Intranasal Oxymetazoline Research Articles

Urinary bladder retention secondary to intranasal administration of oxymetazoline "Afrin" for intra-arterial chemotherapy.

Selective ophthalmic artery infusion of chemotherapy (SOAIC) has emerged as the standard of care for retinoblastoma (RB). Intranasal oxymetazoline (INO), Afrin, is often intraoperatively administered adjunctively to optimize flow to the orbit. There has been one report to date that suggests the adjunctive use of INO has led to systemic side effects. To our knowledge, this is the first documented case of INO causing urinary retention in a patient undergoing SOAIC, and the recommended treatment.

Prevention of middle ear barotrauma with oxymetazoline/fluticasone treatment

Prevention of middle ear barotrauma with oxymetazoline/fluticasone treatment Middle ear barotrauma (MEB) is a common complication of hyperbaric oxygen (HBO2) therapy. It has been reported in more than 40% of HBO2 treatments and can interrupt the sequence of HBO2. MEB may lead to pain, tympanic membrane rupture, and even hearing loss.The aim of this study was to determine if pretreatment with intranasal fluticasone and oxymetazoline affected the incidence of MEB. We conducted a retrospective chart review of subjects undergoing HBO2 at our institution between February 1, 2014, and May 31, 2019. Subjects in the fluticasone/oxymetazoline (FOT) treatment group used intranasal fluticasone 50 mcg two times per day and oxymetazoline 0.05% one spray two times per day beginning 48 hours prior to initial HBO2. Oxymetazoline was discontinued after four days. Fluticasone was continued for the duration of HBO2 therapy. A total of 154 unique subjects underwent 5,683 HBO2 treatments: 39 unique subjects in the FOT group underwent 1,501 HBO2; 115 unique subjects in the nFOT (no oxymetazoline or fluticasone treatment) group underwent 4,182 HBO2 treatments. The incidence of MEB was 15.4% in the FOT group and 16.2% in the nFOT group. This was not a statistically significant difference (OR = 0.77; p = 0.636). Treatment pressure, age over 65 years, male sex, and BMI were not associated with a difference in MEB incidence. In summary, pretreatment with intranasal oxymetazoline and fluticasone in patients undergoing HBO2 did not significantly reduce MEB. More investigation with larger numbers of participants and prospective studies could further clarify this issue.

Correlation of Technical and Adjunctive Factors with Quantitative Tumor Reduction in Children Undergoing Selective Ophthalmic Artery Infusion Chemotherapy for Retinoblastoma.

Selective ophthalmic artery infusion chemotherapy has improved ocular outcomes in children with retinoblastoma. Our aim was to correlate quantitative tumor reduction and dichotomous therapeutic response with technical and adjunctive factors during selective ophthalmic artery infusion chemotherapy for retinoblastoma. An understanding of such factors may improve therapeutic efficacy. All patients with retinoblastoma treated by selective ophthalmic artery infusion chemotherapy at a single center during a 9-year period were reviewed. Only first-cycle treatments for previously untreated eyes were studied. Adjunctive factors (intra-arterial verapamil, intranasal oxymetazoline external carotid balloon occlusion) and technical factors (chemotherapy infusion time, fluoroscopy time) were documented by medical record review. Quantitative tumor reduction was determined by blinded comparison of retinal imaging acquired during examination under anesthesia before and 3-4 weeks after treatment. The dichotomous therapeutic response was classified according to quantitative tumor reduction as satisfactory (≥ 50%) or poor (<50%). Twenty-one eyes met the inclusion criteria. Patients ranged from 2 to 59 months of age. Adjuncts included intra-arterial verapamil in 15, intranasal oxymetazoline in 14, and external carotid balloon occlusion in 14. Quantitative tumor reduction ranged from 15% to 95%. Six showed poor dichotomous therapeutic response. A satisfactory dichotomous therapeutic response was correlated with intra-arterial verapamil (P = .03) in the aggregate cohort and in a subgroup undergoing treatment with single-agent melphalan at a dose of <5 mg (P = .02). In the latter, higher average quantitative tumor reduction correlated with intra-arterial verapamil (P < .01). Intra-arterial verapamil during selective ophthalmic artery infusion chemotherapy is correlated with an improved therapeutic response, particularly when treating with lower doses of single-agent melphalan.

Effects of oxymetazoline on nasal flow and maximum aerobic exercise performance in patients with inferior turbinate hypertrophy.

