Oxymetazoline (Dristan Long Lasting Nasal Spray)

1. Health Canada Product Monograph — Oxymetazoline

• Short-term relief of nasal congestion associated with the common cold, allergic rhinitis, sinusitis, or acute rhinosinusitis.
• No randomized controlled trials have specifically evaluated its effectiveness in acute rhinosinusitis; use is based on symptomatic decongestant effect rather than disease-modifying evidence.

• If a decongestant is needed in pregnancy, a topical (intranasal) product such as this one is preferred over an oral decongestant to reduce fetal drug exposure. Limit use to no more than 3-5 days, ideally after the first trimester and not during labour, given pregnant patients' tendency toward rebound congestion.

• Considered safe during breastfeeding when used for no more than 3-5 days; topical products are preferred over oral decongestants to reduce infant drug exposure. Watch for signs of toxicity in the infant (irritability, nervousness, insomnia, excitation) with any decongestant use during breastfeeding.

• Use with caution in patients with hypertension, cardiovascular disease, diabetes, hyperthyroidism, or benign prostatic hyperplasia — conditions more common in this population.

• Efficacy and safety have not been well studied in children under 12 years of age; carefully weigh risks and benefits before recommending. Caution is required around young children — accidental ingestion of even small amounts (1-2 mL) can cause serious adverse events, including sedation, hypothermia, and bradycardia.

• Adults and children 6 years and older (0.05%): 2-3 sprays or drops per nostril every 12 hours as needed, maximum 2 doses per 24 hours.
• Do not use for more than 3-5 consecutive days.

If overdose is suspected, seek emergency medical attention immediately or contact your regional Poison Control Centre without delay.

• Accidental pediatric ingestion is a recognized cause of serious toxicity — sedation, hypothermia, bradycardia, and respiratory depression have been reported even with small volumes. Contact Poison Control or seek emergency care immediately if ingestion is suspected.

• Transient burning, stinging, and dryness of the nasal mucosa.

Serious side effects require immediate discussion with the prescriber or emergency care.

• Rebound congestion (rhinitis medicamentosa) with use beyond 3-5 consecutive days — can be difficult to reverse and may require gradual withdrawal, sometimes with the assistance of an intranasal corticosteroid.
• Rare hypertensive episodes or arrhythmia with excessive or systemic exposure.

• Use with caution in patients with hypertension, diabetes, cardiovascular disease, prostatic hyperplasia, or hyperthyroidism.

• Concurrent use with a nonselective MAOI, or within 2 weeks of stopping one — risk persists for 2 weeks after discontinuation of the MAOI.

• MAOIs: avoid combination — hypertensive crisis risk persists for 2 weeks after stopping a nonselective MAOI (e.g., phenelzine).

• None known.

• Every 12 hours as needed, not exceeding 2 doses per 24 hours, for no more than 3-5 consecutive days.

• Store at room temperature. Keep out of reach of children given the toxicity risk with accidental ingestion.

• Do not use for more than 3-5 days in a row — longer use causes rebound congestion that can be worse than the original problem and harder to treat.
• Keep out of reach of children — even a small accidental dose can be dangerous.
• Never use if you are taking, or have recently stopped, a monoamine oxidase inhibitor (MAOI) antidepressant.
• Topical products cause fewer systemic side effects than oral decongestants but are still absorbed to some degree — use with caution if you have high blood pressure, heart disease, or thyroid disease.