Decongestants for local use. International Journal of Experimental Education. Rinomaris ® - a new generation decongestant

For citation: Berdnikova N.G. Decongestants: from proven agents to improved combinations // RMJ. 2011. No. 23. S. 1446

Runny nose (rhinitis) is a common and understandable disease for any ordinary person. Everyone suffers from rhinitis throughout their lives and more than once a year. However, for a doctor, rhinitis is a rather complicated phenomenon, since at least 20 of its varieties are described in modern international classifications. The classic manifestations of rhinitis are symptoms such as congestion, rhinorrhea, sneezing, itching in the nose. Behind the seeming ease in making a diagnosis of rhinitis, problems can be hidden, which will entail erroneous, and sometimes belated, measures to establish the causes of this disease and, as a result, affect the treatment tactics.

The modern classification of rhinitis still continues to be revised. This is due to the fact that the universal clinical signs of rhinitis can have different pathogenesis: infectious, allergic, occupational, hormonal, drug. Often, doctors at their own discretion establish a diagnosis, continuing to use different and mutually exclusive concepts to define the same conditions: “rhinopathy”, “rhinosinusopathy”, “vasomotor, allergic”, etc. This leads not only to errors in the epidemiological analysis, but and to difficulties and difficulties in interpreting the results of clinical trials.
According to the report of the International Consensus on the Diagnosis and Treatment of Rhinitis (1996), rhinitis is classified as follows: allergic (seasonal and year-round), infectious (acute and chronic) and other types (idiopathic, occupational, hormonal, drug-induced, caused by irritating substances, food, psychogenic, atrophic). A slightly different classification used in Russia distinguishes allergic, infectious, non-allergic eosinophilic, vasomotor, hypertrophic and atrophic rhinitis. Depending on the duration, rhinitis is divided into acute and chronic.
According to foreign data, rhinitis is proposed to be classified into allergic and non-allergic, the latter being subdivided into subtypes not associated with allergens, infectious agents and anatomical defects - non-allergic rhinopathy (vasomotor rhinitis), non-allergic rhinitis with eosinophilia, atrophic rhinitis, drug-induced rhinitis, hormone-induced rhinitis, including rhinitis of pregnancy, and nasal liquorrhea.
The most complete is the classification of rhinitis according to T.I. Garashchenko (1998), which subdivides rhinitis into 6 positions: etiology, clinical course, morphological nature of the pathological process, periods of the disease, functional state and age-related features, but in real clinical practice it is complex and not very convenient. However, most of the current classifications are based on the etiological factor that contributes to the occurrence of rhinitis, and its morphological characteristics.
However, the question of the classification of rhinitis still continues to be debatable. Thus, the morphological picture of rhinitis can undergo changes as the disease progresses: hypertrophy of the mucous membranes of the turbinates can be the final stage of any form of rhinitis, except for atrophic. Post-traumatic or postoperative rhinitis found in some classifications is almost always bacterial in nature. We should not forget that rhinitis can be a manifestation of other diseases (sinusitis, adenoiditis, liquorrhea).
The exception is allergic rhinitis, for which there is the greatest certainty in both diagnosis and treatment strategy. So, according to Allergic rhinitis and its impact on asthma initiative (ARIA, 2001), allergic rhinitis is classified into intermittent (seasonal) and persistent (year-round) and their severity is defined as mild, moderate or severe.
According to ICD-10, the following classification is considered for statistical processing:
J00 Acute nasopharyngitis (runny nose)
J30 Vasomotor and allergic rhinitis
. J30.0 Vasomotor rhinitis
. J30.1 Allergic rhinitis due to plant pollen
. J30.2 Other seasonal allergic rhinitis
. J30.3 Other allergic rhinitis
. J30.4 Allergic rhinitis, unspecified
J31 Chronic rhinitis, nasopharyngitis and pharyngitis
. J31.0 Chronic rhinitis
. J31.1 Chronic nasopharyngitis
. J31.2 Chronic pharyngitis.
Most often, general practitioners meet with rhinitis of viral and allergic etiology. Infectious diseases of the upper respiratory tract are diagnosed year-round, with a peak incidence in the autumn-winter period and are most often associated with viral infections. According to statistics, acute respiratory viral infection (ARVI) is the most common infectious disease in developed countries. On average, an adult gets ARVI at least 2-3 times a year, and children - 2-3 times more often. The duration of acute viral rhinitis is 7-10 days. The danger is represented by complications that can develop against the background of rhinitis: inflammation of the paranasal sinuses (sinusitis, frontal sinusitis, ethmoiditis) and otitis media.
