CLASSES

Ocular Decongestants, Sympathomimetics
Other Ophthalmologicals, Topical
Topical Nasal Decongestants
Topical Sympathomimetics

DEA CLASS

OTC, Rx

DESCRIPTION

Alpha adrenoreceptor agonist that acts as a vasoconstrictor
Available as a topical cream, intranasal spray, and an ophthalmic solution
Indicated to treat persistent facial erythema in adults with rosacea (cream), nasal congestion (intranasal spray), redness of the eye due to minor eye irritants (0.025% ophthalmic solution), acquired blepharoptosis io adults (0.1% ophthalmic solution)

COMMON BRAND NAMES

12 Hour Nasal, Afrin, Afrin Extra Moisturizing, Afrin Nasal Sinus, Afrin No Drip Severe Congestion, Dristan, Duration, Genasal, Mucinex Children's Stuffy Nose, Mucinex Full Force, Mucinex Moisture Smart, Mucinex Sinus-Max, Mucinex Sinus-Max Sinus & Allergy, NASAL Decongestant, Nasal Relief, Neo-Synephrine 12-Hour, Neo-Synephrine Severe Sinus Congestion, Nostrilla Fast Relief, Reliable-1 12 hour Decongestant, Rhinase D, RHOFADE, Sinex 12-Hour, Sudafed OM Sinus Cold Moisturizing, Sudafed OM Sinus Congestion Moisturizing, Upneeq, Vicks Qlearquil Decongestant, Vicks Sinex, Vicks Sinex Severe, Vicks Sinus Daytime, Zicam Extreme Congestion Relief, Zicam Intense Sinus

HOW SUPPLIED

12 Hour Nasal/Afrin/Afrin Extra Moisturizing/Afrin Nasal Sinus/Afrin No Drip Severe Congestion/Dristan/Duration/Genasal/Mucinex Children's Stuffy Nose/Mucinex Full Force/Mucinex Moisture Smart/Mucinex Sinus-Max/Mucinex Sinus-Max Sinus & Allergy/NASAL Decongestant/Nasal Relief/Neo-Synephrine 12-Hour/Neo-Synephrine Severe Sinus Congestion/Nostrilla Fast Relief/Oxymetazoline/Oxymetazoline Hydrochloride/Reliable-1 12 hour Decongestant/Sinex 12-Hour/Sudafed OM Sinus Cold Moisturizing/Sudafed OM Sinus Congestion Moisturizing/Vicks Qlearquil Decongestant/Vicks Sinex/Vicks Sinex Severe/Vicks Sinus Daytime/Zicam Extreme Congestion Relief/Zicam Intense Sinus Nasal Sol: 0.05%
12 Hour Nasal/Afrin/Afrin Extra Moisturizing/Afrin Nasal Sinus/Afrin No Drip Severe Congestion/Dristan/Duration/Genasal/Mucinex Children's Stuffy Nose/Mucinex Full Force/Mucinex Moisture Smart/Mucinex Sinus-Max/Mucinex Sinus-Max Sinus & Allergy/NASAL Decongestant/Nasal Relief/Neo-Synephrine 12-Hour/Neo-Synephrine Severe Sinus Congestion/Nostrilla Fast Relief/Oxymetazoline/Oxymetazoline Hydrochloride/Reliable-1 12 hour Decongestant/Sinex 12-Hour/Sudafed OM Sinus Cold Moisturizing/Sudafed OM Sinus Congestion Moisturizing/Vicks Qlearquil Decongestant/Vicks Sinex/Vicks Sinex Severe/Vicks Sinus Daytime/Zicam Extreme Congestion Relief/Zicam Intense Sinus Nasal Spray: 0.05%
Oxymetazoline/Oxymetazoline Hydrochloride Nasal Gel: 0.05%
RHOFADE Topical Cream: 1%
Upneeq Ophthalmic Sol: 0.1%

DOSAGE & INDICATIONS

†Indicates off-label use

MAXIMUM DOSAGE

8 drops/eye/day of the 0.025% ophthalmic solution; 1 drop/eye/day of the 0.1% ophthalmic solution; 6 sprays/nostril/day of the nasal spray; 1 topical application/day of the cream.

