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Over-the-counter (OTC) nasal decongestants often contain oxymetazoline, an alpha adrenergic 1 and 2 agonist, and are not recommended for children younger than 6 years. Severe toxicity — bradycardia, hypotension, respiratory depression — has been reported from exposure to as little as 1.0–2.5 mL of 0.05% oxymetazoline.
In an in vitro study, investigators measured the volume of oxymetazoline delivered from a single spray of three different brands of OTC 0.05% oxymetazoline nasal decongestants with the container held at a 45° angle. This angle was chosen to simulate administration to a supine child. The mean volumes of 0.05% oxymetazoline decongestant delivered from a single depression of the nasal spray container ranged from 0.66 to 0.90 mL. T…