Topical Decongestant

Aka: Topical Decongestant, Spray Decongestant, Oxymetazoline, Afrin, Intranasal Phenylephrine, Intranasal Neo-Synephrine, Intranasal Propylhexedrine, Benedrex

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II. Indications

  1. Acute Sinusitis
  2. Epistaxis

III. Precautions

  1. Avoid using longer than 3 days
  2. Overuse results in Rhinitis Medicamentosa
  3. Avoid afrin (Oxymetazoline) in children (due to central alpha-2 Agonist, Clonidine-like CNS depression)
    1. See One Pill Can Kill
    2. If a nasal Decongestant is used in children, Neo-Synephrine (Phenylephrine) is preferred
  4. Propylhexedrine (Benedrex) abuse
    1. Has been abused via ingestion, injection or large inhalation for Amphetamine-like effect
    2. Risk of Arrhythmia, Chest Pain, Agitation, Psychosis, death
    3. (2021) Presc Lett 28(5): 30 [PubMed]

IV. Preparations

  1. Oxymetazoline (Afrin)
    1. Two sprays per nostril twice daily for 2-3 days
  2. Phenylephrine (Neo-Synephrine)
    1. Adults: 2 sprays per nostril four times daily for 2-3 days
    2. Child: Neo-Synephrine 1/8% every 4-6 hours for 2-3 days
  3. Propylhexedrine (Benedrex)
    1. Adults and Children over age 6 years: two sprays each nostril up to every 2 hours for 2-3 days

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