Topical decongestants
Place in Therapy
Place in Therapy
In order to determine the efficacy of a topical decongestant, many studies quantitatively measured a change in nasal airway resistance (NAR) and subjectively measured patient’s symptoms through the use of questionnaires and rating scales (1). It was found that just one dose of xylometazoline significantly improved and maintained nasal air flow and patient symptoms for up to 10 hours, while one dose of oxymetazoline could illicit the same effects for 7 hours (2,3). Effective concentrations were found to be 0.05% and 0.1% xylometazoline and 0.05% of oxymetazoline used in either a drop or spray dosage form (2,3,4). Although the efficacy of these products is comparable to oral decongestants, their faster onset of action and safety profile make them the first line choice (2).
According to the literature, topical decongestants are very well tolerated with adverse events being mild to moderate in nature (2). Side effects may include headache, burning or tingling of the nasal passages, dryness, sneezing, and runny nose (4,5). In one study, xylometazoline produced fewer adverse events than placebo (2). Topical decongestants should not be used in patients under the age of 12 as their efficacy and safety have not been studied (1). Due to their low systemic absorption, topical decongestants have been deemed safe for short term use in pregnancy, and are preferred over oral decongestants in the first trimester (4). Patients with diabetes, cardiovascular disease, hypothyroidism, or hypertension should consult a physician before using these products and those taking an MAOI should avoid these products completely (6). Prolonged use of a topical nasal decongestant may lead to rhinitis medicamentosa, resulting in more severe congestion and decreased effectiveness of the medication. To avoid this, patients must limit use to 3-5 days and administer small amounts, only when necessary (5).
References
1. Taverner D, Latte J. Nasal decongestants for the common cold. Cochrane Database Syst Rev. 2007;(1):CD001953.
2. Eccles R, Eriksson M, Garreffa S, Chen SC. The nasal decongestant effect of xylometazoline in the common cold. Am J Rhinol. 2008;22(5):491-6.
3. Akerlund A, Klint T, Olén L, Rundcrantz H. Nasal decongestant effect of oxymetazoline in the common cold: an objective dose-response study in 106 patients. J Laryngol Otol. 1989;103(8):743-6.
4. Lynch T. Respiratory Disorders: Viral Rhinitis. In: Gray Jean, editor. e-Therapeutics+ [Internet]. Ottawa (ON): Canadian Pharmacists Association; 2007 [updated Sep 2006; cited 2014 Mar 11]. Available from: http://www.e-therapeutics.ca.
5. May R, Smith PH. Chapter 104. Allergic Rhinitis. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L. eds. Pharmacotherapy: A Pathophysiologic Approach, 8e. New York: McGraw-Hill; 2011. http://accesspharmacy.mhmedical.com.proxy.lib.uwaterloo.ca/content.aspx?bookid=462&Sectionid=41100885. Accessed March 01, 2014
6. Xylometazoline. Lexi-Drugs Online. Hudson, OH: Lexi-Comp, Inc. Updated February 26, 2014. Available from: http://online.lexi.com.proxy.lib.uwaterloo.ca/lco/action/doc/retrieve/docid/lexier/390058.Accessed Mar 10, 2014.
In order to determine the efficacy of a topical decongestant, many studies quantitatively measured a change in nasal airway resistance (NAR) and subjectively measured patient’s symptoms through the use of questionnaires and rating scales (1). It was found that just one dose of xylometazoline significantly improved and maintained nasal air flow and patient symptoms for up to 10 hours, while one dose of oxymetazoline could illicit the same effects for 7 hours (2,3). Effective concentrations were found to be 0.05% and 0.1% xylometazoline and 0.05% of oxymetazoline used in either a drop or spray dosage form (2,3,4). Although the efficacy of these products is comparable to oral decongestants, their faster onset of action and safety profile make them the first line choice (2).
According to the literature, topical decongestants are very well tolerated with adverse events being mild to moderate in nature (2). Side effects may include headache, burning or tingling of the nasal passages, dryness, sneezing, and runny nose (4,5). In one study, xylometazoline produced fewer adverse events than placebo (2). Topical decongestants should not be used in patients under the age of 12 as their efficacy and safety have not been studied (1). Due to their low systemic absorption, topical decongestants have been deemed safe for short term use in pregnancy, and are preferred over oral decongestants in the first trimester (4). Patients with diabetes, cardiovascular disease, hypothyroidism, or hypertension should consult a physician before using these products and those taking an MAOI should avoid these products completely (6). Prolonged use of a topical nasal decongestant may lead to rhinitis medicamentosa, resulting in more severe congestion and decreased effectiveness of the medication. To avoid this, patients must limit use to 3-5 days and administer small amounts, only when necessary (5).
References
1. Taverner D, Latte J. Nasal decongestants for the common cold. Cochrane Database Syst Rev. 2007;(1):CD001953.
2. Eccles R, Eriksson M, Garreffa S, Chen SC. The nasal decongestant effect of xylometazoline in the common cold. Am J Rhinol. 2008;22(5):491-6.
3. Akerlund A, Klint T, Olén L, Rundcrantz H. Nasal decongestant effect of oxymetazoline in the common cold: an objective dose-response study in 106 patients. J Laryngol Otol. 1989;103(8):743-6.
4. Lynch T. Respiratory Disorders: Viral Rhinitis. In: Gray Jean, editor. e-Therapeutics+ [Internet]. Ottawa (ON): Canadian Pharmacists Association; 2007 [updated Sep 2006; cited 2014 Mar 11]. Available from: http://www.e-therapeutics.ca.
5. May R, Smith PH. Chapter 104. Allergic Rhinitis. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L. eds. Pharmacotherapy: A Pathophysiologic Approach, 8e. New York: McGraw-Hill; 2011. http://accesspharmacy.mhmedical.com.proxy.lib.uwaterloo.ca/content.aspx?bookid=462&Sectionid=41100885. Accessed March 01, 2014
6. Xylometazoline. Lexi-Drugs Online. Hudson, OH: Lexi-Comp, Inc. Updated February 26, 2014. Available from: http://online.lexi.com.proxy.lib.uwaterloo.ca/lco/action/doc/retrieve/docid/lexier/390058.Accessed Mar 10, 2014.