8 drops/eye/day of the 0.025% ophthalmic solution; 1 drop/eye/day of the 0.1% ophthalmic solution; 6 sprays/nostril/day of the nasal spray; 1 topical application/day of the cream.

8 drops/eye/day of the 0.025% ophthalmic solution; 6 sprays/nostril/day of the nasal spray; safety and efficacy have not been established for the 0.1% ophthalmic solution or the topical cream.

6 to 12 years: 8 drops/eye/day of the 0.025% ophthalmic solution; 6 sprays/nostril/day of the nasal spray; safety and efficacy have not been established for the 0.1% ophthalmic solution or the topical cream.
1 to 5 years: Safety and efficacy have not been established.

Safety and efficacy have not been established.

Safety and efficacy have not been established.

DOSING CONSIDERATIONS

Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.

Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.

ADMINISTRATION

Visually inspect for discoloration. Do not use if solution changes color or becomes cloudy.
Remove contact lenses before instilling drops. Contact lenses may be reinserted 15 minutes after administering the dose.
If more than 1 ophthalmic medication is being used, the medications should be administered at least 15 minutes apart.
To avoid contamination, do not touch the tip of container to any surface.
To prevent infection, avoid the use of the container by more than 1 person.
Tilt head back, pull down the lower eyelid with a finger, and instill drop into the conjunctival sac of the affected eye.
For the 0.1% solution, each single patient-use container will provide enough medicine to treat both eyes (if needed) 1 time each day. There is some extra solution in each single patient-use container in case the drop misses the eye. Discard the single patient-use container and any unused solution immediately after dosing.
For the 0.025% solution, replace the cap after each use.[61735] [65687]

STORAGE

Generic:
- Store at room temperature (between 59 to 86 degrees F)
12 Hour Nasal :
- Store between 68 to 77 degrees F
Afrin:
- Store between 68 to 77 degrees F
Afrin Extra Moisturizing:
- Store between 68 to 77 degrees F
Afrin Nasal Sinus:
- Store between 68 to 77 degrees F
Afrin No Drip Severe Congestion:
- Store between 68 to 77 degrees F
Dristan:
- Store between 68 to 77 degrees F
Duration:
- Store between 68 to 77 degrees F
Genasal :
- Store between 68 to 77 degrees F
Mucinex Children's Stuffy Nose:
- Store between 68 to 77 degrees F
Mucinex Full Force:
- Store between 68 to 77 degrees F
Mucinex Moisture Smart:
- Store between 68 to 77 degrees F
Mucinex Sinus-Max:
- Store between 68 to 77 degrees F
Mucinex Sinus-Max Sinus & Allergy:
- Store between 68 to 77 degrees F
NASAL Decongestant:
- Store between 68 to 77 degrees F
Nasal Relief :
- Store between 68 to 77 degrees F
Neo-Synephrine 12-Hour:
- Store between 68 to 77 degrees F
Neo-Synephrine Severe Sinus Congestion:
- Store between 68 to 77 degrees F
Nostrilla Fast Relief:
- Store between 68 to 77 degrees F
Reliable-1 12 hour Decongestant:
- Store between 68 to 77 degrees F
Rhinase D:
- Store between 68 to 77 degrees F
RHOFADE:
- Store between 68 to 77 degrees F, excursions permitted 59 to 86 degrees F
Sinex 12-Hour:
- Store between 68 to 77 degrees F
Sudafed OM Sinus Cold Moisturizing:
- Store between 68 to 77 degrees F
Sudafed OM Sinus Congestion Moisturizing:
- Store between 68 to 77 degrees F
Upneeq:
- Avoid excessive heat (above 104 degrees F)
- Discard unused portion. Do not store for later use.
- Store between 68 to 77 degrees F
- Store in original package until time of use
Vicks Qlearquil Decongestant:
- Store between 68 to 77 degrees F
Vicks Sinex:
- Store between 68 to 77 degrees F
Vicks Sinex Severe:
- Store between 68 to 77 degrees F
Vicks Sinus Daytime:
- Store between 68 to 77 degrees F
Visine L.R.:
- Store between 59 to 77 degrees F
Zicam Extreme Congestion Relief:
- Store between 68 to 77 degrees F
Zicam Intense Sinus:
- Store between 68 to 77 degrees F

CONTRAINDICATIONS / PRECAUTIONS

Take care to avoid ocular exposure during the use of oxymetazoline topical cream and nasal spray formulations. To avoid accidental exposure of non-treatment sites, instruct patients to wash hands immediately after applying the topical cream. Prior to the use of the ophthalmic solution, contact lenses must be removed. Contact lenses may be reinserted 15 minutes after administration of the dose.

