Decongestion Effect and Rebound Swelling of the Nasal Mucosa during 4-Week Use of Oxymetazoline

Abstract

The aim of this study was to investigate whether long-term use of oxymetazoline induces a rebound swelling of the nasal mucosa and whether the decongestion effect is altered during medication. Eight healthy volunteers had oxymetazoline nasal spray (0.5 mg/ml; 0.1 ml in each nostril, three times daily) for 30 days and registrations of the mucosal surface positions were made using rhinostereometry. Compared to the registrations before the start of medication, no rebound swelling was registered after 10 days. After 30 days, however, a rebound swelling was registered in all subjects (p < 0.001). All of them, then, also reported nasal stuffiness. The decongested position of the nasal mucosa after one single dose of oxymetazoline was the same in the whole study. It is concluded that rhinitis medicamentosa develops after a relatively short time on oxymetazoline, even in healthy volunteers, and that the swelling probably is due to a vasodilatation rather than an edema. The study supports the recommendation that the drug should not be used over periods > 10 days.

Correlation between Objective Nasal Mucosal Swelling and Estimated Stuffiness during Long-Term Use of Vasoconstrictors

“…After 1 month of medication, rebound swelling and an increase in histamine sensitivity was recorded which reflected rhinitis medicamentosa and nasal hyperreactivity [12,13]. The results, therefore, con firmed the clinical observation that rhinitis medicamen tosa is indistinguishable from vasomotor rhinitis [14][15][16],…”

“…We have shown that the mucosal swelling after hista mine provocation was the same for the oxymetazoline and xylometazoline groups in all four histamine provoca tion tests [12,13], The rebound swelling after 30 days on both drugs were also the same. Therefore, for the purpose of this study, the results from the oxy-and xylometazoline groups were analyzed together.…”

“…Therefore, for the purpose of this study, the results from the oxy-and xylometazoline groups were analyzed together. Regarding the mucosal baseline position, it has been shown that there is no signif icant day-to-day variation in healthy volunteers [13]. Moreover, the decongested mucosal position remained the same in repeated measurements during the 30-day use of oxymetazoline [13], The histamine challenge was per formed on only one side of the nose with the opposite nos tril as a reference.…”

One-Week Use of Oxymetazoline Nasal Spray in Patients with Rhinitis medicamentosa 1 Year after Treatment

“…In fact, the symptom scores show that the nasal stuffiness starts already after 3-day use of the nasal decongestant spray. With rhinostereometry we have previously shown that oxymetazoline nasal spray induces mucosal congestion and nasal hyperreactivity, as indicated by increased hista mine sensitivity, in healthy subjects after 30 days but not after 10 days [11], The increase in histamine sensitivity was in agreement with that seen in patients with vasomo tor rhinitis and it was greater than that of healthy subjects [12,13]. In another study, we investigated two groups of healthy subjects who received oxymetazoline nasal spray with and without benzalkonium chloride for 10 days [14].…”

Topical decongestants: myth and reality

“…Эти явления ухудшают вентиляцию назальной и параназальной полостей и дополнительно вызывают изменения способности к мукоцилиарному клиренсу, что может привести к застою секрета или длительному сохра-нению медиаторов воспаления в слизистой оболочке носа, но главным образом к неспособности выведения вирус-ных, бактериальных и грибковых патогенов. Лекарствен-ный ринит связан с использованием лекарственных средств, содержащих, в частности, эфедрин, тогда как для современных сосудосуживающих средств этот эффект менее характерен и встречается реже [8,9].…”