Oxymetazoline
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Pharmacokinetic data | |
Metabolism | Kidney (30%), fecal (10%) |
Elimination half-life | 5–6 hours |
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Melting point | 301.5 °C (574.7 °F) |
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Oxymetazoline, sold under the brand name Afrin among others, is a
Oxymetazoline is a derivative of imidazole.[2] It was developed from xylometazoline at Merck by Wolfgang Fruhstorfer and Helmut Müller-Calgan in 1961.[3] A direct sympathomimetic, oxymetazoline binds to and activates α1 adrenergic receptors and α2 adrenergic receptors, most notably.[2] One study classified it in the following order: α(2A) > α(1A) ≥ α(2B) > α(1D) ≥ α(2C) >> α(1B), but this is not universally agreed upon.[4] There is little consistency across the (relatively large) number of in-vitro studies with respect to binding affinity/selectivity.
Another study classified it with selectivity ratios in alpha 2 adrenergic receptors of 200 for a2A vs a2B, 7.1 a2A vs a2C, and 28.2 a2B vs a2C.[5] Making it a highly selective a2A agonist.
In 2021, it was the 292nd most commonly prescribed medication in the United States, with more than 600,000 prescriptions.[6][7]
Medical uses
Oxymetazoline is available over-the-counter as a topical decongestant in the form of oxymetazoline hydrochloride in nasal sprays.[8]
In the United States, oxymetazoline 1% cream is approved by the Food and Drug Administration for topical treatment of persistent facial erythema (redness) associated with rosacea in adults.[9]
Due to its vasoconstricting properties, oxymetazoline is also used to treat
In July 2020, oxymetazoline received approval by the FDA for the treatment of acquired drooping eyelid.[13]
Side effects
Rebound congestion
Rebound congestion, or rhinitis medicamentosa, may occur. A 2006 review of the pathology of rhinitis medicamentosa concluded that use of oxymetazoline for more than three days may result in rhinitis medicamentosa and recommended limiting use to three days.[14]
Australian regulatory submission
In a submission to the Therapeutic Goods Administration, a Novartis representative concluded, "The justification was not based on evidence." Citing an existing extensive body of evidence and noting a range of recommended periods from five to ten days, Novartis recommended the established five day period for its use for self-medication without medical consultation as it coincides with the typical duration of the common cold.[15]
Use in pregnancy
The Food and Drug Administration places oxymetazoline in category C, indicating risk to the fetus cannot be ruled out. While it has been shown that a single dose does not significantly alter either maternal or fetal circulation,[16] this subject has not been studied extensively enough to draw reliable conclusions.[original research?]
Overdose
If accidentally ingested, standard methods to remove unabsorbed drugs should be considered.[
Pharmacology
Pharmacodynamics
Oxymetazoline is a
Pharmacokinetics
Since imidazolines are sympathomimetic agents, their primary effects appear on α adrenergic receptors, with little if any effect on β adrenergic receptors.[21] Like other imidazolines, Oxymetazoline is readily absorbed orally.[21] Effects on α receptors from systemically absorbed oxymetazoline hydrochloride may persist for up to 7 hours after a single dose.[22] The elimination half-life in humans is 5–8 hours.[23] It is excreted unchanged both by the kidneys (30%) and in feces (10%).[22]
History
The oxymetazoline brand Afrin was first sold as a prescription medication in 1966. After finding substantial early success as a prescription medication, it became available as an over-the-counter drug in 1975. Schering-Plough did not engage in heavy advertising until 1986.[24]
Society and culture
Brand names
Brand names include Afrin,[25] ClariClear, Dristan, Drixine, Drixoral, Nasivin, Nasivion, Nezeril, Nostrilla, Logicin, Vicks Sinex, Visine L.R., Sudafed OM, Otrivin[26] Oxy, SinuFrin, Upneeq, and Mucinex Sinus-Max.[27]
References
- ^ https://www.newsendip.com/in-norway-700000-people-are-addicted-to-nasal-sprays/
- ^ a b "Oxymetazoline". PubChem. Bethesda (MD): National Library of Medicine (US), National Center for Biotechnology Information. CID 4636.
- ^ DE 1117588, Fruhstorfer W, Müller-Calgan H, "2-(2,6-dimethyl-3-hydroxy-4-tert-butyl-benzyl)-2-imidazoline,and acid addition salts thereof,and process for their manufacture", issued 23 November 1961, assigned to E Merck AG.
- S2CID 25064699.
- PMID 36101495.
- ^ "The Top 300 of 2021". ClinCalc. Archived from the original on 15 January 2024. Retrieved 14 January 2024.
- ^ "Oxymetazoline - Drug Usage Statistics". ClinCalc. Retrieved 14 January 2024.
- ^ "Oxymetazoline". Lexi-Comp: Merck Manual Professional. Merck.com. Retrieved 15 April 2013.
- S2CID 19930755.
- PMID 2310576.
- S2CID 37579139.
- ^ "VISINE Original Red Eye Drops | VISINE products". Visine.com. Archived from the original on 2 December 2010. Retrieved 15 April 2013.
- ^ "UPNEEQ Label" (PDF). accessdata.fda.gov. 8 July 2020.
- PMID 16784007.
- ^ Nguyen TM (2014). "Consultation submission: OTC nasal decongestant preparations for topical use: proposed advisory statements for medicines" (PDF). Novartis Consumer Health Australasia.
- PMID 2196495.
- ^ Westfall TC, Westfall DP. "Chapter 6. Neurotransmission: The Autonomic and Somatic Motor Nervous Systems". In Brunton LL, Lazo JS, Parker KL (eds.). Goodman & Gilman's The Pharmacological Basis of Therapeutics (11th ed.). Archived from the original on 30 September 2011. Retrieved 24 January 2015 – via AccessMedicine.
Anatomy and General Functions of the Autonomic and Somatic Motor Nervous Systems
. - ^ Biaggioni I, Robertson D. "Chapter 9. Adrenoceptor Agonists & Sympathomimetic Drugs". In Katzung BG (ed.). Basic & Clinical Pharmacology (11th ed.). Archived from the original on 30 September 2011. Retrieved 30 November 2011.
- S2CID 46018611.
- S2CID 37998936.
- ^ OCLC 460904351.
- ^ a b "Decongestants (Toxicity) - Toxicology". Merck Veterinary Manual. Retrieved 3 April 2023.
- )
- ^ Dougherty PH (20 October 1986). "Advertising; Afrin Goes After Users Of Nasal Decongestants". The New York Times. Retrieved 30 March 2015.
- ^ "Afrin".
- ^ "Otrivin". www.otrivin.ca. Retrieved 14 June 2023.
- ^ "Mucinex Cold and Flu Relief in Canada | Mucinex Canada". www.mucinex.ca. Retrieved 14 June 2023.