Antihistamines, Decongestants, and Expectorants during Pregnancy
“Bert” Bertis Britt Little in 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).
Information on level of drugs into breastmilk
Wendy Jones in Breastfeeding and Medication, 2013
Nasal decongestants Nasal decongestant of choice in a mother during breastfeeding based on evidence of benefit and safety for the baby: There is little evidence of benefit for oral decongestants in preference to topical forms. Simple saline drops are cheap and effective If necessary, use steam inhalation, nasal drops or spray of decongestant Nasal congestion may be a symptom of the common cold or of allergic rhinitis. The common cold is usually self-limiting and lasts for 4 to 10 days. Symptoms include nasal discharge and stuffiness, sneezing, sore throat and cough. Sympathomimetic agents are widely used for symptomatic relief produced by vasoconstriction. Products containing ephedrine sodium chloride 0.9%, phenylephrine, naphazoline, oxymetazoline and xylometazoline can be used topically as nasal drops or sprays. Use should be restricted to less than 7 days or rebound congestion may be produced. 162
The nose and nasopharynx
Rogan J Corbridge in Essential ENT, 2011
This is an acquired sensitivity of the nasal lining in response to the prolonged use of topical nasal decongestant substances. The root of the problem lies in the fact that, once the effect of a nasal decongestant has worn off, there is a rebound vasodilation. This leads to further nasal congestion, and the patient feels the need for relief and so uses the decongestant again. The whole process rapidly becomes self-perpetuating and results in turbinate hypertrophy with chronic, unresponsive nasal obstruction. Many over-the-counter preparations contain nasal decongestants, and these must be enquired about directly when taking the history, since patients will rarely offer this information spontaneously.
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
Brimonidine tartrate ophthalmic solution 0.025% for redness relief: an overview of safety and efficacy
Published in Expert Review of Clinical Pharmacology, 2022
Clinical trials using 0.025% brimonidine tartrate have proven the drug to be relatively safe with little systemic and ocular adverse events. The few adverse events identified included pain upon instillation, irritation, and pruritus, all of which were described to be mild to moderate in severity. However, many of the adverse events of concern, especially those that have limited wider uses of previous generations of vasoconstrictors, such as allergic reaction and tachyphylaxis, are known to occur with a long-term continuous use. The 4-week regimen of the 3 trials introduced in this review may not have been sufficiently long enough to identify all possible side effects. Furthermore, although the drug level was negligible in plasma samples of those topically applying the ophthalmic solution, we cannot entirely rule out the possibility of systemic adverse events. Theoretically, the drug might be able to cross immature or damaged blood–brain barrier such as those with previous history of head trauma, cerebral hemorrhage, or intracranial operations in considerable quantities. The vasoconstrictor may act on vessels systemically to aggravate preexisting vascular conditions such as the Raynaud phenomenon or cerebral aneurysm. Surveys of decongestant users have reported side effects such as headache, chest pain, and palpitations. Long-term studies and market surveys are necessary to confirm that brimonidine does not suffer from the same limitations of its predecessors.
Current and emerging treatment modalities for bacterial rhinosinusitis in adults: a comprehensive review
Published in Expert Opinion on Pharmacotherapy, 2022
Maria Gabriella Matera, Barbara Rinaldi, Vito de Novellis, Paola Rogliani, Mario Cazzola
Based on the available data, the EPOS2020 steering committee is dubious about the possible use of an anti-leukotriene treatment, mainly montelukast, in CRS and does not advocate treatment unless patients are unable to take nasal corticosteroids [14]. Furthermore, the research comparing montelukast to nasal corticosteroids is of low quality [14]. The research comparing antihistamines to placebo is also of poor quality. Consequently, there is inadequate data to decide on the effect of frequent antihistamine usage in treating CRS patients [14]. In general, the EPOS2020 steering group advises against using nasal decongestants in these patients [14]. In cases when the nose is extremely congested, a nasal decongestant may be added to the nasal corticosteroid therapy.
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