To determine the effect of topical intranasal oxymetazoline on nasal resistance and aerobic exercise performance in patients with nasal congestion caused by inferior turbinate hypertrophy. Individual randomized controlled trial. Eight patients with inferior turbinate hypertrophy performed a set of exercise tests to exhaustion 1 week apart. They were given oxymetazoline or a placebo before each of the two test sessions according to a random pattern. Changes in nasal airflow were measured as peak nasal flow and ventilatory efficiency parameters, ventilatory equivalents, end-expiratory pressure, oxygen consumption, cardiac efficiency, rate of perceived exertion, and maximal and submaximal mechanical power. Ten minutes after use of the drug or placebo, improvements in maximum nasal airflow were seen in the oxymetazoline group (P < 0.05). However, exercise tests showed improvements in both groups (P < 0.05). After exertion, there was no difference between the two groups in maximum nasal airflow (P > 0.05). There were no differences between groups in oxygen consumption, rate of perceived exertion, respiratory exchange ratio, ventilation, or ventilatory equivalents for oxygen. Oxymetazoline increased nasal airflow in patients with turbinate hypertrophy, but this change did not translate into gains in physical exercise parameters or perceived exertion. 1b.

Cerebral Vasoconstriction Triggered By Sympathomimetic Drugs During Intra-atrerial Chemotherapy

Reversible cerebral vasoconstriction syndrome is a rare cause of headache and stroke in the pediatric population. Reversible vasoconstriction is reported in a 19-month-old girl with retinoblastoma who underwent selective ophthalmic artery infusion chemotherapy with melphalan. Procedure-related cerebral vasoconstriction was specifically triggered during coadministration of adjunctive medications, which included mydriatic eye drops containing phenylephrine, intranasal oxymetazoline, nebulized albuterol, intravenous hydrocortisone, and intravenous diphenhydramine. The course of cerebral vasospasm, which began with a severe hypertensive surge and resolved spontaneously within hours of blood pressure normalization, was documented by angiography in real time. Subsequent brain magnetic resonance imaging showed no evidence of perfusion abnormality, cerebral infarction, or cerebral hemorrhage, and the patient was discharged home without any neurologic sequelae. In this report, we highlight the potential risk of reversible cerebral vasoconstriction in children administered vasoactive drugs and discuss its relevance during treatment of retinoblastoma by intraarterial chemotherapy.

Decreased Rhinovirus Shedding after Intranasal Oxymetazoline Application in Adults with Induced Colds Compared with Intranasal Saline

Intranasal oxymetazoline (OMZ) is used as a decongestant during common colds. Recently, intracellular adhesion molecule (ICAM) 1 receptor expression in vitro has been shown to be diminished by OMZ. ICAM-1 is the major receptor used by rhinovirus to gain entry to human cells. The objective of this study was to assess the effect of OMZ on geometric mean titer of rhinovirus in nasal lavage fluid after rhinovirus inoculation. Volunteers with antibody titers of ≤1:4 to rhinovirus type 39 were enrolled in a randomized, reference-controlled, double-blind study. Beginning 3 hours after intranasal challenge with 100-300 tissue culture infectious dose (TCID)₅₀ of virus, subjects received active 0.05% OMZ (45 μL containing 22.5 μg of OMZ hydrochloride in citrate buffer) or reference control (physiological saline solution [PSS]) three times daily for 5 days. Rhinovirus was detected in fibroblast cultures. Geometric mean viral titer (log₁₀) in 34 rhinovirus-infected subjects receiving OMZ was 1.49 on day 2 compared with 2.24 in the 38 infected subjects receiving PSS (p = 0.04). On day 3, the mean titers were 1.45 and 2.08, respectively. Median length of viral shedding was 3.3 days (OMZ) and 3.4 (PSS). Duration of clinical illness was 6.1 days in both groups. Topical OMZ decreased viral titer on day 2 during experimental rhinovirus infection in normal volunteers.

Fluticasone Reverses Oxymetazoline-induced Tachyphylaxis of Response and Rebound Congestion

Chronic use of intranasal decongestants, such as oxymetazoline, leads to tachyphylaxis of response and rebound congestion, caused by alpha-adrenoceptor mediated down-regulation and desensitization of response. We evaluated if tachyphylaxis can be reversed by intranasal fluticasone propionate, and the relative alpha(1)- and alpha(2)-adrenoceptor components of tachyphylaxis using the alpha(1)-antagonist prazosin. In a randomized, double-blind, placebo-controlled, crossover design, 19 healthy subjects received intranasal oxymetazoline, 200 microg three times a day for 14 days, followed by the addition of fluticasone, 200 microg twice a day for a further 3 days. At Days 1, 14, and 17, participants received a single dose of oral prazosin, 1 mg, or placebo with measurements made before and 2 hours later. Outcomes evaluated were peak nasal inspiratory flow, nasal resistance, blood flow, and oxymetazoline dose-response curve (DRC). On Day 14 versus Day 1, inspiratory flow decreased (mean difference, 95% confidence interval) (-47.9 L x min(-1); -63.9 to -31.9; P < 0.001) and the DRC shifted downward (24.8 L x min(-1); 20.3-29.3; P < 0.001). On Day 17 versus Day 14, after fluticasone, inspiratory flow increased (45 L x min(-1); 30-61; P < 0.001) and the DRC shifted upward (26.2 L x min(-1); 21.7-30.7; P < 0.001). On Day 1, prazosin reduced inspiratory flow (-52.6 L x min(-1); -19.2 to -86) compared with baseline. This effect was abolished on Day 14 (7.9 L x in(-1); -41.3 to 25.5). Oxymetazoline-induced tachyphylaxis and rebound congestion are reversed by intranasal fluticasone. Further studies are indicated to evaluate if combination nasal sprays of decongestant and corticosteroid are an effective strategy to obviate tachyphylaxis and rebound in rhinitis. Clinical trial registered with www.clinicaltrials.gov (NCT 00487032).