Caution is advised when administering oxymetazoline to patients receiving concurrent MAOI therapy. Monoamine oxidase inhibitors can affect the metabolism and uptake of circulating amines; thereby potentiating the vasoconstrictive effects of oxymetazoline.

Oxymetazoline (an alpha-adrenergic agonist) acts as a vasoconstrictor, which may adversely affect blood pressure; thus, caution is advised when administering the drug to patients with severe or unstable cardiovascular diseases, orthostatic hypotension, and uncontrolled hypertension or hypotension. Instruct patients with cardiac disease to seek immediate medical attention if their condition worsens.

Caution is advised when administering oxymetazoline (a vasoconstrictor) to patients with vascular and autoimmune diseases, such as coronary artery disease, cerebrovascular disease, diabetes mellitus, thyroid disease, prostatic hypertrophy, Sjogren's syndrome, Raynaud's phenomenon, thromboangiitis obliterans (Buerger's disease), and scleroderma. Instruct patients to seek immediate medical care if signs or symptoms of worsening vascular insufficiency develops.

Treatment with oxymetazoline may increase the risk of developing angle-closure glaucoma in patients with closed-angle glaucoma. Instruct patients to seek immediate medical care if signs or symptoms of acute angle-closure glaucoma develop.

Safety and efficacy of oxymetazoline topical cream or the 0.1% ophthalmic solution have not been established in pediatric patients younger than 18 years of age (i.e., neonates, infants, children, and adolescents); however, the 0.025% ophthalmic solution and nasal spray may be used in children as young as 6 years of age.

Data are limited regarding the use of oxymetazoline during pregnancy. It is unknown if the use of the drug in pregnant women is associated with an increased risk for major birth defects or miscarriages. In animal reproductive studies, no adverse developmental effects were observed after oral administration of oxymetazoline to pregnant rats and rabbits at systemic exposures up to 7- and 278-times the maximum recommended human ophthalmic dose, respectively. Data from 1 literature article found a potential association between second-trimester exposure to oxymetazoline nasal spray and renal collecting system anomalies. In another case, fetal distress was reported in a 41-week pregnant patient following repeated use of oxymetazoline nasal spray at a dose 5-times the recommended dose. The fetal distress resolved hours later, and prior to delivery of the healthy infant. Exposure to oxymetazoline topical cream has also been reported in 2 pregnant females. One pregnancy resulted in the delivery of a healthy child. The other pregnancy ended in spontaneous abortion, which was not considered related to drug exposure.

It is not known whether oxymetazoline is distributed into breast milk, or if the drug affects breast milk production. According to the manufacturer, caution should be exercised when administering it to women who are breast-feeding their infants. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally ingested drug, healthcare providers are encouraged to report the adverse effect to the FDA.

Before prescribing oxymetazoline 0.1% ophthalmic solution for the treatment of blepharoptosis, consider that ptosis may be associated with neurologic or orbital diseases, such as stroke, cerebral aneurysm, Horner syndrome, myasthenia gravis, external ophthalmoplegia, orbital infection, and orbital masses. It is advised to evaluate the patient for these conditions in the presence of ptosis with decreased levator muscle function or other neurologic signs.

