Nasal Decongestant

NASAL
DECONGESTANT
S
Dr. Lokeshwar Chaurasia

MD; Asst. Professor
Dept. Of Pharmacology
Nasal congestion
• It is the blockage of the nasal
passages due to inflamed blood
vessels and swollen membranes
lining the nose.
• Nasal congestion in an infant in
the first few months of life can
interfere with breastfeeding and
cause life-threatening respiratory
distress
Symptoms
• Interfere with sleep
• Snoring
• Sleep apnoea
• In children, nasal congestion from
enlarged adenoids can cause
chronic sleep apnea with insufficient
oxygen level and hypoxia, as well as
right-sided heart failure.
• Mild facial and head pain
Etiology
• Allergy
• Common cold or influenza
• DNS
• Reaction to medication
• Chronic use of nasal decongestants (Oxymetazoline,
Phenylephrine)
• Sinusitis
• Narrow or collapsing nasal valve
• Pregnancy may cause women to suffer from nasal
congestion due to the increased amount of blood
flowing through the body.
• Nasal polyps
• GERD
Treatment
• The treatment of nasal congestion
frequently depends on the underlying
cause.
• A decongestant or nasal
decongestant, is a type of
pharmaceutical drug that is used to
relieve nasal congestion in the upper
respiratory tract.
• The active ingredient in most
decongestants is either
pseudoephedrine or phenylephrine.
• Topical decongestants on topical
application as dilute solution (0.05–
0.1%) produce local
vasoconstriction
• Intranasal corticosteroids can also
be used as decongestants and
antihistaminics can be used to
alleviate runny nose, nasal itch and
sneezing
• Expectorant are a related type of
drug which help to clear mucus.
IDEAL DECONGESTANT
• A-produce prompt, prolonged and
reliable effect
• B-free from tachyphylaxis, local
irritation and dangerous effect on
nasal cilia
• C-Produce no after congestion &
systemic A/E
Medical uses
• Decongestants are used to treat nasal congestion in:
Allergies
Infections (cold, influenza,sinus infection )
Nasal polyps.
To give relief in-
• Temporary common cold
• Acute rhinitis
• Sinusitis
• Acute otitis media , eustachian tube blocking
• To visualise nasal canal cavity before nasal
surgery
• Combination with antihistaminic, antitussive,
mucolytics, expectorant etc
Adverse effect
• Stinging sensation,local discomfort ,burning,
dryness of nasal mucosa
• Ischaemic damage to mucosa- if used more
often less than 3 hrly or prolonged period >3
weeks
• Rebound congestion on over use
• Atropic rhinitis(rhinitis
medicementosa),anosmia result due to
persistent vasoconstriction
• Impaired mucosal ciliary function
• Lipoid pneumonia on long term use enter into
lung
• Hypertensive crisis-if taken together with
MAO inhibitor
Contraindication
• Cautiously used in hypertensive
and elderly people
• Infants and children-these drug
may cause disturbances of body
temp.
• CNS depression,even coma at high
dose
Nasal decongestants
• All sympathomimetics with alpha adrenoceptor effect
have been used for this purpose with or without H1
antihistaminic
• Drugs used:
• TOPICAL-as nasal drops
Ephedrine(o.5 % in NS)
Phenylephrine(o.25 %)
 Imidazoline compounds- Nafazoline(o.5%)
Xylometazoline(o.1%)
Oxymetazoline(o.o5%)
• Orally administerd —
1. Phenylephrine 2. Pseudoephedrine
3. Ephedrine 4. Phenylpropanolamine
• CORTICOSTEROIDS: Budesonide, Prednisolone,
Fluticasone, Dexamethasone
MOA
• Constrict the blood vessels in nose,
throat and paranasal sinuses through
alpha receptor stimulation  reduced
swelling(congestion) and mucus
formation in these areas.
• Shrink the swollen turbinate
• Reduce the local edema
• Increase the nasal patency, decrease
resistance , produce relief
Alpha adrenergic agonist
• First treatment of choice.
• Both Influenza and common cold are self-limiting
conditions that improve with time; however,
drugs such as paracetamol, aspirin and ibuprofen
may provide some relief.
• Congestion related to allergy: avoid allergens ±
Antihistamines
• Antihistamines may be given continuously during
pollen season for optimum control of symptoms.
• Topical decongestants should be used for max of
3 days rebound congestion rhinitis
medicamentosa
• In infants with nasal congestion: noasal
aspirator may be used to remove the mucus
• Pseudoephedrine acts indirectly on the
adrenergic receptor system, whereas
phenylephrine and oxymetazoline are direct
agonist
• The effects are not limited to the nose, and
these medicines may cause vasoconstriction
hypertension
• Common side-effects: sleeplessness, anxiety,
dizziness, excitability, and nervousness.
• Topical nasal or ophthalmic decongestants
quickly develop tachyphylaxis
• Long-term use is not recommended, since
these agents lose effectiveness after a few
days.
THANK YOU!!!

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NASAL

Dr. Lokeshwar Chaurasia

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