Xylometazoline nasal spray (Otrivine): uses, limits and cautions

Xylometazoline is a decongestant. The emc entry for Otrivine Blocked Nose Relief 0.1% lists symptomatic relief of nasal congestion, perennial and allergic rhinitis including hay fever, and sinusitis. It relieves stuffiness only; it does not treat an infection or an allergy itself, so the underlying cause of a persistently blocked nose still needs attention.

The drug constricts the small blood vessels in the lining of the nose, reducing the swelling that blocks the airway. The effect is local and starts when the mist reaches the lining, which is why people reach for it for a quick clearing before sleep. The trade-off is that the vessels can swell back worse than before if the spray is used too long.

The entry gives adults and older people one application in each nostril up to 3 times daily, never more than 3 applications into each nostril in a day. It is not suitable for children under 12, and the recommended dose should not be exceeded, particularly in children and older people. Before the first use, the pump is primed by pressing it several times; it needs re-priming if unused for longer than 7 days.

Crucially, the product information advises not using decongestants for more than seven consecutive days. Prolonged or excessive use may cause rebound congestion, where the nose becomes more blocked once the drug wears off, and may cause atrophy, or thinning, of the nasal lining. If your nose is still blocked after a week, a pharmacist or doctor can look for another cause or suggest a different treatment such as a steroid nasal spray.

The entry lists contraindications: known hypersensitivity to xylometazoline; having had trans-sphenoidal pituitary surgery or surgery that exposed the dura mater; narrow-angle glaucoma; dry or atrophic rhinitis; use under 12 years; and phaeochromocytoma, an enlarged prostate, or treatment with monoamine oxidase inhibitors now or within the last two weeks.

It should be used with caution if you react strongly to sympathomimetic drugs, with signs such as insomnia, dizziness, tremor, arrhythmias or raised blood pressure; and with hypertension, cardiovascular disease, overactive thyroid, diabetes or treatment with tricyclic or tetracyclic antidepressants. People with long QT syndrome may be at increased risk of serious ventricular arrhythmias.

Headache, nausea, nasal dryness, nasal discomfort and a burning sensation at the application site, in the nose and throat, are listed as common, and nosebleeds as uncommon. Very rare effects include allergic reactions with swelling, rash or itching, transient visual impairment and a fast or irregular heartbeat. The spray contains benzalkonium chloride, which can irritate the nasal lining.

Stop the spray and seek medical advice if you develop swelling of the face or lips, a persistent nosebleed, vision changes or heart palpitations. Suspected side effects can be reported through the Yellow Card scheme.

Using it alongside monoamine oxidase inhibitors, or tri- and tetracyclic antidepressants, can raise blood pressure through combined cardiovascular effects.

There are no foetal toxicity or fertility studies in animals, and because of its potential to constrict blood vessels the entry advises avoiding Otrivine during pregnancy. No adverse effect on breastfed infants has been seen, but it is unknown whether xylometazoline reaches breast milk, so it should be used while breastfeeding only on a doctor's advice. It has no or negligible effect on driving.

Too much, or accidental swallowing, may cause severe dizziness, sweating, a very low body temperature, headache, a slow heartbeat, high blood pressure, slowed breathing, coma and convulsions, and small children are more sensitive. Anyone who has swallowed the spray or used far too much needs urgent medical help: call 111 or 999 and keep the packaging.

Medicines belong out of sight and reach of children. If a blocked nose keeps coming back, it is worth finding the cause, whether that is allergy, a cold, sinus inflammation or polyps, rather than relying on repeated courses of a decongestant.