Oxymetazoline
Nasal decongestants
Nasal decongestants
A long-acting nasal decongestant spray; used for no more than 3 days to avoid rebound congestion.
Quick facts
- Group
- Nasal decongestants
- Target
- Alpha-1A and alpha-2A adrenergic receptors
- Used for
- Nasal congestion of colds
- Key effects
- Burning · Sneezing · Runny nose
- Monitor
- Days of use · Blood pressure in hypertensive patients
- ATC
- R01AA05
No doses: the clinician sets them by the current guideline.
Mechanism of action
The figure shows oxymetazoline bound to the human alpha-1A adrenergic receptor in complex with its G protein (cryo-electron microscopy).
Oxymetazoline is an imidazoline that directly stimulates alpha-1 and alpha-2 adrenergic receptors on the vessels of the nasal mucosa. The vessels constrict within minutes, mucosal swelling falls and the nose opens for many hours. With use beyond a few days, the vessels rebound when the drug wears off and congestion becomes worse (rhinitis medicamentosa). If swallowed, especially by young children, it can act on central alpha-2 receptors and cause sedation, slow heart rate and low blood pressure.
- Oxymetazoline is sprayed onto the nasal mucosa
- It activates alpha receptors on the nasal vessels
- Vessels constrict and the swelling falls
- Use beyond a few days causes rebound congestion
Indications
- Nasal congestion of colds Common cold (acute viral rhinopharyngitis) →
- Nasal congestion of allergic rhinitis (short term) Allergic rhinitis →
- Sinus congestion and pressure Acute rhinosinusitis →
Adverse effects
Common
- Burning, stinging or dryness of the nose
- Sneezing
- Runny nose
Contraindications
- Use longer than 3 days
- Children under 6 years unless recommended by a doctor
- Caution in heart disease, hypertension, thyroid disease, diabetes and prostate enlargement
- MAO inhibitors
Key interactions
- MAO inhibitors
- Risk of a dangerous rise in blood pressure
- Other decongestants or sympathomimetics
- Additive cardiovascular effects
What is monitored
- Days of use
- Blood pressure in hypertensive patients
Administration and safety
- Nasal spray only; not swallowed
- Used for no more than 3 days
- Each bottle is used by one person only, to avoid spreading infection
Pregnancy and breastfeeding
Short topical use is sometimes accepted in pregnancy; the clinician decides.
Nursing care
- Teach the 3-day limit and explain rebound congestion
- Store out of reach of children
- Ask about hypertension, heart disease and MAO inhibitors
Pharmacokinetics
- Absorption
- Acts locally; some is absorbed through the mucosa or swallowed
- Onset and duration
- Within minutes, lasting many hours
Test yourself
Think of the answer, then tap the question to see it.
What is the maximum usual length of oxymetazoline nasal spray use, and why?
3 days, because longer use causes rebound congestion.
Which receptors does oxymetazoline stimulate?
Alpha-1 and alpha-2 adrenergic receptors.
What can happen if a toddler swallows oxymetazoline?
Sedation, slow heart rate and low blood pressure from central alpha-2 stimulation.
Connections
← Back to the class: Nasal decongestants
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Oxymetazoline Nasal Spray: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2016); Decongestants - NHS (NHS, 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.