Xylometazoline
Nasal decongestants
Nasal decongestants
An imidazoline nasal decongestant spray or drops on the WHO essential list; short use only, because of rebound congestion.
Quick facts
- Group
- Nasal decongestants
- Target
- Alpha adrenergic receptors of the nasal vessels
- Used for
- Nasal congestion of colds · Sinus congestion
- Key effects
- Nasal burning · Sneezing · Headache
- Monitor
- Days of use · Blood pressure in hypertensive patients
- ATC
- R01AA07
No doses: the clinician sets them by the current guideline.
Mechanism of action
The figure shows oxymetazoline, a closely related imidazoline that occupies the same site, bound to the human alpha-1A adrenergic receptor.
Xylometazoline is an imidazoline that directly stimulates alpha adrenergic receptors on the vessels of the nasal mucosa. The vessels constrict, mucosal swelling falls and nasal breathing improves within minutes for several hours. Repeated use beyond a few days causes rebound congestion, and swallowed doses in young children can cause sedation and slow heart rate.
- Xylometazoline is sprayed or dropped into the nose
- It activates alpha receptors on nasal vessels
- The vessels constrict and the nose opens
- Overuse causes rebound congestion
Indications
- Nasal congestion of colds Common cold (acute viral rhinopharyngitis) →
- Nasal congestion of allergic rhinitis (short term) Allergic rhinitis →
- Sinus congestion Acute rhinosinusitis →
Adverse effects
Common
- Nasal burning, stinging or dryness
- Sneezing
- Headache
Contraindications
- Hypersensitivity to xylometazoline
- Use beyond a few days
- Caution in hypertension, heart disease, diabetes, glaucoma, thyroid disease and prostate enlargement; not used in pregnancy without advice
- Young children unless a child formulation and medical advice
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 or drops only; children's strength is different from the adult one
- Short courses only
- One bottle per person
Pregnancy and breastfeeding
Decongestants are generally not used in pregnancy without advice; the clinician decides.
Nursing care
- Teach the short time limit and explain rebound congestion
- Keep away from children
- Ask about hypertension, heart disease, pregnancy and MAO inhibitors
Pharmacokinetics
- Absorption
- Acts locally; a little is absorbed or swallowed
- Onset and duration
- Within minutes, lasting several hours
Test yourself
Think of the answer, then tap the question to see it.
To which chemical group does xylometazoline belong?
The imidazolines, like oxymetazoline.
Why is xylometazoline used only for short courses?
Longer use causes rebound congestion (rhinitis medicamentosa).
Which nasal decongestant is on the WHO essential medicines list?
Xylometazoline.
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: Decongestants - NHS (NHS, 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026); eEML - Electronic Essential Medicines List (World Health Organization, 2025).
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Representative model, for educational purposes only.