Reactions Following Use of Nasal Decongestants

Greenstein, Nathan M.

doi:10.1001/jama.1955.02950300081021

Cited by 12 publications

(8 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…When highly concentrated solutions are used, as in our patient, the threshold for intoxication is easily exceeded. Infants and young children are particularly prone to intoxication even with allegedly normal doses [5]. The symptoms of intoxication occur soon after intake or administration appearing within the first hours and peaking after 8 h [-3, 5].…”

Section: Discussionmentioning

confidence: 99%

Imidazoline intoxication in children

Mahieu

Rooman

Goossens³

1993

Eur J Pediatr

View full text Add to dashboard Cite

A 15-month-old girl with rhinopharyngitis was treated with a nasal solution containing the imidazoline derivative naphazoline. She rapidly developed profound CNS depression with stupor, hypothermia, hypoventilation and bradycardia. All symptoms disappeared within 24 h. The symptomatology of 18 other paediatric cases of naphthylimidazoline exposure reported to the Belgian National Poison Centre, is also discussed. Imidazoline intoxication due to overdose or accidental ingestion but also after normal therapeutic usage is frequent in children. It can cause severe CNS depression, especially in very young children. For these reasons vasoconstrictor imidazoline containing solutions should be prescribed with caution and kept out of reach of children.

show abstract

Section: Discussionmentioning

confidence: 99%

Imidazoline intoxication in children

Mahieu

Rooman

Goossens³

1993

Eur J Pediatr

View full text Add to dashboard Cite

show abstract

“…Sir: since 1945, a few cases of transitory depression of the central nervous system have been reported in children following intra-nasal administration of imidazoline-containing products [1][2][3][4][5][10][11][12]. Most of these intoxications were due to repeated instillations at regular intervals over several hours or days [1,[10][11][12].…”

mentioning

confidence: 99%

Coma in a neonate following single intranasal dose of xylometazoline

1993

View full text Add to dashboard Cite

“…Os derivados imidazolínicos vêm sendo amplamente utilizados desde a década de 1940, quando foi introduzida a nafazolina no mercado farmacêutico 2,4,11,14 . Desde então, trabalhos esporádicos, a maioria como relatos de casos isolados, têm alertado quanto ao risco do uso indiscriminado dessas medicações, principalmente em crianças com menos de dois anos de idade 5,7,[9][10][11][12][13][14]16 . Dentre os trabalhos publicados, apenas três estudos, desde 1970, descrevem séries clínicas de pacientes expostos a derivados imidazolínicos [9][10][11] .…”

Section: Discussionunclassified

“…O tratamento das manifestações clínicas é basicamente sintomático e de suporte, incluindo a ventilação mecânica nos pacientes com depressão respiratória grave, sendo questionável o uso da atropina 5,7,9 , que foi usada em um paciente desta série. A remissão do quadro ocorre geralmente em 24 a 36 horas 1,5,7,[9][10][11][12][13][14]16 . Na presente série, a ventilação mecânica foi empregada em apenas um paciente, sendo que 68,4% dos pacientes encontravam-se assintomáticos após 24 horas da exposição.…”

Section: Discussionunclassified

“…Os derivados imidazolínicos também podem estimular receptores α 2 -adrenérgicos pré-sinápticos dos centros de controle cardiovascular do sistema nervoso central, determinando a inibição da atividade simpática cerebral 5,[7][8][9] . Nessas situações, os pacientes, principalmente as crianças, podem apresentar depressão neurológica e respiratória, bradicardia e hipotensão arterial decorrentes da exposição a doses tóxicas ou "terapêuticas" 1,5,7,[9][10][11][12][13][14][15][16] .…”

Section: Introductionunclassified

See 1 more Smart Citation

Acute exposure to imidazoline derivatives in children

Bucaretchi¹,

Dragosavac²,

Vieira³

2003

J Pediatr (Rio J)

View full text Add to dashboard Cite

Objectives: To study acute exposure to imidazoline derivatives in 72 children younger than 15 years of age, followed-up from January 1994 to December 1999. Methods: This is a retrospective study of 72 patients with age between 2 months and 13 years (median 2 years; 25-75% = 1 to 3 years old) exposed to naphazoline (N=48), fenoxazoline (N=18), oxymetazoline (N=5) and tetrahydrozoline (N=1), through oral (N=46), nasal (N=24) or unknown (N=2) routes. Results: Fifty-seven children developed clinical manifestations such as somnolence (N=34/57), sweating (N=20/57), pallor (N=17/ 57), hypothermia (N=16/57), bradycardia (N=13/57), cool extremities (N=9/57), restlessness (N=7/57), tachycardia (N=6/57), vomiting (N= 5/57), irregular respiratory pattern and apnea (N= 5/57), miosis/ mydriasis (N=4/57). Naphazoline was the active ingredient most frequently involved (N=47), followed by phenoxazoline (N=5) and oxymetazoline (N=4). The onset of clinical manifestations was rapid, beginning within 2 hours after exposure in 32/57 children. Only supportive measures were employed, with one child requiring mechanical ventilation after accidental naphazoline ingestion. In most of the children resolution of symptoms occurred within 24 hours (N= 39/57). No deaths were observed. Patients exposed to naphazoline (N=47/48) presented a higher frequency of clinical signs of poisoning in comparison with those exposed to phenoxazoline (N= 5/18) (p < 0.001). There were no significant differences in the frequency of patients who presented clinical manifestations considering the route of exposure [oral (N=34/46), nasal (N=21/24); p=0.31]. Conclusions: Most children (especially those younger than 3 years) exposed to imidazoline derivatives (especially naphazoline) presented early signs of poisoning regardless of the exposure route (nasal or oral). The main signs observed were nervous system, cardiovascular and respiratory depression. Most children showed complete resolution of the symptoms within 24 hours.

show abstract

Reactions Following Use of Nasal Decongestants

Cited by 12 publications

References 0 publications

Imidazoline intoxication in children

Imidazoline intoxication in children

Coma in a neonate following single intranasal dose of xylometazoline

Acute exposure to imidazoline derivatives in children

Contact Info

Product

Resources

About