With regard to allergic rhinitis, epidemiological data indicate that they suffer in varying degrees of severity from 10 to 30% of adults and up to 40% of children. The importance of this problem is also due to the fact that allergic rhinitis is closely associated with such very common diseases as acute and chronic sinusitis, allergic conjunctivitis, and is one of the decisive risk factors for the development of bronchial asthma or it already accompanies and aggravates. For example, out of 2580 patients with bronchial asthma (62% with atopy), 80.7% had indications of seasonal rhinitis, and in 72% of cases, exacerbation of rhinitis was accompanied by a worsening of asthma. In cases of achieving asthma control (40.3% of patients), most patients used drugs to treat rhinitis.
Regardless of the etiology, the main pathogenetic link in the vast majority of diseases of the nasal cavity, paranasal sinuses and middle ear is mucosal edema. It is impossible to consider rhinitis and not take into account its close relationship with the paranasal sinuses and the auditory tube. Mucosal edema and hypersecretion in the nasal cavity inevitably impede ventilation and worsen mucociliary clearance, which creates conditions for the development of acute inflammation of the middle ear and paranasal sinuses, which, as a rule, are complicated by the addition of a bacterial infection.
In most cases, patients with acute inflammatory diseases of the upper respiratory tract begin treatment mainly with available, over-the-counter and "harmless" symptomatic drugs. The share of medicines aimed at treating the common cold and cough in Russia is about 30% of the total medicine market (according to DSM Group). Studies show that for 70-80% of patients, the biggest problem that worsens the quality of life is precisely the feeling of nasal congestion, so restoring nasal breathing is an important task. And this is due not only to the discomfort that rhinitis causes, but also to the fact that edema, hypersecretion and a sharp decrease in the activity of the ciliated epithelium create ideal conditions for the attachment of infectious agents. In this regard, it is necessary to facilitate nasal breathing and the elimination of secretions from the nasal cavity by prescribing local vasoconstrictors.
Rhinorrhea and nasal congestion are natural stages of the inflammatory process, and therefore the rate of this condition depends on the effectiveness of anti-inflammatory treatment. However, in practice, anti-inflammatory nasal drugs are not often used, because. in each case, an individual choice of the drug is required depending on the etiology of rhinitis, which presents certain difficulties. Unfortunately, universal anti-inflammatory drugs do not exist. At the same time, over-the-counter nasal vasoconstrictors, which are suitable for a wide range of patients, quickly alleviate the patient's condition, although they do not affect the nature of the inflammation.
The use of local therapy allows you to quickly stop the pathological process, avoid complications that accompany rhinitis and, in some cases, refuse the use of antibiotics, mucolytics and systemic anti-inflammatory drugs. Local therapy has a number of huge advantages: a quick effect, a direct effect on the mucous membrane, the creation of a high concentration of the drug in the area of inflammation, the ability to use small concentrations of the drug, and the absence of a systemic effect.
Of great importance is also the form of release of the drug. Nasal drops are difficult to dose, since most of the instilled drug flows down the bottom of the nasal cavity into the pharynx. In this case, the desired therapeutic effect is not achieved, and there is a threat of overdose. Therefore, it is more preferable to use nasal nebulizers, which allow uniform irrigation of the nasal mucosa in small concentrations.
There are a huge number of decongestants on the domestic market: Naftizin, Xymelin, Nazol, Dlyanos, Tizin, Nazivin, Otrivin. All of them differ in composition, duration of action, have advantages and disadvantages, but the mechanism of action of all drugs is fundamentally the same. Decongestants, being α-agonists, constrict the vessels of the nasal mucosa, resulting in a decrease in edema and hyperproduction of mucus by goblet cells. All drugs according to the duration of action can be divided into short-acting, medium-lasting and long-acting drugs. The short-acting derivatives include naphazoline and tetrizoline derivatives - their effect lasts no more than 4-6 hours, which requires their 4-fold use. They negatively affect the ciliated epithelium of the nasal cavity. Decongestants of medium duration (up to 8-10 hours) include xylometazoline derivatives. Oxymetazoline derivatives are long-acting vasoconstrictor drugs - 10-12 hours. Due to this, it is enough to use them 2-3 times a day. The long-term effect of these α2-agonists is explained by their delayed elimination from the nasal cavity due to a decrease in blood flow in the mucous membrane.
