12.2.2 Topical nasal decongestants

NHS England (NHSE) has published new prescribing guidance for various common conditions for which over-the-counter (OTC) items should not be routinely prescribed in primary care (quick reference guide). These conditions include mild to moderate hay fever/seasonal allergic rhinitis and coughs, colds, and nasal congestion.

Many of these products are cheap to buy and are readily available OTC along with advice from pharmacies. Some self-care medicines are available from shops and supermarkets. Please click here for further information, exceptions, and a patient leaflet.

Sodium chloride
  • Nasal drops 0.9% (£0.99 = 10ml)

Indications

  • Sodium Chloride 0.9% given as nasal drops may help relieve nasal congestion by helping to liquefy mucous secretions.

Sympathomimetics

Topical nasal decongestants containing sympathomimetics, ephedrine and xyometazoline, can cause rebound congestion following prolonged use (more than 7 days) and are therefore of limited value.

Xylometazoline
  • Nasal drops 0.1% (adult strength) (£1.91 = 10ml)
  • Nasal drops 0.05% (paediatric strength) (£2.18 = 10ml)
  • Nasal spray (£2.18 = 10ml)

Indications

  • Rhinorrhoea associated with allergic and non-allergic rhinitis

Dose

  • Nasal drops: 2–3 drops into each nostril 2–3 times daily when required; maximum duration 7 days; not recommended for children under 12 years
  • Paediatric nasal drops: 6–12 years 1–2 drops into each nostril 1–2 times daily when required; maximum duration 5 days
  • Spray: 1 spray into each nostril 1–3 times daily when required; maximum duration 7 days; not recommended for children under 12 years

Notes

  1. Xylometazoline 0.05% nasal drops are only licensed for children aged 6 years or over (short-term use only).

Antimuscarinic

Ipratropium Bromide
  • Nasal spray 0.03% (£6.54 = 180 sprays)

Indications

  • Rhinorrhoea associated with allergic, non-allergic and senile rhinitis

Dose

  • Adult and child over 12 years, 2 sprays into each nostril 2–3 times daily

Notes

  1. Ipratropium may be useful to treat non-allergic watery rhinorrhoea. It does not act directly to reduce blood flow to the nose but reduces watery secretions.

Systemic nasal decongestants

Many nasal decongestant products are cheap to buy and are readily available, along with advice, from pharmacies. Some self-care medicines are available in shops and supermarkets. Please click here for further information and a patient leaflet

Pseudoephedrine See 3.10 Systemic nasal decongestants

Notes

  1. Systemic nasal decongestants are of doubtful value but unlike the preparations for local application they do not give rise to rebound nasal congestion.
  2. Sympathomimetics should be avoided in patients with hypertension, hyperthyroidism, coronary heart disease, or diabetes, and in patients taking monoamine-oxidase inhibitors.

 

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