xylometazoline hydrochloride
Otrivin, Otrivin Pediatric Nasal Drops

Available forms
Available without a prescription
Nasal drops: 0.05% (pediatric use), 0.1%
Nasal spray: 0.1%

Indications and dosages
 Nasal congestion. Adults and children older than age 12: 2 or 3 drops or sprays of 0.1% solution to nasal mucosa q 8 to 10 hours, not to exceed three times in 24 hours.
Infants and children ages 6 months to 12 years: 2 or 3 drops of 0.05% solution to nasal mucosa q 8 to 10 hours, not to exceed three times in 24 hours.
Infants younger than age 6 months: 1 drop of 0.05% solution in each nostril q 6 hours, p.r.n., under medical direction.

Pharmacodynamics
Decongestant action: Acts on alpha-adrenergic receptors in nasal mucosa to produce constriction, decreasing blood flow and nasal congestion.

Pharmacokinetics
Absorption: None reported.

Contraindications and precautions
Contraindicated in patients hypersensitive to drug and patients with acute angle-closure glaucoma. Use cautiously in patients with hyperthyroidism, cardiac disease, hypertension, diabetes mellitus, and advanced arteriosclerosis.

Interactions
Drug-drug. Tricyclic antidepressants: May potentiate pressor effects of xylometazoline if significant systemic absorption occurs. Monitor patient closely.

Adverse reactions
EENT: transient burning or stinging, dryness or ulceration of nasal mucosa, sneezing, rebound nasal congestion, irritation (with excessive or long-term use).

Effects on lab test results
None reported.

Overdose and treatment
Signs and symptoms of overdose include somnolence, sedation, sweating, CNS depression with hypertension, bradycardia, decreased cardiac output, rebound hypotension, CV collapse, depressed respirations, coma.
 Because of rapid onset of sedation, emesis isn’t recommended in therapy unless given early. Activated charcoal or gastric lavage may be used initially. Monitor vital signs and ECG. Treat seizures with I.V. diazepam.

Special considerations
• Systemic absorption is less likely and drug is more effective if 3 to 5 minutes elapse between sprays and nose is cleared before next spray.
• Watch carefully for adverse effects in patients with CV disease, diabetes mellitus, or hyperthyroidism.
Pediatric patients
• Keep in mind that children may be prone to greater systemic absorption and increased adverse effects.
Geriatric patients
• Use cautiously in elderly patients with cardiac disease, diabetes mellitus, or poorly controlled hypertension.

Patient education
• Inform patient that drug should be used only for short-term relief of symptoms (3 to 5 days maximum).
• Instruct patient on correct method of administration.
• Caution patient not to exceed recommended dose to avoid rebound congestion.
• Instruct patient to promptly report insomnia, dizziness, weakness, tremor, or irregular heartbeat.

Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE THREATENING.
◆ Canada only
◇ Unlabeled clinical use