There have been reports of worsening nasal congestion (rebound congestion) when the effects of nasal decongestant sprays or drops containing xylometazoline hydrochloride and oxymetazoline hydrochloride, referred to hereafter as ‘xylometazoline’ and ‘oxymetazoline’, wear off. This typically occurs when these medicines are used for longer than recommended. Continued use can also lead to more serious and longer-lasting changes to the lining and structures of the nose (rhinitis medicamentosa). In addition, repeated use will result in a rapid and noticeable reduction in the medicine’s effectiveness (tachyphylaxis).
Patients and caregivers should be informed not to exceed the recommended dose and not to use for more than 5 consecutive days. Continuous use of these medicines for more than 5 days can lead to an increased risk of side effects. Medical advice should be sought if symptoms of nasal congestion persist, worsen or do not improve after 5 days, as alternative treatment may be required.
- rebound congestion, rhinitis medicamentosa, and tachyphylaxis through overuse are recognised side effects with nasal sprays and drops containing xylometazoline or oxymetazoline when used beyond the maximum recommended duration
- patients may mistakenly interpret a rebound congestion effect as a continuation of the original congestion when it is a response to prolonged use of the product
- advise patients and their caregivers that xylometazoline and oxymetazoline are for short term use only and advise against prolonged or extended use beyond 5 days
- advise patients and their caregivers not to exceed the daily recommended dose and to take note of the minimum dosing interval stated in the product information
- if the symptoms of nasal congestion persist, worsen or do not improve after 5 days, alternative treatment may be required
- patients experiencing rebound congestion or related side effects may feel the need to continue using the products, leading to a cycle of overuse. Opportunistically review patients who may have become reliant on using these products and advise them on how to gradually stop using these medications. Stopping abruptly can worsen symptoms, but patients typically recover within 3 months with early recognition and treatment
- rhinitis medicamentosa is the most serious of these reported effects and is associated with persistent nasal congestion and longer-lasting changes to the nasal mucosa or structures of the nose. Symptoms may not resolve quickly after stopping the decongestant and, in severe cases, may require surgical intervention. Look out for patients presenting with severe nasal congestion and visible changes to the nasal mucosa or other internal nasal structures . Associated symptoms may include nasal irritation or itching, sneezing, and a runny nose. Management may require a tailored treatment plan, including gradual withdrawal of the decongestant, use of alternative therapies, and clinical follow-up to monitor recovery
Excerpt from the official page. The original is authoritative. Continue reading at UK Drug Safety Update ↗