ADVERSE REACTIONS

keratitis / Delayed / 1.0-5.0
bradycardia / Rapid / Incidence not known
coma / Early / Incidence not known
visual impairment / Early / Incidence not known

blurred vision / Early / 1.0-5.0
conjunctival hyperemia / Early / 1.0-5.0
contact dermatitis / Delayed / 2.0-3.0
erythema / Early / 1.0-2.0
sinus tachycardia / Rapid / Incidence not known
hypertension / Early / Incidence not known
hypotension / Rapid / Incidence not known
respiratory depression / Rapid / Incidence not known

ocular irritation / Rapid / 1.0-5.0
headache / Early / 1.0-5.0
xerophthalmia / Early / 1.0-5.0
ocular pain / Early / 1.0-5.0
pruritus / Rapid / 1.0-2.0
hypothermia / Delayed / Incidence not known
vomiting / Early / Incidence not known
mydriasis / Early / Incidence not known
lethargy / Early / Incidence not known
nausea / Early / Incidence not known
rhinorrhea / Early / Incidence not known
sneezing / Early / Incidence not known
nasal irritation / Early / Incidence not known
nasal congestion / Early / Incidence not known

DRUG INTERACTIONS

Acebutolol: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by beta-blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Alfuzosin: (Major) Caution is advised when administering alfuzosin with oxymetazoline. Alfuzosin, an alpha adrenergic blocker, would likely antagonize the sympathomimetic effects of oxymetazoline, alpha adrenergic agonists; thereby reducing the effectiveness of oxymetazoline.
Aliskiren; Amlodipine: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by calcium-channel blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by calcium-channel blockers. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Aliskiren; Hydrochlorothiazide, HCTZ: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Aliskiren; Valsartan: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. If these drugs are used together, closely monitor for changes in blood pressure.
Ambrisentan: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by ambrisentan. If these drugs are used together, closely monitor for changes in blood pressure.
Amiloride: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Amiloride; Hydrochlorothiazide, HCTZ: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Amlodipine: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by calcium-channel blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Amlodipine; Atorvastatin: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by calcium-channel blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Amlodipine; Benazepril: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by calcium-channel blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Amlodipine; Celecoxib: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by calcium-channel blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Amlodipine; Olmesartan: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by calcium-channel blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Amlodipine; Valsartan: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by calcium-channel blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by calcium-channel blockers. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Angiotensin II receptor antagonists: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. If these drugs are used together, closely monitor for changes in blood pressure.
Angiotensin-converting enzyme inhibitors: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. If these drugs are used together, closely monitor for changes in blood pressure.
Atenolol: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by beta-blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Atenolol; Chlorthalidone: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by beta-blockers. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Azilsartan: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. If these drugs are used together, closely monitor for changes in blood pressure.
Azilsartan; Chlorthalidone: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Benazepril: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. If these drugs are used together, closely monitor for changes in blood pressure.
Benazepril; Hydrochlorothiazide, HCTZ: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Bendroflumethiazide; Nadolol: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by beta-blockers. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Beta-blockers: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by beta-blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Betaxolol: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by beta-blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Bisoprolol: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by beta-blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Bisoprolol; Hydrochlorothiazide, HCTZ: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by beta-blockers. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Brimonidine; Timolol: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by beta-blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Bumetanide: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Butorphanol: (Moderate) The rate of butorphanol absorption through the nasal mucosa is decreased when administered with sympathomimetic nasal decongestants such as oxymetazoline. However, the extent of absorption is not decreased. A slower onset of action should be expected if butorphanol is administered concurrently with or immediately following a sympathomimetic nasal decongestant.
Caffeine: (Moderate) Caffeine is a CNS stimulant and such actions are expected to be additive when coadministered with other CNS stimulants or psychostimulants. Caffeine should be avoided or used cautiously with oxymetazoline.
Calcium-channel blockers: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by calcium-channel blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Candesartan: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. If these drugs are used together, closely monitor for changes in blood pressure.
Candesartan; Hydrochlorothiazide, HCTZ: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Captopril: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. If these drugs are used together, closely monitor for changes in blood pressure.
Captopril; Hydrochlorothiazide, HCTZ: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Cardiac glycosides: (Major) Caution is advised when taking cardiac glycosides with alpha adrenergic agonists, such as oxymetazoline. Alpha adrenergic agonist can enhance ectopic pacemaker activity; thus, concurrent use with cardiac glycosides may result in arrhythmias.