The severity of the anti-edematous action of all imidazoline derivatives is approximately the same. In 20 minutes. after their application, approximately 60% of their maximum effect develops, which manifests itself after 40 minutes. However, the duration of their action is very different: after 4 hours, the anti-edematous effect of indanazoline, naphazoline and tetrizoline is no longer present, but remains with xylometazoline, oxymetazoline, and also tramazoline. 8 hours after application to the mucosa, only oxymetazoline has a pronounced effect.
The undoubted advantages of oxymetazoline is the absence of a toxic effect on the cells of the ciliated epithelium, which maintains mucociliary clearance.
All decongestants have class-specific undesirable effects: there is a burning sensation, sneezing, congestion (reactive hyperemia), dry mucous membranes. The development of reactive hyperemia and dryness of the mucosa can be avoided when additional components such as menthol, camphor, eucalyptol are used as part of decongestants. These natural ingredients not only have moisturizing and anti-inflammatory effects, but also contribute to a more even distribution of the main vasoconstrictor drug and are perfectly combined with it.
An additional advantage is also the anti-inflammatory effects of these substances. Thus, eucalyptol is a strong inhibitor of the production of cytokines such as TNF-α and interleukin-1, and thus reduces the excessive secretion of the mucous membranes of the respiratory tract, which enhances the effect of the main substance - oxymetazoline. In addition, eucalyptol and camphor have antimicrobial and antifungal activity, in particular against Cl. perfringens and C. albicans.
As for the evidence base for the effectiveness of decongestants, Taverner D. et al. a meta-analysis included 7 randomized placebo-controlled trials evaluating the effectiveness of oral and local decongestants in adults and children with SARS (The Cochrane Library, MEDLINE, OLDMEDLINE, EMBASE). A statistically significant 6% reduction in nasal congestion was demonstrated after a single dose of decongestants compared to placebo. With repeated use of vasoconstrictors, the reduction in nasal congestion was reduced to 4%. Two studies demonstrated safety and few side effects. The authors concluded that a single dose provided nasal relief with continued efficacy for 3-5 days. No studies have been conducted in children. Previously, the same authors showed that 286 patients significantly - by 13% - noted a subjective decrease in the symptoms of nasal congestion after the use of decongestants compared with placebo, with repeated use, the effect slightly decreased.
In the EPOS recommendations, the category of evidence for the use of decongestants for acute sinusitis is rated as Ib (-), and the strength of the recommendation is D (category IV evidence, the lowest). Therefore, topical corticosteroids are suggested as the main therapy (recommendations A). However, this does not exclude, and in the case of a purulent form, the simultaneous administration of decongestants is actively recommended. According to the ARIA concept, decongestants are indicated for any form and severity of allergic rhinitis as symptomatic therapy, but not more than 10 days.
Today, Knoxprey appeared on the market - oxymetazoline in combination with eucalyptol, camphor, menthol in the form of a spray and is characterized by all the advantages of its constituent substances: the duration of action of oxymetazoline along with a minimal toxic effect on the function of the ciliated epithelium, antimicrobial and immunostimulating properties of essential oils, preservation of natural humidity of the nasal mucosa. Noxprey is available in the form of a spray that evenly irrigates the nasal cavity and excludes accidental overdose and can be used only 2 times a day.
Currently, in the arsenal of general practitioners and otorhinolaryngologists there is a sufficient number of effective and safe pathogenetic drugs for the treatment of diseases of the upper respiratory tract. The main goals of such therapy are not only to alleviate the patient's condition and reduce the duration of the disease, but also to prevent the development of complications. When choosing a drug intended for the symptomatic treatment of rhinitis, sinusitis, otitis media, preference should be given to drugs with a good safety profile, long-term action and additional auxiliary effects.

