Ortrivin (Xylometazoline) Dosage Guidelines
For adults and children over 6 years, use xylometazoline 0.1% nasal spray (2-3 sprays per nostril) up to 3 times daily for a maximum of 3 consecutive days to prevent rebound congestion, while children 2-6 years should use the 0.05% concentration with reduced frequency. 1, 2
Age-Specific Dosing
Adults and Children ≥6 Years
- Concentration: 0.1% xylometazoline 1
- Dose: 1-2 sprays per nostril 1, 3
- Frequency: Up to 3 times daily 3
- Maximum duration: 3 consecutive days 1, 2
Children 2-6 Years
- Concentration: 0.05% xylometazoline 4
- Dose: 1 spray per nostril 4
- Frequency: 2-3 times daily maximum 5
- Maximum duration: 3 consecutive days 2
Infants <2 Years
- Concentration: 0.025% xylometazoline 5
- Frequency: Maximum 3 times daily 5
- Safety note: Recent evidence suggests low-dose xylometazoline appears safe in hospitalized infants when properly dosed, though FDA approval is only for ages ≥6 years 5, 6
Critical Duration Limits
The 3-day maximum is essential to prevent rhinitis medicamentosa (rebound congestion), which can develop as early as the third or fourth day of continuous use. 1, 2
- Rebound congestion onset: Can occur within 3-4 days of continuous use 1, 2
- Some patients may not develop symptoms until 4-6 weeks, but this variability makes the 3-day rule the safest approach 1
- Short-term use (<10 days) has not shown rebound congestion in clinical studies, but the conservative 3-day recommendation remains standard 3, 7
Administration Technique
- Direct spray away from the nasal septum to minimize irritation and bleeding risk 2
- Use spray bottle in upright position with patient upright to avoid excessive administration 6
- For optimal effect, clear nasal passages before application 3
Combination Therapy Strategy
When severe congestion requires longer treatment, combine xylometazoline with an intranasal corticosteroid from the outset to prevent rebound congestion entirely. 1, 2
Combination Protocol
- Apply xylometazoline first 2
- Wait 5 minutes 2
- Then apply intranasal corticosteroid (e.g., fluticasone, mometasone) 2
- This combination can be safely used for 2-4 weeks without causing rebound congestion 1, 2
Clinical Efficacy
- Onset of action: Within minutes 2
- Duration of effect: Up to 10 hours of superior decongestant effect compared to placebo 3
- Xylometazoline was found superior to intranasal corticosteroids for immediate nasal decongestion in a 28-day study, though corticosteroids are more effective for overall rhinitis symptoms long-term 1
Safety Profile and Adverse Effects
Common Side Effects
- Epistaxis (nosebleeds): 3.4% of patients 3
- Blood-tinged mucus: 10-26% of patients 3
- Headache: 3.4% 3
- Local nasal irritation, burning, or dryness 1
Serious Considerations
- No sedation reported with proper dosing 3
- No systemic sympathomimetic effects (unlike oral decongestants) when used as directed 3
- Cardiovascular effects possible with excessive dosing, particularly in children—monitor quantity used 6
- Benzalkonium chloride preservative may augment pathologic effects when used ≥30 days 2
Key Contraindications and Precautions
- Avoid in patients currently using or recently discontinued (within 2 weeks) MAO inhibitors 1
- Use caution in cardiovascular disease, hypertension, hyperthyroidism, closed-angle glaucoma 1
- Not recommended for continuous use beyond 3 days without intranasal corticosteroid co-administration 1, 2
Management of Rhinitis Medicamentosa
If rebound congestion develops from prolonged use, immediately discontinue xylometazoline and start an intranasal corticosteroid (2 sprays per nostril daily). 2
- Intranasal corticosteroids are first-line treatment for established rhinitis medicamentosa 2
- For severe withdrawal symptoms, consider a 5-7 day course of oral corticosteroids 2
- Hypertonic saline irrigation provides symptomatic relief during withdrawal without dependency risk 2
- Complete recovery typically occurs over several weeks with corticosteroid therapy 2