Decongestants topical

Among the treatment options, topical decongestants, topical and oral antihistamines, mast cell stabilizers, dual-action/multiaction drugs, and certain nonsteroidal antiinflammatory agents have proven useful for alleviating the signs and symptoms associated with ocular allergic reactions. Homeopathic preparations have also become of interest to the ophthalmic community, and their scientific... 

Cyclobenzaprine Decongestants (topical and systemic) Dextromethorphan Dopamine Ephedrine Epinephrine Guanethidine... 

Proven therapeutic modalities include avoidance of allergens and pharmacologic management with antihistamines, topical and systemic decongestants, topical steroids, cromolyn sodium, and immunotherapy. 

I Topical Decongestants. Topical decongestants are applied directly to swollen nasal mucosa via drops or sprays. Table 93-6 lists the common topical decongestants and their durations of... 

The goal in treatment of sinusitis is eradication of infection with clearance of the infected material from the sinuses. While the use of an appropriate antibiotic is necessary, the use of ancillary therapy is also of utmost importance. Steam and nasal saline, decongestants, topical corticosteroids, and mucoevacuants are given in an attempt to reduce nasal obstruction, increase sinus ostia size, promote improved mucociliary function, decrease mucosal inflammation, and thin secretions. In selected patients who fail to respond to aggressive medical therapy, functional endoscopic surgery can often provide relief. In patients with poorly controlled asthma, treatment of underlying sinusitis has been shown to dramatically improve the asthmatic state. 

Antibiotic Heart stimulant Respiratory decongestant Topical... 

The principal OTC pharmaceutical products include cold remedies, vitamins and mineral preparations, antacids, analgesics, topical antibiotics, antiftingals and antiseptics, and laxatives. Others include suntan products, ophthalmic solutions, hemorrhoidal products, sleep aids, and dermatological products for treatment of acne, dandmff, insect parasites, bums, dry skin, warts, and foot care products (11). More recent prescription-to-OTC switches have included hydrocortisone, antihistamine and decongestant products, antiftingal agents, and, as of 1995, several histamine H2-receptor antagonists. 

Hypotension and allergic disorders, asthma 25/mg—50 mg IM, SO, or IV topical nasal decongestant instill in each nostril q4h... 

Decongestants are used to treat the congestion associated with rhinitis, hay fever, allergic rhinitis, sinusitis, and the common cold. In addition, they are used in adjunctive therapy of middle ear infections to decrease congestion around the eustachian tube Nasal inhalers may relieve ear block and pressure pain during air travel. Many can be administered orally as well as topically, but topical application is more effective than the oral route. 

When used topically in prescribed doses, there are usually minimal systemic effects in most individuals. On occasion, nasal burning, stinging, and dryness may be seen. When the topical form is used frequently or if the liquid is swallowed, the same adverse reactions seen with the oral decongestants may occur. 

SUM MARY DRUG TABLE SYSTEM 1C AND TOPICAL NASAL DECONGESTANTS... 

Understand tiiat overuse of topical nasal decongestants can make the symptoms worse ... 

Nasal burning and stinging may occur with the topical decongestants. This effect usually disappears with use If burning or stinging becomes severe, discontinue use and discuss this problem with the primary health care provider, who may prescribe or recommend another drug. 

Menthol, also known as peppermint oil, is used widely in toothpastes, mouthwashes, gum, sore-throat lozenges, lip balms, and nasal decongestants. For topical analgesic use, it is available in creams, lotions, ointment, and patches. The patches can be trimmed to fit the affected area. 

Pharmacotherapy has an important role in managing AR symptoms (Table 59-2). Intranasal corticosteroids, systemic and topical antihistamines and decongestants, mast cell stabilizers, and immunotherapy all are beneficial in treating symptoms of AR.9 Antihistamines and intranasal corticosteroids are considered first-line therapy for AR, whereas decongestants, mast cell stabilizers, leukotriene modifiers, and systemic corticosteroids are secondary treatment options10-12 (Fig. 59-2). Whenever exposure to allergens can be predicted (e.g., SAR or visiting homes with a pet), medications should be used pro-phylactically to maximize effectiveness.11... 