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The common cold is the most common illness affecting people of all ages. At the same time, you can catch a cold not only in the autumn-winter period, but also in spring, and even in summer. The first sign of illness is a runny or stuffy nose. And with these signs, not all people want to go to the clinic for qualified help.

Most prefer to cope with these unpleasant symptoms using drugs that belong to the category of vasoconstrictors.

It is important to know what decongestants are. These are drugs that constrict blood vessels and thereby help get rid of nasal congestion. This term, translated from English, means "a remedy for stagnation or blockage." It is worth noting that these drugs can be used in different ways.

There are drugs for oral and topical use. The former act as systemic agents, while the latter are used directly for instillation into the nose. It is noted that all means are fast-acting and effective. And this is precisely the reason for the popularity of drugs. After all, they help to cope with and quickly enough.

Since today there are many such drugs, it is not surprising that doctors use a special classification for them. To classify drugs, the international ATC system is used.

All drugs used to treat patients are divided into groups according to their basic composition and the therapeutic effect they have on the body. According to the ATC, all decongestants are divided into 3 large groups:

To the first category include all funds, the main component of which is pseudoephedrine. Most of these are systemic drugs that are intended for oral administration. However, there are also complex drugs that have a pronounced antihistamine effect. They are mainly used by people with allergies. Most often they are prescribed by a doctor. However, they do not provoke serious side effects, so often people pick them up on their own.
To the second group includes drugs that contain a large amount of such a component as phenylephrine. They are also represented by drugs of the combined type. But in pharmacies you can find local preparations. Drops and sprays that can be used to combat allergy symptoms are quite rare. These drugs are especially popular because they are freely available. Therefore, in order to acquire them, it is not necessary to visit a doctor at all.
Third category means includes preparations containing phenylpropanolamide. They are combined drugs with antihistamine properties. That is why they are most often used by people for whom a runny nose is not a symptom of the disease, but a constant companion of allergies.

There is another classification of decongestants, based not on their composition, but on the duration of action:

short acting drugs- this category includes remedies that relieve a person of a runny nose, nasal congestion and other symptoms of a cold for only 4-6 hours. After the specified time, the unpleasant symptoms return, and the person is forced to take the dose of the medicine again;
intermediate acting drugs- are used most often, since their duration is approximately 8-10 hours;
long-acting agents- It is customary to include in this category all drugs that act within 12-15 hours. Often they can be purchased only on the prescription of a doctor. They are used to treat chronic and.

In cases where the course of the disease passes with complications that eventually become the cause of swelling of the airways, doctors resort to the help of drugs such as anticongestants. What are they?

Anticongestants are agents whose principle of action is in many ways similar to decongestants. The difference is observed only in the fact that they have a strongly pronounced anti-inflammatory effect, due to which there is a decrease in the resulting edema.

It is worth noting that the funds belonging to this group are never prescribed for a long time. This is due to the fact that the body quickly gets used to them. As a result, tachyphylaxis develops.

Important. In other words, this addiction leads to the fact that gradually the effect obtained from the use of the drug decreases.

The most popular and available decongestants

Going to the pharmacy to choose the right products on your own, it must be remembered that not all of them are released without a prescription from a doctor. So, which drug is a decongestant that can be purchased from the appropriate doctor's prescription.

