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# Sinex (oxymetazoline)
## Overview
Oxymetazoline is a topical nasal decongestant that acts as a direct-acting sympathomimetic amine (alpha-1 agonist), causing vasoconstriction of nasal mucosa arterioles and reducing edema/congestion.
## Primary Indications
- Symptomatic relief of nasal congestion due to:
- Common cold
- Allergic rhinitis
- Sinusitis
- Also available as ophthalmic solution for ocular redness (separate preparation)
## Adult Dosing
**Intranasal (0.05% solution):**
- 2–3 sprays per nostril every 10–12 hours
- Maximum: 2 doses in 24 hours
- Do not use for longer than **3 consecutive days** (rebound congestion risk)
## Pediatric Dosing
**0.05% solution:**
- Children 6–12 years: 1–2 sprays per nostril every 10–12 hours (max 2 doses/day)
- Children 2–6 years: **Consult pediatrician**; use with caution; dose per local protocol (often 1 spray per nostril q12h)
- Children <2 years: **Contraindicated** (risk of CNS depression, seizures, apnea)
## Dose Adjustments
- Hepatic/renal impairment: No specific adjustments; use minimal effective dose due to systemic absorption risk
- Elderly: Use lowest effective dose; more susceptible to adverse effects (hypertension, dizziness)
## Contraindications
- Hypersensitivity to oxymetazoline or any component
- Children <2 years (intranasal)
- Narrow-angle glaucoma
- Concomitant MAO inhibitor use (or within 14 days)
- Severe hypertension or coronary artery disease (relative; use with caution)
- Transsphenoidal surgery history
## Adverse Effects
**Common:** Burning/stinging, sneezing, dryness, transient nasal irritation
**Serious:** Rebound congestion (rhinitis medicamentosa) with >3 days use, hypertension, palpitations, headache, CNS depression (children), epistaxis
## Key Drug Interactions
- **MAO inhibitors:** Risk of hypertensive crisis (avoid)
- **Tricyclic antidepressants:** Possible enhanced pressor effect
- **Beta-blockers:** Risk of severe hypertension (alpha-mediated vasoconstriction unopposed)
- **Other sympathomimetics:** Additive cardiovascular effects
## Monitoring
- Duration of therapy: Instruct patient to stop after 3 days
- Blood pressure in hypertensive patients during prolonged use (rare)
- Assess for symptoms of rebound congestion (worsening with withdrawal)
## Clinical Pearls
- Rebound congestion (rhinitis medicamentosa) is the most important adverse effect—duration of use must be strictly limited to ≤3 days
- **Ocular formulation (0.025% or 0.05%):** 1–2 drops per eye q6–8h for redness; same contraindications as nasal form
- For sinusitis or chronic congestion, prefer intranasal corticosteroids or saline rinses first-line
- Systemic absorption is minimal with proper topical use but increases if mucosa is excoriated
- If patient uses >3 days, taper by alternating one nostril, then every other day; consider specialist referral
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*This information is for educational purposes only. Verify up-to-date prescribing information, local protocols, and full prescribing details before clinical use.*
