Fetal heart rate changes following maternal administration of a nasal decongestant

The diagnosis and management of rhinitis: An updated practice parameter

“…Intranasal decongestants usually do not cause systemic sympathomimetic symptoms; however, a variety of cerebrovascular adverse events have been reported, including anterior ischemic optic neuropathy, 920 stroke, 921 branch retinal artery occlusion, 922 and ''thunderclap'' vascular headache. 923,924 Caution for use of decongestants during the first trimester is recommended because fetal heart rate changes with administration during pregnancy 925 have been reported. Topical vasoconstrictors should be used with care below age 1 year because of the narrow margin between the therapeutic and toxic dose, which increases the risk for cardiovascular and CNS side effects.…”

Use of Decongestants During Pregnancy and the Risk of Birth Defects

“…Although administered intranasally for an intended localized effect and generally thought to carry less risk than systemically administered agents, intranasal decongestants, mainly oxymetazoline and xylometazoline, are absorbed well from the nasal mucosa to produce systemic effects (24). Though it is not known whether these agents cross the placenta (24), a report of fetal heart rate changes after maternal use of oxymetazoline nasal spray (27) suggests that oxymetazoline and possibly other intranasal decongestants could affect the fetus. In addition to their vasoconstrictive α-adrenoceptor agonistic activity (28), oxymetazoline and xylometazoline are also agonists of some 5-hydroxytryptamine (serotonin) receptor subtypes (29,30).…”

Role of Topical Oxymetazoline for Management of Erythematotelangiectatic Rosacea

“…7 Reports of use of oxymetazoline during pregnancy are inconclusive on safety and are limited to the nasal spray. 11,12 Lactation data are limited, but rat models suggest that oxymetazoline is excreted into breast milk. The cream has not been studied in pediatric patients.…”