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Oxymetazoline vs Phenylephrine – Which Is Better For Nasal Congestion?

Oxymetazoline vs Phenylephrine – Which Is Better For Nasal Congestion

Nasal congestion occurs when the blood vessels in the nose swell causing expansion of the nasal tissue.

Allergic rhinitis accounts for a large proportion of all rhinitis cases and is a frequent cause of nasal congestion.

Symptoms

Common symptoms of nasal congestion include:

  • headache;
  • being unable to breathe through the nose;
  • cough, particularly when lying down;
  • clear or yellow discharge in the back of the throat;
  • clear or yellow discharge from the nose;
  • feeling like there is something in the nose.

Causes

Possible causes of nasal congestion include:

  • acute sinusitis (sinus infection);
  • side-effects of some medication;
  • tobacco smoke;
  • allergies;
  • tumors of the sinuses or inside of the nose;
  • chronic sinusitis;
  • foreign bodies in the nose;
  • Churg-Strauss syndrome;
  • thyroid disorders;
  • common cold;
  • injuries to the nose;
  • decongestant nasal spray overuse;
  • swollen adenoid glands;
  • stress;
  • deviated septum;
  • respiratory syncytial virus;
  • drug addiction;
  • pregnancy;
  • occupational asthma;
  • dry air;
  • nonallergic rhinitis (chronic sneezing not related to allergies);
  • nasal polyps;
  • enlarged adenoids;
  • drugs, such as high blood pressure drugs;
  • hormonal changes;
  • granulomatosis with polyangiitis.

Note – nasal congestion which lasts longer than 7 days is commonly a symptom of an underlying health issue.

Treatment

In most cases, nasal congestion is not a serious matter, however, it may cause substantial sleep disturbance, especially in children.

But, no matter what’s causing nasal congestion, you can find relief by doing any or all of the following:

  • if you have allergies, an antihistamine may help alleviate the symptom;
  • drink plenty of fluids to thin the mucus;
  • sit in a steamy bathroom a few times each day;
  • use a humidifier or vaporizer;
  • apply a warm, moist cloth across the nose.

In addition, you may use an over-the-counter medicine.

Here is a comparison between oxymetazoline and phenylephrine:

Oxymetazoline

It is an α-adrenergic agonist which is typically used as a topical sympathomimetic agent in OTC decongestant sprays.

This medicine comes in the form of nasal drops, tablets, nasal sprays, and syrups, and is meant either to be administered orally or for topical application.

It belongs to a class of drugs known as decongestants.

It can be found under the following brand names:

  • Sudafed;
  • Sinex Long-Acting;
  • Afrin;
  • Sinarest Nasal;
  • Nostrilla;
  • Neo-Synephrine 12 Hour;
  • Nasal Mist;
  • Mucinex;
  • Duramist Plus;
  • Dristan 12-Hour.

Phenylephrine

It is an active ingredient which has different uses in OTC medicines and relieves a stuffy nose that is caused by the common cold or other health problem.

It can be found under the following brand names:

  • Sudogest;
  • Sudafed PE Children’s Nasal Decongestant;
  • Nasop12;
  • Nasop;
  • Dimetapp Cold Drops.

Uses

Oxymetazoline can be used as an ophthalmic agent to reduce the swelling of the blood vessels in the eyes, hence, temporarily reducing their redness.

But, its main uses are as a decongestant since it relieves the nasal discomfort associated with sinusitis, allergies, hay fever, and a common cold.

Phenylephrine is used to gain relief from a stuffy nose which is caused by the common cold, flu, allergies, or other health problems like bronchitis and sinusitis.

Note – these medicines don’t cure the conditions, they just help reduce the symptoms.

Mechanism of Action

Both act as a decongestant which shrinks blood vessels in the nasal passages.

Side Effects

Oxymetazoline

The most common adverse events can include:

  • a runny nose;
  • sneezing;
  • mild burning of the nose;
  • mild stinging of the nose.

Serious side effects may include:

  • feeling short of breath;
  • worsening symptoms;
  • confusion;
  • anxiety;
  • fast or uneven heart rate;
  • buzzing in the ears;
  • a severe headache;
  • chest pain;
  • severe burning in the nose, especially after using the medicine.