With a runny nose and nasal congestion, vasoconstrictors are popular. It has been proven that in the acute period they reduce clinical manifestations by almost 2 times. About the action of drugs, about side effects, contraindications and possible complications.

Vasoconstrictor drugs that relieve nasal congestion are called decongestants. The term translated from English means "against stagnation, blockage."

These medicinal substances can be used:

Orally (systemic).
Locally (on the nose).

Decongestants are represented by three groups:

With the main component pseudoephedrine. Systemic agents for oral administration: TeraFlu, Grippex and complex preparations with an antihistamine component Akrivastine, Actipred, Brompheniramine.
With the main component phenylephrine. These are systemic combined (Maxicold, Coldrex, Rinza) and local preparations (Adrianol) with a duration of action of 4 to 6 hours. This group also includes Vibrocil (drops, spray) - an allergic combination drug.
With the main component phenylpropanolamide - a combined agent with antihistamine action Contact 400.

Combined drugs, in addition to vasoconstriction, give an antibacterial, anti-inflammatory and mucolytic effect. They are prescribed for colds, sinusitis, acute and chronic rhinitis, allergies of the upper respiratory tract.

The use of decognestants in most cases is justified: nasal congestion worsens the quality of life, negatively affects sleep, work and study. The drugs act quickly and effectively. They are convenient to use and most of them can be purchased at the pharmacy without a prescription.

But, despite the objective merits of the means, self-medication and uncontrolled intake can lead to serious consequences.

Flaws

Systemic (oral) decongestant preparations have an extensive list of side effects. This is due to the fact that they are quickly absorbed and affect the nervous system as stimulants. From the category of over-the-counter decongestants are gradually transferred to prescription drugs.

According to special indications, they are prescribed to patients with hypertension, men with prostate pathology. Decongestants cause nervous overexcitation and insomnia, so they are not recommended for use in the evening.

Local nasal remedies after use can provoke both undesirable local symptoms and a general toxic effect.

Local manifestations:

Burning, dryness of the mucous membranes in the nose and nasopharynx
Signs of the "rebound" syndrome: deterioration after discontinuation or reduction in dosage.
Vegetative changes, nasal hyperactivity.
Inhibition of secretory ability.
Violation of the microcirculation of the mucosa.
Development of medical or atrophic rhinitis.

Local remedies of this group have another side effect: they stop the work of ciliated epithelial cells, and this makes self-cleaning of the mucosa difficult. This leads to the uncontrolled development of bacterial flora in the paranasal sinuses.

Security questions

The most serious problem associated with the use of decongestants is drug dependence and secondary nasal vasodilation (persistent enlargement of the blood vessels). Prolonged use of drugs leads to drug-induced rhinitis, when hyperemia, swelling and congestion persists despite the therapy.

Vagotonics are susceptible to drug dependence on decognestants - people in whom the parasympathetic division of the nervous system predominates: hypotension with wet cold palms, and sensitivity to temperature changes.

In such patients, nasal decongestants normalize blood pressure, increase vitality and physical activity. For them, drops replace several cups of coffee, and they use them more often. A vicious circle is formed: active, uncontrolled use worsens nasal breathing, the general toxic effect increases, and patients are unable to stop using these drops on their own.

Most of them show withdrawal symptoms, which differ little from those of alcohol or drugs.

Features of application in pediatric practice

It has been proven that small patients under 10 years of age are not susceptible to drug-induced rhinitis and "rebound syndrome". This is due to the fact that at this age they are sympathetic - with increased physical activity, heart palpitations, early morning rises. But with uncontrolled treatment and overdoses, it is possible to obtain a general toxic and stimulating effect.

Ignorance of adults about side effects, availability of drugs, lack of control by pediatricians lead to severe decongestant poisoning. Clinical manifestations of intoxication in children pass in two phases:

General nausea and vomiting, headaches, anxiety.
Paleness or cyanosis of the skin, muscle weakness, decreased body temperature.

