Patients using oxymetazoline should be aware of the potential side effects and take precautions to minimize their risk, including:
- Using the medication only as directed and for the recommended duration 3
- Monitoring their use and adjusting their dosage as needed 3
- Being aware of the signs and symptoms of rebound congestion and seeking medical attention if they occur 6
- Informing their healthcare provider about their use of oxymetazoline and any other medications they are taking 3