Topical intranasal decongestants (e.g., oxymetolazine, xylome-tolazine, phenylephrine, and naphazoline) are OTC options that provide prompt relief of nasal congestion. Nasal decongestants are dosed multiple times daily.15 Tachyphylaxis, rebound congestion, and rhinitis medicamentosa may occur with chronic use therefore, use should be limited to 3 to 5 days.8,12 These may be used 5 to 10 minutes before administration of intranasal corticosteroids in patients with blocked nasal passages.15... 

For resistant cases of nasal obstruction, evaluate the need for topical decongestants, oral decongestants, or short-course oral steroids. 

If artificial tears are insufficient, the second treatment step is a topical antihistamine or antihistamine/decongestant combination. The antihistamine/decongestant combination is more effective than either agent is alone. Decongestants are vasoconstrictors that reduce redness and seem to have a small synergistic effect with the antihistamine. The only topical... 

Short-term topical oxymetazoline or inhaled corticosteroids may be preferred over oral decongestants, especially during early pregnancy. 

Acetaminophen or a nonsteroidal antiinflammatory agent, such as ibu-profen, can be used to relieve pain and malaise in acute otitis media. Decongestants, antihistamines, topical corticosteroids, or expectorants have not been proven effective for acute otitis media. 

Topical and systemic decongestants are sympathomimetic agents that act on adrenergic receptors in the nasal mucosa to produce vasoconstriction, shrink swollen mucosa, and improve ventilation. Decongestants work well in combination with antihistamines when nasal congestion is part of the clinical picture. 

Other adverse effects of topical decongestants include burning, stinging, sneezing, and dryness of the nasal mucosa. 

Pseudoephedrine (see Table 79-2) is an oral decongestant that has a slower onset of action than topical agents but may last longer and cause less local irritation. Also, rhinitis medicamentosa does not occur with oral decongestants. Doses up to 180 mg produce no measurable change in blood pressure... 

Rhinocort Aqua and Nasonex are preparations containing topical nasal corticosteroids (budesonide and mometasone furoate respectively). Otrivine contains a nasal decongestant (xylometazoline) and Sudafed is a systemic preparation containing a nasal decongestant (phenylephrine). Molcer is a preparation for ear-wax removal and which contains docusate sodium. Emadine contains an antihistamine (emedastine) and is presented as eye drops. 

Phenylephrine is a nasal decongestant that mimics the sympathetic system, thereby increasing the heart rate and blood pressure. It may aggravate conditions such as diabetes, hypertension and glaucoma. Patients with hypertension, ischaemic heart disease, hyperthyroidism, diabetes and glaucoma are therefore given topical nasal sympathomimetics rather than systemic sympathomimetics. Both topical and systemic sympathomimetics are contraindicated in patients taking monoamine oxidase inhibitors, because concurrent administration of the two products may lead to a hypertensive crisis. 

Sodium chloride 0.9% is safe and effective in relieving rhinorrhoea. It is safer to use in children than topical nasal decongestants (xylometazoline), which are to be avoided in children under 6 years as the latter are more likely are cause side-effects (such as effects on sleep or hallucinations). Budesonide spray is used for allergic conditions and is not normally used in paediatric patients. Benzydamine spray is a throat spray intended to relieve pain in the throat. Mupirocin is indicated for staphylococcal infections. 

Paracetamol is indicated as an anti-pyretic and may be safely administered in a patient on warfarin. A topical nasal decongestant is effective for rhinorrhoea (runny nose) and would not interfere with warfarin. Altering the dose of warfarin is only recommended on the basis of results of international normalised ratio (INR) levels. 

Functional antagonists of mediators of allergy, a) a-Sympathomi-metics, such as naphazoline, oxymeta-zoline, and tetrahydrozoline, are applied topically to the conjunctival and nasal mucosa to produce local vasoconstriction, and decongestion and to dry up secretions (p. 90), e.g., in hay fever. Since they may cause mucosal damage, their use should be short-term. 

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