ipratropium bromide + xylometazoline hydrochloride: clinical use

Prescribing considerations

• Confirm that both congestion and rhinorrhoea are associated with a common cold.
• Review cardiovascular disease, hypertension, long-QT syndrome, hyperthyroidism, diabetes, phaeochromocytoma, prostatic enlargement, bladder-neck obstruction, cystic fibrosis, paralytic ileus and susceptibility to nosebleeds.
• Check antidepressants, sympathomimetics, beta-2 agonists and anticholinergic burden.
• Repeated or prolonged xylometazoline exposure can cause tachyphylaxis, rebound congestion and rhinitis medicamentosa.

Contraindications and cautions

• Age under 18 years
• Hypersensitivity to either active ingredient, an excipient, atropine or atropine-like substances
• Glaucoma
• Rhinitis sicca or atrophic rhinitis
• Previous trans-sphenoidal hypophysectomy or other surgery in which the dura mater may have been penetrated

Monitoring

• Nasal dryness, ulceration, irritation and epistaxis
• Recurrent or worsening congestion suggesting overuse
• Blood pressure, palpitations or arrhythmia symptoms in susceptible patients
• Ocular pain or visual disturbance, particularly after eye exposure
• Urinary retention or troublesome anticholinergic effects

Clinical pharmacology

Xylometazoline is an alpha-adrenergic agonist producing local nasal vasoconstriction. Ipratropium is a quaternary antimuscarinic that competitively inhibits cholinergic receptors around the nasal epithelium, reducing glandular secretion; systemic concentrations after nasal administration are low.

Formulation and product differences

• The clear, colourless nasal solution is supplied in a multidose metered bottle.
• Vertical two-finger and lateral thumb-actuated pumps may be supplied; priming and re-priming instructions differ, so follow the relevant leaflet.
• The formulation contains disodium edetate, glycerol, purified water and pH-adjusting agents.

Nasal preparation

Route: Nasal

Strengths: 0.5 mg/mL + 0.6 mg/mL