Usage
D-Panthenol + Oxymetazoline is prescribed for the temporary relief of nasal congestion associated with the common cold, sinusitis, hay fever, and other upper respiratory allergies. Dexpanthenol, a derivative of pantothenic acid (vitamin B5), is added to soothe and moisturize irritated nasal mucosa.
- Pharmacological Classification: Decongestant (Oxymetazoline), moisturizer/epithelial protectant (D-Panthenol)
- Mechanism of Action: Oxymetazoline, an alpha-adrenergic agonist, constricts blood vessels in the nasal mucosa, reducing swelling and congestion. Dexpanthenol promotes wound healing and protects the mucosal lining.
Alternate Names
- Xylometazoline hydrochloride + Dexpanthenol
- Septanazal
- Otrivin Plus Dexpanthenol (and other brand names varying by region)
- Nasasyn
- ratioSoft plus Dexpanthenol
How It Works
Pharmacodynamics: Oxymetazoline acts as an alpha-adrenergic agonist, primarily stimulating alpha-2 adrenergic receptors in the nasal mucosa. This leads to vasoconstriction, reducing blood flow and subsequently decreasing nasal congestion. Dexpanthenol, a provitamin of pantothenic acid (vitamin B5), is metabolized to pantothenic acid, which plays a crucial role in maintaining the integrity of the nasal mucosa and promoting tissue regeneration.
Pharmacokinetics: Oxymetazoline exhibits limited systemic absorption following intranasal administration. Dexpanthenol is absorbed through the nasal mucosa and converted to pantothenic acid. Both drugs are primarily excreted via renal and fecal pathways.
Mode of Action: Oxymetazoline binds to alpha-2 adrenergic receptors on vascular smooth muscle in the nasal mucosa. This receptor activation triggers a signaling cascade, leading to vasoconstriction. Dexpanthenol is converted into pantothenic acid, which is essential for coenzyme A synthesis. Coenzyme A is vital for cellular metabolism and is directly involved in wound healing and tissue regeneration within the nasal mucosa.
Receptor Binding, Enzyme Inhibition, or Neurotransmitter Modulation: Oxymetazoline is an alpha-2 adrenergic receptor agonist. No significant enzyme inhibition or neurotransmitter modulation occurs with dexpanthenol.
Elimination Pathways: Both oxymetazoline and dexpanthenol are primarily eliminated through renal (urine) and fecal (stool) routes.
Dosage
Standard Dosage
Adults:
Nasal Spray: 1-2 sprays (containing 0.05% oxymetazoline and 5% dexpanthenol) in each nostril every 10-12 hours.
Nasal Drops: 2-3 drops (0.05% oxymetazoline and 5% dexpanthenol solution) in each nostril every 10-12 hours.
Maximum Dosage: Do not exceed 2 doses in a 24-hour period or use for more than 3-5 days. Prolonged use can lead to rebound congestion.
Children:
Ages 6-11: 2-3 sprays/drops (0.025-0.05% oxymetazoline solution, depending on the product and 5% dexpanthenol) in each nostril every 10-12 hours. Do not exceed 2 doses in a 24-hour period or use for more than 3 days.
Under 6 Years: Use is generally not recommended due to lack of safety and efficacy data.
Special Cases:
Elderly Patients: Use with caution due to potential for cardiovascular side effects. Monitor blood pressure and heart rate.
Patients with Renal Impairment: Use with caution. Dose adjustments may be necessary.
Patients with Hepatic Dysfunction: Use with caution. Dose adjustments may be necessary.
Patients with Comorbid Conditions: Use with caution in patients with hypertension, heart disease, diabetes, hyperthyroidism, glaucoma, and enlarged prostate. Close monitoring is recommended.
Clinical Use Cases
D-Panthenol + Oxymetazoline is not typically used in clinical settings such as intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. Its primary indication is for the short-term relief of nasal congestion related to upper respiratory tract infections or allergies.
Dosage Adjustments
Dose modifications may be necessary based on individual patient response and tolerance. In patients with renal or hepatic impairment, dose adjustments should be considered based on the severity of the dysfunction. Patients with comorbid conditions, particularly cardiovascular diseases or glaucoma, require close monitoring.
Side Effects
Common Side Effects:
- Nasal burning or stinging
- Sneezing
- Dryness of the nasal mucosa
- Runny nose
Rare but Serious Side Effects:
- Tachycardia (rapid heart rate)
- Hypertension (elevated blood pressure)
- Rebound congestion (worsening of congestion after discontinuation)
- Headache
- Dizziness
- Nausea
- Insomnia
- Tremors
- Anxiety
- Irritability
Long-Term Effects:
Rhinitis medicamentosa (rebound congestion) can develop with prolonged use.
Adverse Drug Reactions (ADR):
Severe rebound congestion, allergic reactions, cardiovascular effects (tachycardia, hypertension).