The gap in tobacco use between remote Indigenous Australian communities and the Australian population can be closed

<h3>BACKGROUND AND PURPOSE:</h3> Selective ophthalmic artery infusion chemotherapy has improved ocular outcomes in children with retinoblastoma. Our aim was to correlate quantitative tumor reduction and dichotomous therapeutic response with technical...

The effect of intranasal oxymetazoline on the safety and pharmacokinetics of intranasal ketamine hydrochloride

Intranasal (IN) oxymetazoline 0.05% is commonly used to treat nasal congestion. The objective of this study was to determine the effect of concomitant administration of IN oxymetazoline on the safety and pharmacokinetics of a proprietary formulation of IN ketamine hydrochloride under development for the treatment of acute pain. Healthy volunteers received IN ketamine 30mg alone or one hour after receiving IN oxymetazoline in this randomized, open-label, cross-over study. Blood samples for analysis of ketamine and norketamine, an active metabolite, were collected through 36 hours post-dose.

Avoiding airway obstruction after pediatric adenotonsillectomy

Objective To evaluate the efficacy of a protocol designed to prevent post-adenotonsillectomy airway obstruction in small children with obstructive sleep apnea. Design Computerized retrospective review of single surgeon case series. Setting Tertiary children's medical center. Methods Children with sleep study proven obstructive sleep apnea or children under the age of 3 years with clinically suspected obstructive sleep apnea were treated according to a protocol that included: (1) rapid bloodless tonsillectomy; (2) repeated release of the tonsillar retractor; (3) avoidance of uvular edema; (4) routine intra-operative intranasal oxymetazoline, and placement of nasal airway; (5) extended recovery room observation. Primary outcome measures were (1) avoidance of unexpected intensive care unit admission; (2) post-extubation pulmonary edema; (3) aspiration pneumonia. Results During the period March 2004–August 2007, 864 children underwent adenotonsillectomy by a single surgeon—604 for the indication of obstructive sleep apnea or adenotonsillar hypertrophy with obstruction. Two hundred and ten were under the age of 3 years or had sleep study proven obstructive sleep apnea. There were two unexpected admissions to the pediatric intensive care unit for persistent upper airway obstruction—none required intubation. No child developed post-obstructive pulmonary edema. Three children were treated for infiltrates consistent with aspiration pneumonitis. Conclusion Most cases of post-extubation pulmonary edema and pneumonia can be avoided in young children and those with mild-to-moderate obstructive sleep apnea following a protocol that anticipates and avoids precipitating causes of upper airway obstruction.

404: Effects of Intranasal Oxymetazoline on the Pediatric Population Aged 1 to 12 Month: An Interim Analysis

Young children are obligate nose breathers. When these patients develop severe congestion, they can present to the emergency department (ED) with difficulty feeding, tachypnea, retractions, and respiratory distress, despite nasal saline and suction at home. Intranasal oxymetazoline has been used in the adult population to counter congestion with a minimal side effect profile. It can offer an alternative management for parents and physicians. This is a preliminary safety study of using oxymetazoline in the pediatric population with the hypothesis that medication administration will not have a significant side effect on heart rate, blood pressure, or respiratory rate, and can be a safe treatment option for children 1 month to 12 months old.

The Effect of Intranasal Oxymetazoline on Serum Levels of Cocaine after Intranasal Cocaine Application

A prospective analysis was performed on healthy volunteers to determine whether pretreatment with the vasoconstrictor, oxymetazoline, could decrease the blood concentration of cocaine topically applied to the nasal mucosa. Blood pressure, pulse, continuous ECG recordings, and participant responses also were monitored as an indicator of systemic effects. Anesthesia was roughly assessed using a sterile 22-gauge needle touched to the anterior aspect of the inferior turbinate. Blood samples drawn at predetermined intervals were analyzed for cocaine using gas chromatography. Pretreatment with oxymetazoline significantly reduced the rate and extent of the increase in blood cocaine levels and resulted in a statistically significant lower systolic blood pressure and pulse rate. There was no significant difference in topical anesthesia between the two groups. Pretreatment with oxymetazoline before application of nasal cocaine thus appears to be beneficial.