BNF for Children 2011-2012

BNFC 2011–2012 12.2.2 Topical nasal decongestants 541Indication and doseTreatment of allergic rhinitisChild 2–6 years 55 micrograms (1 spray) intoeach nostril once daily; max. duration of treatment3 monthsChild 6–12 years 55 micrograms (1 spray) intoeach nostril once daily, increased if necessary to110 micrograms (2 sprays) into each nostril oncedaily; when control achieved, reduce to 55 micrograms(1 spray) into each nostril once daily; max.duration of treatment 3 monthsChild 12–18 years 110 micrograms (2 sprays)into each nostril once daily; when controlachieved, reduce to 55 micrograms (1 spray) intoeach nostril once dailyNasacort c (Sanofi-Aventis) AAqueous nasal spray, triamcinolone acetonide55 micrograms/metered spray. Net price 120-sprayunit = £7.39Excipients include benzalkonium chloride, disodium edetate, polysorbate80CromoglicateSODIUM CROMOGLICATE(Sodium Cromoglycate)Side-effects local irritation; rarely transient bronchospasmLicensed use licensed for use in children (age rangenot specified by manufacturers)Indication and doseProphylaxis of allergic rhinitis for dose, see underpreparationsRynacrom c (Sanofi-Aventis)4% aqueous nasal spray, sodium cromoglicate 4%(5.2 mg/spray). Net price 22 mL (150-spray unit withpump) = £17.07Excipients include benzalkonium chloride, disodium edetateDosenose, 1 spray into each nostril 2–4 times dailyVividrin c (Pharma-Global)Nasal spray, sodium cromoglicate 2%. Net price15 mL (approx. 110-spray unit) = £11.60Excipients include benzalkonium chloride, edetic acid, polysorbate 80DoseNose, 1 spray into each nostril 4–6 times daily12.2.2 Topical nasaldecongestantsSodium chloride 0.9% given as nasal drops or spraymay relieve nasal congestion by helping to liquefymucous secretions in children with rhinitis. In infants,1–2 drops of sodium chloride 0.9% solution in eachnostril before feeds will help relieve congestion andallow more effective suckling.Inhalation of warm moist air is useful in the treatmentof symptoms of acute nasal congestion in infants andchildren, but the use of boiling water for steam inhalationis dangerous for children and should not be recommended.Volatile substances (section 3.8) such asmenthol and eucalyptus may encourage inhalation ofwarm moist air.Topical nasal decongestants containing sympathomimeticscan cause rebound congestion (rhinitismedicamentosa) following prolonged use (more than 7days), and are therefore of limited value in the treatmentof nasal congestion.Ephedrine nasal drops is the least likely of the sympathomimeticnasal decongestants to cause reboundcongestion and can provide relief for several hours.The more potent sympathomimetic drugs oxymetazolineand xylometazoline are more likely to causea rebound effect.The CHM/MHRA has stated that non-prescriptioncough and cold medicines containing ephedrine, oxymetazoline,or xylometazoline can be considered for upto 5 days’ treatment in children aged 6–12 years afterbasic principles of best care have been tried; thesemedicines should not be used in children under 6years of age (section 3.9.1).Non-allergic watery rhinorrhoea often responds well totreatment with the antimuscarinic ipratropiumbromide.Recurrent, persistent bleeding may respond to the useof a sympathomimetic nasal spray; if infection is present,chlorhexidine and neomycin (Naseptin c ) cream(section 12.2.3) may be effective.Systemic nasal decongestants—see section 3.10.Sinusitis and oral pain Sinusitis affecting the maxillaryantrum can cause pain in the upper jaw. Wherethis is associated with blockage of the opening from thesinus into the nasal cavity, it may be helpful to relievethe congestion with inhalation of warm moist air (section3.8) or with ephedrine nasal drops (see above).For antibacterial treatment of sinusitis, see Table 1,section 5.1.SympathomimeticsEPHEDRINE HYDROCHLORIDECautions see notes above; also avoid excessive orprolonged use; hyperthyroidism; diabetes mellitus;cardiovascular disease (including hypertension);interactions: Appendix 1 (sympathomimetics)Pregnancy avoidBreast-feeding avoidSide-effects local irritation, nausea, headache; afterexcessive use tolerance with diminished effect,rebound congestion; cardiovascular effects alsoreportedLicensed use not licensed for use in children under12 yearsIndication and doseNasal congestion (see notes above)Child 12–18 years instil 1–2 drops (0.5%strength) into each nostril up to 3 or 4 times dailywhen required; max. duration 7 days12 Ear, nose, and oropharynx