Carteolol: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by beta-blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Carvedilol: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by beta-blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Chlorothiazide: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Chlorthalidone: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Chlorthalidone; Clonidine: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by clonidine. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Clevidipine: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by calcium-channel blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Clonidine: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by clonidine. If these drugs are used together, closely monitor for changes in blood pressure.
Diazoxide: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by vasodilators. Also vasodilators can antagonize the effectiveness of oxymetazoline. If these drugs are used together, closely monitor for changes in blood pressure.
Digitoxin: (Major) Caution is advised when taking cardiac glycosides with alpha adrenergic agonists, such as oxymetazoline. Alpha adrenergic agonist can enhance ectopic pacemaker activity; thus, concurrent use with cardiac glycosides may result in arrhythmias.
Digoxin: (Major) Caution is advised when taking cardiac glycosides with alpha adrenergic agonists, such as oxymetazoline. Alpha adrenergic agonist can enhance ectopic pacemaker activity; thus, concurrent use with cardiac glycosides may result in arrhythmias.
Diltiazem: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by calcium-channel blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Dorzolamide; Timolol: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by beta-blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Doxazosin: (Major) Caution is advised when administering doxazosin with oxymetazoline. Doxazosin, an alpha adrenergic blocker, would likely antagonize the sympathomimetic effects of oxymetazoline, alpha adrenergic agonists; thereby reducing the effectiveness of oxymetazoline.
Enalapril, Enalaprilat: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. If these drugs are used together, closely monitor for changes in blood pressure.
Enalapril; Felodipine: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by calcium-channel blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Enalapril; Hydrochlorothiazide, HCTZ: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Eplerenone: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by eplerenone. If these drugs are used together, closely monitor for changes in blood pressure.
Epoprostenol: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by epoprostenol. If these drugs are used together, closely monitor for changes in blood pressure.
Eprosartan: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. If these drugs are used together, closely monitor for changes in blood pressure.
Eprosartan; Hydrochlorothiazide, HCTZ: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Esmolol: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by beta-blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Ethacrynic Acid: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Felodipine: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by calcium-channel blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Fenoldopam: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by vasodilators. Also vasodilators can antagonize the effectiveness of oxymetazoline. If these drugs are used together, closely monitor for changes in blood pressure.
Fentanyl: (Major) Pain control may be impaired if fentanyl nasal spray is administered in patients receiving vasoconstrictive nasal decongestants (e.g., oxymetazoline); do not titrate fentanyl nasal spray dose in such patients. Oxymetazoline use results in a decrease in the rate and extent of fentanyl absorption through the nasal mucosa. Measured fentanyl pharmacokinetic values decreased as follows in patients treated concurrently with oxymetazoline: mean Cmax decreased approximately 32-40% and mean AUC decreased 10-17%. Further, the mean time to maximum fentanyl plasma concentration was 0.75-1.25 h (range 0.08-3 h) for oxymetazoline-treated patients as compared to 0.25-0.33 h (range 0.17-2 h) in patients who did not receive the drug. This interaction is not expected with other fentanyl administration routes.
Fosinopril: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. If these drugs are used together, closely monitor for changes in blood pressure.
Fosinopril; Hydrochlorothiazide, HCTZ: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Furosemide: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Guanabenz: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by guanabenz. If these drugs are used together, closely monitor for changes in blood pressure.
Guanfacine: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by guanfacine. If these drugs are used together, closely monitor for changes in blood pressure.
Hydralazine: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by vasodilators. Also vasodilators can antagonize the effectiveness of oxymetazoline. If these drugs are used together, closely monitor for changes in blood pressure.
Hydralazine; Hydrochlorothiazide, HCTZ: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by vasodilators. Also vasodilators can antagonize the effectiveness of oxymetazoline. If these drugs are used together, closely monitor for changes in blood pressure.
Hydralazine; Isosorbide Dinitrate, ISDN: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by vasodilators. Also vasodilators can antagonize the effectiveness of oxymetazoline. If these drugs are used together, closely monitor for changes in blood pressure.
Hydrochlorothiazide, HCTZ: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Hydrochlorothiazide, HCTZ; Methyldopa: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by methyldopa. If these drugs are used together, closely monitor for changes in blood pressure.
Hydrochlorothiazide, HCTZ; Moexipril: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Indapamide: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Irbesartan: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. If these drugs are used together, closely monitor for changes in blood pressure.
Irbesartan; Hydrochlorothiazide, HCTZ: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Isocarboxazid: (Major) Oxymetazoline should generally not be used in patients taking non-selective monoamine oxidase inhibitors (MAOIs). The combination of an MAOI and a sympathomimetic drug, including decongestants given via topical, nasal, or ophthalmic routes, may rarely result in high blood pressure or in more serious cases, hypertensive crisis. Avoid use during and up to 2 weeks following discontinuation of the MAOI. Consider alternative treatments for the patient's condition.
