C H A P T E R 5 4
Drugs acting on the upper respiratory tract
847
indicate lesions or erosion of the mucous membranes.
Use for longer than 3 to 5 days can lead to rebound con-
gestion. (Rebound congestion occurs when the nasal
passages become congested as the drug effect wears off.
As a result, people tend to use more drug to decrease the
congestion, thus initiating a vicious cycle of congestion–
drug–congestion, which leads to abuse of the decongest-
ant.) Sympathomimetic effects (e.g. increased pulse and
blood pressure; urinary retention) should be monitored
because some systemic absorption may occur, although
these effects are less likely with topical administration
than with other routes.
Clinically important drug–drug interactions
The use of topical nasal decongestants is contraindi-
cated with concurrent use of cyclopropane or halothane
TABLE 54.2
DRUGS IN FOCUS Decongestants
Drug name
Dosage/route
Usual indications
Topical nasal decongestants
ephedrine
Instill solution in each nostril q 4 hours, do not
use for children <6 years unless advised by
doctor
Relieves discomfort of nasal congestion
associated with the common cold,
sinusitis, allergic rhinitis; relieves
pressure of otitis media
oxymetazoline (Dimetapp,
Drixine)
Adult and paediatric (>6 years): two to three
sprays or drops in each nostril b.d.
Paediatric (2–6 years): two to three drops of
0.125% solution in each nostril q 4 hours as
needed
Relieves discomfort of nasal congestion
associated with the common cold,
sinusitis, allergic rhinitis
phenylephrine (Nyal)
Adult and paediatric (>6 years): one to two
sprays in each nostril q 3–4 hours
Paediatric (2–6 years): two to three drops of
0.125% solution in each nostril q 4 hours as
needed
Relieves discomfort of nasal congestion
associated with the common cold,
sinusitis, allergic rhinitis
xylometazoline (FLO
Xylo-POS)
Adult and paediatric (over 10 years): one spray
into each nostril 2–3 times daily
Relieves discomfort of nasal congestion
associated with the common cold,
sinusitis, allergic rhinitis; relieves
pressure of otitis media
Oral decongestant
pseudoephedrine
(Codral, Demazin,
Logicin, Sudafed)
Adult: 60 mg PO q 4–6 hours
Paediatric: 6–12 years: 30 mg PO q 4–6 hours
2–5 years: 15 mg PO q 4–6 hours
1–2 years: 0.02 mL/kg PO q 4–6 hours
3–12 months: three drops/kg PO q 4–6 hours
Decreases nasal congestion associated
with the common cold, allergic rhinitis;
relief of pain and congestion of otitis
media
Topical steroid nasal decongestants
beclomethasone
(Beconase)
Adult: one to two inhalations in each nostril
b.d.
Paediatric (6–11 years): one inhalation in each
nostril b.d.
Treatment of seasonal allergic rhinitis
in people who are not obtaining a
response with other decongestants
or preparations; relieves inflammation
following removal of nasal polyps
budesonide (Pulmicort)
Adult and paediatric (>6 years): two sprays
in each nostril morning and evening or four
sprays in each nostril in the morning
Treatment of seasonal allergic rhinitis
in people who are not obtaining a
response with other decongestants
or preparations; relieves inflammation
following removal of nasal polyps
fluticasone (Avamys,
Flixonase)
Adult and paediatric (4–11 years): two sprays in
each nostril daily
Treatment of seasonal allergic rhinitis
in people who are not obtaining a
response with other decongestants
or preparations; relieves inflammation
following removal of nasal polyps
triamcinolone (Telnase)
Adult: two sprays in each nostril every day
Treatment of seasonal allergic rhinitis
in people who are not obtaining a
response with other decongestants
or preparations; relieves inflammation
following removal of nasal polyps