In medical protocols for the treatment of bacterial and viral infections, children under 6 months of age with nasal congestion are shown to moisten the mucosa with saline only. Local decongestants are allowed for children older than six months. It is strictly forbidden to use them for more than three days!

Security questions

Experts believe that decongestants are best used in the form of nasal sprays. Thanks to this dosage form, uniform irrigation of the mucosa and accurate dosage are ensured.

Rules for using decognestants:

Before the procedure, thoroughly clean the nasal passages from mucus.
While sitting or lying down, tilt your head back. When irrigating the left nostril, slightly turn the head to the left, the right - to the right.
Keep in mind that with curvature of the nasal septum and polyps, the effectiveness of local decongeners is markedly reduced.
Use the medicine for no more than three days. In special cases, according to the appointment of a specialist, the treatment period can be extended up to one week.

Small patients (6-12 years old) with nasal congestion are prescribed half doses of drugs, up to 6 years - quarter doses. Babies under 2 years of age should be treated with decongestants only according to the indications and under the supervision of a pediatrician.

Preparations for the treatment of the common cold are among the ten most frequent requests from pharmacy visitors. Among them, in turn, the most popular drugs traditionally remain nasal vasoconstrictor drugs (decongestants or alpha-agonists).

All nasal decongestants are allowed to be sold without a doctor's prescription, so the first-timers have the right to recommend these drugs to buyers. Let's take a closer look at this group of drugs.

Vasoconstrictor drugs are used for inflammatory diseases of the upper respiratory tract. Apply drugs of this group topically (drops in the nose, sprays) or inside. The anti-edematous effect of drugs is the result of the activation of alpha-adrenergic receptors and constriction of the vessels of the mucous membranes and venous formations of the nasal conchas.

The mechanism of action of nasal decongestants is a stimulating effect on alpha-adrenergic receptors of the vessels of the nasal mucosa, which causes their narrowing. This in turn leads to a decrease in excess secretion (rhinorrhea) and mucosal edema and a rapid relief of disturbed nasal breathing.

For sinusitis and otitis media, decongestants are the first line of therapy. They improve nasal breathing, reduce rhinorrhea, help restore the patency of the fistulas of the paranasal sinuses and auditory tubes.

A course of treatment with topical decongestants exceeding 5 days is not recommended by doctors because of the risk of developing drug-induced rhinitis. For short-acting drugs, the duration of treatment is limited to 3 days. Prolonged use of drugs in this group without medical supervision is dangerous for the development of atrophy of the nasal mucosa.

Systemic decongestants

Systemic decongestants include phenylephrine, which is part of oral preparations. Preparations that contain phenylephrine include Theraflu, Grippoflu, Coldact Flu Plus, Coldrex, Rinza and other combined preparations.

The use of phenylephrine in some cases is associated with the development of headache, dizziness, irritability. In addition, against the background of taking phenylephrine, patients have arterial hypertension, pain in the heart area and arrhythmia. Therefore, phenylephrine preparations are not prescribed to patients with cardiovascular pathology. In children, phenylephrine is approved for use only from the age of 15.

What preparations and from what age are applied?

The duration of action of various decongestants and the frequency of their use during the day

Decongestants, depending on the duration of action, are divided into preparations of short (up to 4 hours), medium (6-8 hours) and long-acting (up to 12 hours).

Typical representatives of drugs with a short, up to 4 hours, action are tetrizoline (Tizin) and naphazoline (Naphthyzinum). The rate of occurrence of the clinical effect of this group of drugs has to be paid by an increase in the level of side effects.

The increased risk is understandable, because short-acting drugs need to be used 3-4 times a day. This increases the likelihood of dystrophy of the mucous membrane, disorders of the vascular tone of the cavernous formations of the nasal cavity. The latter are manifested by difficulty in nasal breathing.

