From the Guidelines
Oxymetazoline should be used with caution and only for a short period, typically not exceeding 3 consecutive days, due to the risk of rebound congestion (rhinitis medicamentosa) as suggested by the european position paper on rhinosinusitis and nasal polyps 2020 1. When considering the use of oxymetazoline, it's essential to weigh the benefits against the potential risks, particularly the risk of rebound congestion. The european position paper on rhinosinusitis and nasal polyps 2020 1 suggests that adding a nasal decongestant to intranasal corticosteroids may improve symptomatology in CRS, but the risk of rebound swelling was not shown in this study. However, the EPOS2020 steering group suggests in general not to use nasal decongestants in CRS.
Key Considerations
- The standard adult dosage of oxymetazoline is typically 2-3 sprays in each nostril every 10-12 hours, not exceeding twice daily use.
- Oxymetazoline works by stimulating alpha-adrenergic receptors in blood vessels, causing vasoconstriction that reduces blood flow and swelling in nasal tissues, quickly opening airways.
- Side effects may include burning, stinging, dryness, or sneezing.
- People with high blood pressure, heart disease, diabetes, thyroid disorders, or those taking MAO inhibitors should consult a healthcare provider before using this medication.
- The diagnosis and management of rhinitis: an updated practice parameter 1 also highlights the risk of rhinitis medicamentosa with the repetitive and prolonged use of topical a-adrenergic nasal decongestant sprays such as oxymetazoline.
Clinical Implications
- Oxymetazoline should be used for the shortest duration necessary to alleviate symptoms, and patients should be monitored for signs of rebound congestion.
- In situations where the nose is very blocked, the temporary addition of a nasal decongestant to the nasal corticosteroid treatment can be considered, as suggested by the european position paper on rhinosinusitis and nasal polyps 2020 1.
- Treatment of rhinitis medicamentosa consists of suspending the use of topical decongestants and administering intranasal corticosteroids to control symptoms while allowing the rebound effects of the nasal decongestant spray to resolve, as outlined in the diagnosis and management of rhinitis: an updated practice parameter 1.
From the Research
Oxymetazoline Efficacy
- Oxymetazoline (0.05%) provides relief of nasal symptoms for 12 hours, as shown in a study published in Rhinology 2.
- The study found statistically significant changes from baseline in subjective nasal congestion and objective measures of nasal patency at each hourly time-point from Hour 1 through Hour 12.
- Another study published in Pulmonary pharmacology & therapeutics found that 0.05% oxymetazoline nasal spray is effective in treating objective nasal congestion, with significant reductions in inferior and middle turbinate volumes up to 12 hours post-administration 3.
Oxymetazoline Safety and Duration of Use
- A study published in The Laryngoscope found that extended use of oxymetazoline (up to 4 weeks) did not result in adverse effects, such as rebound swelling (rhinitis medicamentosa), when used once nightly 4.
- A more recent study published in Journal of asthma and allergy found that oxymetazoline, when used in combination with fluticasone furoate, did not cause rebound congestion or rhinitis medicamentosa after 28 days of continuous use 5.
Oxymetazoline Combination Therapy
- The study published in Journal of asthma and allergy found that a fixed-dose combination of fluticasone furoate and oxymetazoline nasal spray was superior to fluticasone alone in relieving nasal congestion and reducing total nasal symptom score in patients with allergic rhinitis 5.
- The combination therapy was well-tolerated, with no significant differences in adverse events between the treatment groups.