Isradipine: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by calcium-channel blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Labetalol: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by beta-blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Levamlodipine: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by calcium-channel blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Levobetaxolol: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by beta-blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Levobunolol: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by beta-blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Lisinopril: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. If these drugs are used together, closely monitor for changes in blood pressure.
Lisinopril; Hydrochlorothiazide, HCTZ: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Loop diuretics: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Losartan: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. If these drugs are used together, closely monitor for changes in blood pressure.
Losartan; Hydrochlorothiazide, HCTZ: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Methyclothiazide: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Methyldopa: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by methyldopa. If these drugs are used together, closely monitor for changes in blood pressure.
Metolazone: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Metoprolol: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by beta-blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Metoprolol; Hydrochlorothiazide, HCTZ: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by beta-blockers. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Minoxidil: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by vasodilators. Also vasodilators can antagonize the effectiveness of oxymetazoline. If these drugs are used together, closely monitor for changes in blood pressure.
Moexipril: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. If these drugs are used together, closely monitor for changes in blood pressure.
Monoamine oxidase inhibitors: (Major) Oxymetazoline should generally not be used in patients taking non-selective monoamine oxidase inhibitors (MAOIs). The combination of an MAOI and a sympathomimetic drug, including decongestants given via topical, nasal, or ophthalmic routes, may rarely result in high blood pressure or in more serious cases, hypertensive crisis. Avoid use during and up to 2 weeks following discontinuation of the MAOI. Consider alternative treatments for the patient's condition.
Nadolol: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by beta-blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Nafarelin: (Moderate) If use of a topical nasal decongestants is necessary during therapy with intranasal nafarelin, the decongestant should not be used for at least 2 hours after nafarelin is administered.
Nebivolol: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by beta-blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Nebivolol; Valsartan: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by beta-blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Nicardipine: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by calcium-channel blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Nicotine: (Minor) Vasoconstricting nasal decongestants such as oxymetazoline prolong the time to peak effect of nasally administered nicotine (i.e. nicotine nasal spray); however, no dosage adjustments are recommended.
Nifedipine: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by calcium-channel blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Nimodipine: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by calcium-channel blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Nisoldipine: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by calcium-channel blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Nitroprusside: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by vasodilators. Also vasodilators can antagonize the effectiveness of oxymetazoline. If these drugs are used together, closely monitor for changes in blood pressure.
Olmesartan: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. If these drugs are used together, closely monitor for changes in blood pressure.
Olmesartan; Amlodipine; Hydrochlorothiazide, HCTZ: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by calcium-channel blockers. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Olmesartan; Hydrochlorothiazide, HCTZ: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Penbutolol: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by beta-blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Perindopril: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. If these drugs are used together, closely monitor for changes in blood pressure.
Perindopril; Amlodipine: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by calcium-channel blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Phenelzine: (Major) Oxymetazoline should generally not be used in patients taking non-selective monoamine oxidase inhibitors (MAOIs). The combination of an MAOI and a sympathomimetic drug, including decongestants given via topical, nasal, or ophthalmic routes, may rarely result in high blood pressure or in more serious cases, hypertensive crisis. Avoid use during and up to 2 weeks following discontinuation of the MAOI. Consider alternative treatments for the patient's condition.
Phenoxybenzamine: (Major) Caution is advised when administering phenoxybenzamine with oxymetazoline. Phenoxybenzamine, an alpha adrenergic blocker, would likely antagonize the sympathomimetic effects of oxymetazoline, alpha adrenergic agonists; thereby reducing the effectiveness of oxymetazoline. Clinicians should note that phenoxybenzamine has a long duration of action and its effects may persist for several days after it has been discontinued.
Phentolamine: (Major) Caution is advised when administering phentolamine with oxymetazoline. Phentolamine, an alpha adrenergic blocker, would likely antagonize the sympathomimetic effects of oxymetazoline, alpha adrenergic agonists; thereby reducing the effectiveness of oxymetazoline.
Pindolol: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by beta-blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Potassium-sparing diuretics: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Prazosin: (Major) Caution is advised when administering prazosin with oxymetazoline. Prazosin, an alpha adrenergic blocker, would likely antagonize the sympathomimetic effects of oxymetazoline, alpha adrenergic agonists; thereby reducing the effectiveness of oxymetazoline.
