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12.2.2 - 12.2.3 Topical nasal decongestants, anti-infective nasal preparations

12.2.2 Topical nasal decongestants

Xylometazoline drops / spray
Ephedrine drops 0.5%, 1% - see note
Ipratropium Bromide (Rinatec)


1. Sympathomimetic nasal decongestants, eg Ephedrine drops and Xylometazoline drop are only suitable for short term use only (up to 7 days only), to avoid the development of tolerance and rebound congestion associated with overuse that can lead to habituation and overuse (rhinitis medicamentosa). Ephedrine drops 0.5% are usually effective (1% also available), but the effect lasts for only a few hours. Xylometazoline is longer acting (8-12 hours) but may cause a rebound effect.

2. Ephedrine may be misused – see DSU

3. Steam inhalations are inexpensive and may be beneficial. They may be more attractive to use if given an aromatic odour, for example with compound benzointincture.

4. Ipratropium Bromide is included for the management of non-allergic rhinitis.


12.2.3 Nasal preparations for infection and epistaxis

Chlorhexidine Hydrochloride 0.1% Neomycin Sulphate 3250 units per gram (Naseptin cream)
Mupirocin nasal ointment - see notes
Bismuth Subnitrate and Iodoform paste.
Bismuth impregnated gauze
Glucose 25% in glycerin nasal drops (for atrophic rhinitis)


1. Mupirocin has good activity against Gram positive organisms, including methicillin-resistant staphylococci. It is expensive and should only be used where recommended by Microbiology.

2. Mupirocin nasal ointment is part of the decolonisation procedure:

3. Neilmed Sinus Rinse is not prescribable in primary care on the NHS, and so should not be prescribed on TTOs or on outpatient prescriptions. However, they may be purchased over-the-counter at pharmacies. Also, advice is given in this patient leaflet on preparing a saline nasal wash in the home.

For link to BNF section: 12.2 Drugs acting on the nose