The average duration of action, 6-8 hours, demonstrates xylometazoline. Preparations based on this active substance - Galazolin, Tizin Xylo, Xymelin, Xylen, Snoop, Otrivin, Rinomaris, Dlyanos. In the same list - Grippostad Rino, Rinorus, Rinostop. Intermediate-acting decongestants are administered 2-3 times a day.

Preparations of the second group - combined. Among them, Tizin Xylo BIO with hyaluronic acid, which moisturizes the mucous membrane and reduces the risk of mucosal degeneration. Medicines with essential oils - Xymelin Eco with menthol, Asterisk NOZ - demonstrate antimicrobial, locally irritating and distracting effects. Xymelin Extra contains, in addition to xylometazoline, the anticholinergic component ipratropium bromide. It helps with severe rhinorrhea.

Xylometazoline preparations with sea water are common on pharmacy shelves: Rinomaris and Snoop. They moisturize the mucous membrane, stop atrophic processes, stimulate the ciliated epithelium. Such drugs are useful in acute rhinitis and a pronounced feeling of dryness in the nose.

Decongestants of the third group act up to 12 hours and require the introduction of 1 time per day. The group includes tramazolin (Lazolvan Rino, Adrianol), oxymetazoline (Nazivin).

A single injection improves patient compliance. In addition, the scheme of drug administration reduces the toxic effect of drugs on the ciliated epithelium of the mucosa.

This has a positive effect on the course of the disease.

Rules for safe use decongestants in children

The safest way to improve nasal breathing for children under 6 years of age is to use nasal lavage with 0.9% saline solution.
In cases where there is no sufficient result, children's forms of decongestant preparations can be used: xylometazoline (0.05% drops and gel), oxymetazoline (0.01% solution for children from birth to 1 year and 0.025% solution from one year to 6 years, over 6 - years of age, a 0.05% solution can be used), naphazoline (0.05% solution), tetrazoline (from 3 years old 0.05% solution).
Decongestant preparations are used in the presence of rhinorrhea in children of the first year of life and up to 3 years old, 1 drop each, from 3 to 6 years old, 2 drops each, over 6 years old, more concentrated solutions and gels (0.05%) can be used 2 drops no more than 2-3 times a day, preferably once at night.
To facilitate dosing accuracy, the pediatric solution bottle should have a dropper or graduated pipette marked with the number of drops instead of an atomizer.
Carelessness during instillation of the solution into the nose can lead to its contact with the conjunctiva of the eye and cause a burn.
The effectiveness of the following procedure for very young children has been proven - 1-2 drops of a 0.01% solution are applied to cotton wool and the nasal passages are wiped, used in the form of turundas in the nose.
Simultaneous use with decongestants of other drugs for intranasal use is not recommended.
The duration of the use of decongestant preparations in children cannot be longer than 3-5 days.

First-timer's advice when dispensing decongestants

When dispensing decongestants, pharmacy visitors should find out the age of the patient. An "adult" drug can cause overdose and poisoning in young children. Their body weight is small, and the nasal mucosa is more permeable than in adults. But parents forget this and administer the drug to the child at a concentration that exceeds the required dose by 30 times!

The use of long-acting or intermediate-acting decongestants reduces side effects. It is useful to use other therapeutic agents with decongestants. It is useful to supplement the treatment with solutions of sea water Aqualor or Aqua Maris Plus with dexpanthenol. Another option is antihistamines. To increase the safety of treatment, the exact dosage, frequency, duration of administration should be observed.

Rules for the local use of decongestants:

Clear your nasal cavity.
Tilt your head back.
Drip 5 drops of the drug or make 2 injections into each half of the nose.
Stay with your head thrown back for 2-3 minutes after the procedure.

Conclusions:

Decongestants are used topically and orally. Topical preparations for topical use differ in terms of duration.
Prolonged treatment with topical decongestants without medical supervision increases the risk of mucosal atrophy and drug-induced rhinitis.
Combined topical decongestants of medium duration of action have additional therapeutic effects.
Runny nose in children requires increased attention to the choice and dosage of drugs.