Propranolol: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by beta-blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Propranolol; Hydrochlorothiazide, HCTZ: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by beta-blockers. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Quinapril: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. If these drugs are used together, closely monitor for changes in blood pressure.
Quinapril; Hydrochlorothiazide, HCTZ: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Ramipril: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. If these drugs are used together, closely monitor for changes in blood pressure.
Rasagiline: (Moderate) The concomitant use of rasagiline and sympathomimetics was not allowed in clinical studies; therefore, caution is advised during concurrent use of rasagiline and sympathomimetics including non-prescription nasal and ophthalmic decongestants. Although sympathomimetics are contraindicated for use with other non-selective monoamine oxidase inhibitors (MAOIs), hypertensive reactions generally are not expected to occur during concurrent use with rasagiline because of the selective monoamine oxidase-B (MAO-B) inhibition of rasagiline at manufacturer recommended doses. One case of elevated blood pressure has been reported in a patient during concurrent use of the recommended dose of rasagiline and ophthalmic tetrahydrozoline, a drug similar to oxymetazoline. It should be noted that the MAO-B selectivity of rasagiline decreases as the dose increases above the recommended daily dose and interactions with sympathomimetics may be more likely to occur at these higher doses.
Reserpine: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by reserpine. If these drugs are used together, closely monitor for changes in blood pressure.
Sacubitril; Valsartan: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. If these drugs are used together, closely monitor for changes in blood pressure.
Selegiline: (Moderate) Use these drugs together with caution. Monitor blood pressure for hypertension during concomitant use of selegiline and oxymetazoline. Although oxymetazoline is used by nasal or ophthalmic routes, the use of these drugs together may produce substantial elevations in blood pressure. If a hypertensive crisis occurs, selegiline should be discontinued immediately and therapy to lower blood pressure should be instituted immediately.
Sotalol: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by beta-blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Spironolactone: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Spironolactone; Hydrochlorothiazide, HCTZ: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Telmisartan: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. If these drugs are used together, closely monitor for changes in blood pressure.
Telmisartan; Amlodipine: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by calcium-channel blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Telmisartan; Hydrochlorothiazide, HCTZ: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Terazosin: (Major) Caution is advised when administering terazosin with oxymetazoline. Terazosin, an alpha adrenergic blocker, would likely antagonize the sympathomimetic effects of oxymetazoline, alpha adrenergic agonists; thereby reducing the effectiveness of oxymetazoline.
Testosterone: (Moderate) The drug interaction potential between intranasal testosterone (e.g., Natesto) and other intranasally administered drugs other than sympathomimetic decongestants is unknown. Therefore, concomitant use of intranasal testosterone with intranasal drugs other than sympathomimetic decongestants (e.g., oxymetazoline) is not recommended. Eighteen males with seasonal allergic rhinitis were treated with intranasal testosterone and randomized to receive oxymetazoline (30 minutes prior to intranasal testosterone) or no treatment. In general, serum total testosterone concentrations were decreased by 21-24% in males with symptomatic allergic rhinitis, due to the underlying condition. A mean decrease in AUC and Cmax (2.6% and 3.6%, respectively) for total testosterone was observed in males with symptomatic seasonal rhinitis when treated with oxymetazoline compared to untreated patients. Concomitant use of oxymetazoline does not impact the absorption of testosterone.
Thiazide diuretics: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Timolol: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by beta-blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Torsemide: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Trandolapril: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. If these drugs are used together, closely monitor for changes in blood pressure.
Trandolapril; Verapamil: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by calcium-channel blockers. If these drugs are used together, closely monitor for changes in blood pressure.
Tranylcypromine: (Major) Oxymetazoline should generally not be used in patients taking non-selective monoamine oxidase inhibitors (MAOIs). The combination of an MAOI and a sympathomimetic drug, including decongestants given via topical, nasal, or ophthalmic routes, may rarely result in high blood pressure or in more serious cases, hypertensive crisis. Avoid use during and up to 2 weeks following discontinuation of the MAOI. Consider alternative treatments for the patient's condition.
Treprostinil: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by treprostinil. If these drugs are used together, closely monitor for changes in blood pressure.
Triamterene: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Triamterene; Hydrochlorothiazide, HCTZ: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Valsartan: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. If these drugs are used together, closely monitor for changes in blood pressure.
Valsartan; Hydrochlorothiazide, HCTZ: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. If these drugs are used together, closely monitor for changes in blood pressure. (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by diuretics. If these drugs are used together, closely monitor for changes in blood pressure.
Vasodilators: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by vasodilators. Also vasodilators can antagonize the effectiveness of oxymetazoline. If these drugs are used together, closely monitor for changes in blood pressure.
Verapamil: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by calcium-channel blockers. If these drugs are used together, closely monitor for changes in blood pressure.

