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Antihistamines, Decongestants, and Expectorants during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Naphazoline, oxymetazoline, and xylometazoline are sympathomimetic agents with decongestant in long-acting nasal sprays (Afrin, Allerest, Dristan, 4-Way). Birth defects were not increased in frequency among more than 250 infants born to women who used oxymetazoline during the first trimester (Aselton et al., 1985; Jick et al., 1981). The Swedish registry reported no increased frequency of birth defects (3.3 percent) among 3521 infants whose were exposed to oxymetazoline during organogenesis (Kallen, 2019). Likewise, the frequency of birth defects was not increased in 432 infants exposed to xylometazoline during embryogenesis (Aselton et al., 1985; Jick et al., 1981). The Swedish registry reported the frequency of birth defects was not increased among 1168 infants born to women who used xylometazoline during the first trimester (Kallen, 2019). An incidental observation is that xylometazoline was significantly protective against congenital anomalies in the analysis. No studies have been published regarding naphazoline monotherapy use during pregnancy. However, the combination antazoline—naphazoline ophthalmologic preparation was used during the first trimester among 3061 infants, and the rate of birth defects was not increased above background (3.0 percent) or compared to controls (3.5 percent) (Thomseth et al., 2019).
Biogenic amines
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop
Nasal congestion is a frequent problem for AADC patients probably because of their deficit in catecholamines. Topical application of oxymetazoline or xylometazoline is necessary in most cases. The package insert, as well as major textbooks, warns that the use of the combination of MAO inhibitors and topical alpha-adrenoreceptor agonists nose drops may cause severe hypertensive crises. In AADC patients, however, catecholamines are reduced and in practice we are not aware of any such complication using this combination in our patients.
Adrenergic Agonists
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Xylometazoline stimulates α2 adrenoceptor resulting in constriction of the nasal mucosa. It has CNS-related side effects such as anxiety, dizzy, tremor, and other effects such as rebound congestion on overuse. Topical products may cause local adverse effects like burning, stinging, and dryness. It causes a rise in the heart rate, palpitations, blood pressure so, contraindicated in cardiac disease. The drug is not used in the case of patients treated with MAOIs. It is mainly used as a Topical decongestant (Brunton et al., 2011; Rataboli, 2010; Florey, 2008).
Pre-emptive epinephrine nebulization prior to nasotracheal intubation for mandibular fracture fixation surgeries: Does it really differ? A randomised controlled clinical trial
Published in Egyptian Journal of Anaesthesia, 2023
Rehab Abdelfattah Abdelraziq, Sabah Nagiub Barsoom Ayoub, Hagar Mahmoud El-Sherief, Mohammed Sayed Shorbagy
Local vasoconstrictors such as oxymetazoline, xylometazoline, and epinephrine drops or packs have been studied before for producing nasal mucosa vasoconstriction. On the contrary, according to our study results, oxymetazoline and xylometazoline were superior to epinephrine nasal packs and nasal jelly when studied before. Xylometazoline was more beneficial in reducing severe bleeding and post-extubation bleeding [8] and [23]. In our study, inhalation of epinephrine mixed with lidocaine was superior in decreasing both local nasal bleeding and mucosal surgical bleeding. 48.33% of the patients did not suffer epistaxis during the intubation after using oxymetazoline nasal drops, versus 75% who did not suffer epistaxis after the nebulization session. Total surgical and nasal bleeding decreased by 13.24% with the epinephrine session.
Effect of Hypertonic Saline during Flexible Nasopharyngeal Laryngoscopy: A Double-Blinded, Randomized, Controlled Trial
Published in Journal of Investigative Surgery, 2021
Merih Onal, Bahar Keles, Omer Erdur, Necat Alatas, Ozkan Onal
In the present study, xylometazoline was found to be the second-best agent in terms of quality of the field of view and postoperative pain scores. Moreover, it was the best agent with regard to post-operative discomfort, congruent with some previous findings. Sahin et al8 reported that xylometazoline not only provided the best image quality but also decreased the pain experienced during the procedure. In another study, Sadek et al4 reported that in NPL procedures where only xylometazoline was used, low pain scores and high image quality associated with vasoconstriction were achieved irrespective of the use of local anesthetics. They also demonstrated that the use of xylometazoline generally reduced the dissatisfaction and discomfort associated with vasoconstriction and increased the patients’ tolerance level.4 By contrast, intranasal decongestant usage may result in rebound congestion and may lead to long-term mucosal changes and rhinitis medicamentosa, especially after recurrent applications. Moreover, topical decongestants may cause local ischemia in the nasal mucosa through arteriolar vasoconstriction, along with other minor side effects such as itching, stinging sensation, irritation, edema, and dryness of the mucosa.23
“I’m Going to Scope You”—The Balance between Examiner Visualization and Patient Comfort
Published in Journal of Investigative Surgery, 2021
Christina M. Parducci, Jason E. Cohn
The use of topical agents during upper airway visualization has been called into question over the years as numerous studies suggest that their use is not efficacious and may actually contribute to patient discomfort2 .When comparing routinely used topical agents, it has been found that there is little difference in their effectiveness and the side effects of lidocaine make it less appealing when assessing patient comfort [3]. Alternative methods such as visual distractions have shown to be significantly more pleasant for patients than lidocaine4 .However, other studies suggest that lidocaine is effective at decreasing patient discomfort and can be used to avoid general anesthesia [5]. From a physician’s perspective, the use of anesthetic has proven advantageous in both ease and quality of examination when compared to a placebo6 .Different maneuvers used by more experienced physicians can also allow for increased visualization that may otherwise not be attained7 .Topical decongestants may be used in combination with other methods to maximize the efficiency of upper airway procedures and patient comfort. For example, the use of xylometazoline and oxymetazoline has shown to produce less patient discomfort and a subsequent shorter duration of examination [8], especially when combined with a topical anesthetic [9].