Phenylephrine

Possible side effects can include:

  • difficulty passing urine, especially for males;
  • irritation of the lining of the nose;
  • noticeable heartbeats;
  • headaches;
  • a rapid and/or irregular heartbeat;
  • feeling or being sick;
  • problems sleeping;
  • uncontrollable shaking;
  • a rash;
  • feeling agitated or restless;
  • a dry mouth.

Dosage

The recommended dose of oxymetazoline is 2 or 3 sprays in each nostril. Do not to exceed 2 doses/24 hr for 3 to 5 days.

Phenylephrine comes as a liquid, a tablet, or a dissolving strip to take by mouth. It is commonly used every 4 hours. Follow the instructions on the medicine label.

Warnings & Precautions

Before taking these drugs, tell your healthcare professional if you have:

  • kidney disease;
  • high blood pressure;
  • liver disease;
  • difficulty urinating;
  • irregular heartbeats;
  • an enlarged prostate;
  • increased pressure in the eye;
  • diabetes mellitus;
  • thyroid problems;
  • hardening of the arteries;
  • any type of heart disease.

Use of these decongestants in kids less than 6 years of age is not recommended unless instructed by a healthcare professional.

If you use the medicines for longer than the recommended period of time, your condition may improve but come back or may get worse.

Avoid spraying the decongestants onto the middle of the inside of your nose or into your eyes.

Do not use these drugs if you have used an MAO inhibitor in the past 2 weeks.

Drug Interactions

Oxymetazoline interacts with:

  • phenothiazines, like – perphenazine (Trilafon), fluphenazine (Prolixin), trifluoperazine (Stelazine), mesoridazine, prochlorperazine (Compazine), thioridazine (Mellaril), or chlorpromazine (Thorazine);
  • furazolidone (Furoxone);
  • tricyclic antidepressants, such as – trimipramine (Surmontil), protriptyline (Vivactil), imipramine (Tofranil), desipramine (Norpramin), clomipramine (Anafranil), amoxapine (Asendin), nortriptyline (Pamelor), doxepin (Sinequan), amitriptyline (Elavil);
  • guanethidine (Ismelin);
  • theophylline (Theo-Dur, Theolair);
  • bromocriptine (Parlodel);
  • methyldopa (Aldomet);
  • indomethacin (Indocin).

Phenylephrine interacts with:

  • Synthroid (levothyroxine);
  • Cymbalta (duloxetine);
  • Concerta (methylphenidate);
  • Meloxicam;
  • Adderall.

Alcohol

There are no warnings against the intake of alcoholic beverages while taking these medicines, however, alcohol and both decongestants have the potential to cause a rise in blood pressure.

Is It Safe During Pregnancy or Breastfeeding?

Oxymetazoline

It’s not clear whether it is safe to take the medicine if you’re pregnant or breastfeeding, consulting your doctor is important to ensure that it is safe for both you and your developing fetus to use this decongestant.

Phenylephrine

Since there have been some reports of related birth defects, it’s best to avoid this medicine if you are pregnant, particularly in the first 13 weeks of pregnancy.

After, occasional use of the drug is probably safe. For breastfeeding women, this decongestant does not reduce milk supply.

Bottom Line – Oxymetazoline vs Phenylephrine

Oxymetazoline is a selective α2 adrenergic receptor partial agonist and an α1 adrenergic receptor agonist.

It is usually found as a nasal spray which is used to relieve nasal discomfort that is caused by allergies, colds, and hay fever.

Phenylephrine is a drug that is used as an injection for increasing blood pressure under certain specific conditions. But, it is commonly used as a nasal decongestant medicine that relieves nasal blockage caused by the common cold, allergy, sinusitis, or hay fever.

Therefore, both medications are part of the same family of drugs and have a similar mechanism of action. Both have similar effectiveness in reducing nasal congestion.

However, remember that the use of these decongestant nasal sprays for more than several days may result in rebound nasal congestion.

Sources

https://www.sciencedirect.com/science/article/pii/S2090074011000089
https://www.researchgate.net/publication/230727791_Efficacy
https://www.cambridge.org/core/journals/journal-of-laryngology-and-
https://www.aafp.org/afp/2018/0615/p808.html

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