PREGNANCY AND LACTATION

Data are limited regarding the use of oxymetazoline during pregnancy. It is unknown if the use of the drug in pregnant women is associated with an increased risk for major birth defects or miscarriages. In animal reproductive studies, no adverse developmental effects were observed after oral administration of oxymetazoline to pregnant rats and rabbits at systemic exposures up to 7- and 278-times the maximum recommended human ophthalmic dose, respectively. Data from 1 literature article found a potential association between second-trimester exposure to oxymetazoline nasal spray and renal collecting system anomalies. In another case, fetal distress was reported in a 41-week pregnant patient following repeated use of oxymetazoline nasal spray at a dose 5-times the recommended dose. The fetal distress resolved hours later, and prior to delivery of the healthy infant. Exposure to oxymetazoline topical cream has also been reported in 2 pregnant females. One pregnancy resulted in the delivery of a healthy child. The other pregnancy ended in spontaneous abortion, which was not considered related to drug exposure.

It is not known whether oxymetazoline is distributed into breast milk, or if the drug affects breast milk production. According to the manufacturer, caution should be exercised when administering it to women who are breast-feeding their infants. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally ingested drug, healthcare providers are encouraged to report the adverse effect to the FDA.

MECHANISM OF ACTION

Oxymetazoline stimulates alpha-adrenergic receptors which cause intense vasoconstriction. When administered intranasally, this action promotes drainage and improves ventilation. The 0.025% ophthalmic solution causes vasoconstriction of conjunctival blood vessels thereby providing relief from minor eye irritations. In patients with rosacea, topical use can reduce facial erythema.
 
For the treatment of blepharoptosis, the 0.1% ophthalmic solution targets a subset of adrenoreceptors in the upper eyelid tarsal smooth muscle (Mueller's muscle). Stimulation of these alpha-adrenoceptors causes contraction of the Mueller's muscle and subsequent opening of the eye.

PHARMACOKINETICS

Oxymetazoline is administered via the topical, ophthalmic, and intranasal routes. After systemic absorption, the drug is approximately 57% bound to human plasma proteins. In vitro studies using human liver microsomes showed oxymetazoline was minimally metabolized, with 96% of the parent drug remaining intact after 120-minute incubation. Excretion has not been determined; however, the mean terminal half-life in healthy adults is 8.3 hours (range: 5.6 to 13.9 hours).[61733] [61734] [61735]
 
Affected cytochrome P450 isoenzymes and drug transporters: none