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# Oxymetazoline (Sinex)
## Overview
Oxymetazoline is an alpha-adrenergic agonist that acts as a topical vasoconstrictor.
## Primary Indications
Nasal decongestion.
## Adult Dosing
* **Nasal Spray:** Two sprays in each nostril every 10-12 hours as needed.
* **Maximum Duration:** Do not use for more than 3 consecutive days to avoid rebound congestion (rhinitis medicamentosa).
## Pediatric Dosing
* **Ages 6 to 11 years:** One to two sprays in each nostril every 10-12 hours as needed.
* **Maximum Duration:** Do not use for more than 3 consecutive days.
* **Under 6 years:** Not recommended; consult a pediatrician.
## Dose Adjustments
No dose adjustments are typically needed for renal or hepatic impairment.
## Contraindications
* Hypersensitivity to oxymetazoline or any component of the formulation.
* Patients with narrow-angle glaucoma.
* Patients taking or who have taken MAO inhibitors within the last 14 days (risk of hypertensive crisis).
## Adverse Effects
* **Common:** Nasal burning, stinging, dryness, sneezing.
* **Less Common/Serious:** Rebound congestion (rhinitis medicamentosa), systemic absorption leading to increased blood pressure, headache, insomnia, nervousness, dizziness.
## Key Drug Interactions
* **MAO Inhibitors (and within 14 days of discontinuation):** Can cause severe hypertension.
* **Tricyclic Antidepressants (TCAs):** May potentiate the pressor effects of oxymetazoline.
## Monitoring
* Monitor for signs of systemic absorption, especially in patients with cardiovascular disease or hypertension.
* Assess for rebound congestion if used beyond the recommended duration.
## Clinical Pearls
* Limit use to 3 days to prevent rhinitis medicamentosa.
* Systemic absorption is possible, particularly with overuse or in susceptible individuals.
* Instruct patients to avoid spraying directly towards the nasal septum.
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*Please verify current prescribing information and local protocols for definitive guidance.*
