The Pharmacology of α‐Adrenergic Decongestants

Johnson, David A.; Hricik, Joseph G.

doi:10.1002/j.1875-9114.1993.tb02779.x

Cited by 52 publications

(3 citation statements)

References 16 publications

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“…It enhances the release of noradrenaline from adrenergic termination, immediately relieving the nasal congestion thanks to its vasoconstricting action on the vessels of the nasal mucosa 2 . Because of its adrenergic activity, this drug can also produce adverse effects, like rhinitis medicamentosa, also known as ‘rebound congestion’, which in turn can cause nasal spray addiction to reduce congestion, hypertension, headache and acute depression of the central nervous system with marked sedation 3 . Moreover, cases of ischemic and hemorrhagic stroke secondary to naphazoline use have also been reported, mediated by the alpha-1 and alpha-2 adrenergic vasoconstrictive effect that is also exerted on brain vessels 4,5 .…”

Section: Discussionmentioning

confidence: 99%

Naphazoline abuse: a rare case of myocardial infarction with nonobstructive coronary arteries

Galasso,

Cavallotti,

Giannattasio

et al. 2024

Journal of Cardiovascular Medicine

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Nasal vasoconstrictors are some of the most widely used over-the-counter drugs, considered by many consumers as relatively safe with few significant adverse effects. At recommended dosage, the drug produces local vasoconstriction in nasal mucous membranes. However, the use of such drugs has been linked to cardiovascular adverse effects, including hypertension, arrhythmias, prolongation of the QT interval, and angina pectoris. 1 The various cardiovascular adverse effects may occur with both oral and nasal administration and after a single dose or prolonged treatment, without dose-effect and independently of vascular status and age. 2 Although the effects of ephedrine and pseudoephedrine have been widely studied, the effects of naphazoline are less well known. We describe the case of a previously healthy man who experienced a MINOCA (myocardial infarction with nonobstructive coronary arteries) after abuse of recommended dose of naphazoline. To our knowledge, this is the first time that a strict temporal relation between the occurrence of MINOCA and topical naphazoline abuse is being described.

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Section: Discussionmentioning

confidence: 99%

Naphazoline abuse: a rare case of myocardial infarction with nonobstructive coronary arteries

Galasso,

Cavallotti,

Giannattasio

et al. 2024

Journal of Cardiovascular Medicine

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“…All act by direct a-adrenergic receptor activation in vascular smooth muscle, causing vasoconstriction with consequent reduction in mucosal blood flow and engorgement (2,11) . The exception is cocaine, which acts by catecholamine reuptake inhibition to achieve the same effect (Figure 1).…”

Section: Decongestantsmentioning

confidence: 99%

Topical anaesthesia and decongestion in rhinology

Hale,

Kim,

Douglas

2023

Rhin

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Topical anaesthesia and decongestion of the sinonasal mucosa are used commonly in rhinology practice to facilitate nasal endoscopy, as well as debridement and biopsies. Topical agents used for sinonasal anaesthesia include lignocaine, tetracaine and cocaine. Unlike lignocaine and tetracaine, cocaine also has a decongestant effect. Phenylephrine, oxymetazoline, xylometazoline or adrenaline are usually added to lignocaine and tetracaine to provide decongestion. Several studies have been performed seeking to identify the optimal nasal preparation for nasal endoscopy in the clinic setting. However, there remains no clear consensus in the literature resulting in ongoing wide variation between anaesthetic-decongestant preparations used in clinical practice. Indeed, some authors have argued that no anaesthetic is required at all for flexible nasendoscopy despite the apparent consensus that nasal instrumentation is generally uncomfortable, inferred by the persistence of ongoing research in this area. This review provides a practical summary of local anaesthetic and decongestant pharmacology as it relates to rhinologic practice and summarises the literature to date, with the goal of identifying current gaps in the literature and guiding future research efforts.

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“…Nasal decongestants, mainly sympathomimetics, constrict nasal blood vessels; 56 antitussives centrally or topically reduce the frequency and/or intensity of coughs and include opium alkaloids and derivatives; 57 expectorants increase the production of fluid in the lungs to reduce the viscosity of mucus, whilst mucolytics break down disulfide bonds in the mucus. 55 First-generation antihistamines block both histaminic and muscarinic receptors and, in contrast to second-generation antihistamines, pass the blood-brain barrier, exerting their effects on the cough centre located in the brainstem.…”

Section: Pathophysiology and Current Management Of Murtismentioning

confidence: 99%

The treatment of mild upper respiratory tract infections – a position paper with recommendations for best practice

Smith¹,

Kardos²,

Pfaar³

et al. 2023

DIC

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Following the waning severity of COVID-19 due to vaccination and the development of immunity, the current variants of SARS-CoV-2 often lead to mild upper respiratory tract infections (MURTIs), suggesting it is an appropriate time to review the pathogenesis and treatment of such illnesses. The present article reviews the diverse causes of MURTIs and the mechanisms leading to symptomatic illness. Different symptoms of MURTIs develop in a staggered manner and require targeted symptomatic treatment. A wide variety of remedies for home treatment is available, including over-the-counter drugs and plant-derived substances. Recent pharmacological research has increased the understanding of molecular effects, and clinical studies have shown the efficacy of certain herbal remedies. However, the use of subjective endpoints in these clinical studies may suggest limited validity of the results. In this position paper, the importance of patient-centric outcomes, including a subjective perception of improved well-being, is emphasized. A best practice approach for the management of MURTIs, in which pharmacists and physicians create an improved multi-professional healthcare setting and provide healthcare education to patients, is proposed. Pharmacists act as first-line consultants and provide patients with remedies, considering the individual patient's preferences towards chemical or plant-derived drugs and providing advice for self-monitoring. Physicians act as second-line consultants if symptoms worsen and subsequently initiate appropriate therapies. In conclusion, general awareness of MURTIs should be increased amongst medical professionals and patients, thus improving their management.

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The Pharmacology of α‐Adrenergic Decongestants

Cited by 52 publications

References 16 publications

Naphazoline abuse: a rare case of myocardial infarction with nonobstructive coronary arteries

Naphazoline abuse: a rare case of myocardial infarction with nonobstructive coronary arteries

Topical anaesthesia and decongestion in rhinology

The treatment of mild upper respiratory tract infections – a position paper with recommendations for best practice

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