Contraindications
- Hypersensitivity to oxymetazoline or dexpanthenol
- Dry inflammation of the nasal mucosa (rhinitis sicca)
- History of transsphenoidal hypophysectomy or other nasal surgeries exposing the dura mater
- Narrow-angle glaucoma
- Severe cardiovascular disease (e.g., coronary artery disease, uncontrolled hypertension)
- Pheochromocytoma
- Concomitant use or recent use (within 14 days) of MAO inhibitors.
Drug Interactions
- MAO inhibitors: Co-administration can cause a hypertensive crisis.
- Tricyclic antidepressants: May potentiate the pressor effects of oxymetazoline.
- Other sympathomimetics: Additive effects on cardiovascular and central nervous systems.
- Beta-blockers: May diminish the antihypertensive effects of beta-blockers.
Pregnancy and Breastfeeding
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Pregnancy: Use is not recommended due to limited data on safety and potential risks to the fetus.
-
Breastfeeding: Use is not recommended as it is unknown if oxymetazoline is excreted in breast milk and a risk to the infant cannot be excluded.
Drug Profile Summary
- Mechanism of Action: Oxymetazoline: alpha-adrenergic agonist causing vasoconstriction. Dexpanthenol: enhances mucosal healing and protection.
- Side Effects: Common: nasal burning/stinging, sneezing, dryness. Serious: tachycardia, hypertension, rebound congestion.
- Contraindications: Hypersensitivity, rhinitis sicca, recent nasal surgery, narrow-angle glaucoma, severe cardiovascular disease, pheochromocytoma, concomitant MAOI use.
- Drug Interactions: MAOIs, tricyclic antidepressants, other sympathomimetics, beta-blockers.
- Pregnancy & Breastfeeding: Not recommended.
- Dosage: Adults: 1-2 sprays/2-3 drops in each nostril every 10-12 hours for up to 3-5 days. Children (6-11 years): similar dosing but for a maximum of 3 days. Adjust for specific product concentrations. Not recommended for children under 6.
- Monitoring Parameters: Blood pressure, heart rate.
Popular Combinations
While usually administered as a combination of oxymetazoline and D-panthenol, some formulations combine xylometazoline and dexpanthenol. These combinations are designed to provide both decongestion and mucosal protection. There are no widely recognized combinations with other drugs for systemic use.
Precautions
- General Precautions: Assess for underlying medical conditions before prescribing. Short-term use only (3-5 days maximum).
- Specific Populations: Use with caution in pregnant/breastfeeding women, children under 6, elderly patients, and those with cardiovascular/
- Menstruating Individuals: No specific precautions.
- Lifestyle Considerations: Alcohol may worsen some side effects like dizziness. Smoking is generally detrimental to respiratory health. Avoid operating heavy machinery if dizziness occurs.
FAQs (Frequently Asked Questions)
A: Adults: 1-2 sprays or 2-3 drops (0.05% oxymetazoline and 5% dexpanthenol) in each nostril every 10-12 hours, not exceeding 2 doses in 24 hours or 3-5 days of continuous use. Children (6-11): 2-3 sprays/drops (0.025-0.05% oxymetazoline, 5% dexpanthenol), depending on product, every 10-12 hours, not exceeding 2 doses in 24 hours or 3 days of use. Not recommended for children under 6.
Q2: What are the common side effects?
A: Common side effects include nasal burning/stinging, sneezing, dryness, and increased nasal discharge.
Q3: How does rebound congestion occur?
A: Prolonged use (more than 3-5 days) can lead to rebound congestion, where the nasal passages become more congested after the medication wears off, creating a dependence on the spray.
Q4: What are the contraindications for this drug?
A: Contraindications include hypersensitivity to the components, rhinitis sicca, recent nasal surgery exposing the dura mater, narrow-angle glaucoma, severe cardiovascular disease, pheochromocytoma, and concurrent or recent MAOI use.
Q5: Can pregnant or breastfeeding women use this medication?
A: It is generally not recommended for pregnant or breastfeeding women due to limited safety data.
Q6: What should patients with hypertension be aware of when considering this medication?
A: Patients with hypertension should use this medication cautiously as it can elevate blood pressure. Monitoring is essential.
Q7: What is the mechanism of action of D-Panthenol in this combination?
A: Dexpanthenol, converted to pantothenic acid, aids in mucosal healing and protection, mitigating potential irritation caused by oxymetazoline.
Q8: Are there any clinically significant drug interactions?
A: Yes, clinically significant interactions exist with MAOIs (potentially causing a hypertensive crisis), tricyclic antidepressants (potentiating pressor effects), and other sympathomimetics (additive cardiovascular and CNS effects). Beta-blockers’ effects can also be diminished.
Q9: How long should a patient use this medication?
A: Patients should use this medication for a short duration (3-5 days maximum) to avoid the risk of rebound congestion.
