Xylometazoline + Ipratropium nasal spray
Xylometazoline + ipratropium nasal spray is a combination nasal spray containing two active substances: ipratropium bromide, which helps with the runny nose, and xylometazoline hydrochloride, which has a decongesting effect. Xylometazoline + Ipratropium nasal spray is used for Nasal congestion with runny nose in common colds.
Pronunciation: Not established by the supplied sources..
- Generic name
- xylometazoline hydrochloride / ipratropium bromide
- Brand names
- Otrivine Extra Dual Relief, Otrivin Plus
- Drug class
- Combination nasal decongestant (sympathomimetic) and anticholinergic (antimuscarinic)
- Form
- Nasal spray, solution (metered-dose pump with protective cap; 10 ml bottle contains approximately 70 puffs)
- Route
- Nasal (intranasal spray)
- Legal status
- Not established by the supplied UK sources; refer to the current UK product information and pharmacist.
Availability and supply rules vary by country
Trade names by country:
Australia: · Full directory
What xylometazoline hydrochloride / ipratropium bromide is and how it works
Xylometazoline + ipratropium nasal spray is a combination nasal spray containing two active substances: ipratropium bromide, which helps with the runny nose, and xylometazoline hydrochloride, which has a decongesting effect. It is used for the symptomatic treatment of nasal congestion and rhinorrhoea (runny nose) in connection with common colds. (1) (2)
The effect occurs within 5-15 minutes. This medicine should not be used for more than 7 consecutive days. It is not recommended for children and adolescents below 18 years of age. Use the smallest dose needed for the shortest time needed. You must talk to a doctor or pharmacist if you do not feel better or if you feel worse.
Mechanism of action: how xylometazoline hydrochloride / ipratropium bromide works
Not established by the supplied sources beyond the quoted section heading. The product is a combination of xylometazoline hydrochloride (a decongestant) and ipratropium bromide (an anticholinergic that helps with runny nose). (1)
What is Xylometazoline hydrochloride / ipratropium bromide used for?
Nasal congestion with runny nose in common colds
Symptomatic treatment of nasal congestion and rhinorrhoea in connection with common colds. In the UK it is intended for adults; it is not recommended for children and adolescents below 18 years of age due to lack of sufficient documentation. (1) (2)
Before taking xylometazoline hydrochloride / ipratropium bromide
Do not take / not appropriate for
- Do not use in children below 18 years of age, as adequate information on safety and efficacy is not available. (all patients under 18) (1) (2)
- Do not use if you are allergic to xylometazoline hydrochloride or ipratropium bromide or any of the other ingredients (disodium edetate, glycerol (85%), purified water, sodium hydroxide and hydrochloric acid). (all products) (1) (2)
- Do not use if you are allergic to atropine or atropine-like substances such as hyoscyamine and scopolamine. (all products) (1) (2)
- Do not use after surgical operations where the dura mater may have been penetrated, e.g. trans-sphenoidal hypophysectomy or other trans-nasal operations, including brain surgery carried out through the nose or mouth or pituitary gland removal carried out through the nose. (all products) (1) (2)
- Do not use if you suffer from glaucoma (increased pressure in the eye). (all products) (1) (2)
- Do not use if you have a very dry nose (inflammatory nasal dryness, rhinitis sicca or atrophic rhinitis). (all products) (1) (2)
Tell your clinician about
- Heart disease, including long QT syndrome, and raised blood pressure.
- Diabetes mellitus and an overactive thyroid gland (hyperthyroidism).
- Difficulty in urinating and/or an enlarged prostate gland, or bladder-bar stenosis.
- Narrow-angle (angle closure) glaucoma, or a predisposition to it.
- A tendency to have nosebleeds (e.g. in the elderly).
- Obstruction of the intestine (paralytic ileus).
- Cystic fibrosis.
- Phaeochromocytoma, or a particular sensitivity to adrenaline and nor-adrenaline.
- Sensitivity to adrenergic substances, which may give symptoms such as sleeping disturbances, dizziness, tremor, cardiac arrhythmias or elevated blood pressure.
- Monoamine oxidase inhibitor (MAOI) treatment, or having taken them in the last two weeks.
- Tri-cyclic and tetra-cyclic antidepressant treatment, or having taken them in the last two weeks.
- Beta 2-agonist treatment (e.g. for asthma or COPD) — concomitant use with ipratropium may cause an increased risk of acute glaucoma in patients with a history of angle closure glaucoma.
- Other anticholinergic medicines, such as medicines used for travel sickness or for gut disorders (particularly those for abnormal motility).
- Pregnancy, plans for pregnancy, or breastfeeding.
Xylometazoline hydrochloride / ipratropium bromide dosage and how to take it
- Adults: 1 puff in each nostril up to 3 times daily. At least 6 hours should elapse between two doses. Do not exceed 3 applications daily into each nostril.
- The treatment duration should not exceed 7 days. Do not exceed the stated dose.
- The lowest dose necessary to achieve efficacy should be used for the shortest duration of treatment. It is recommended to stop treatment when the symptoms have diminished, even before the maximum duration of treatment of 7 days, in order to minimise the risk of adverse reactions.
- Do not use this medicine for more than 7 consecutive days. Prolonged or excessive use may cause the nasal stuffiness to return or worsen, and swelling of the nasal mucosa (rebound effect / rhinitis medicamentosa).
- If symptoms get worse or do not improve after 7 days, consult a doctor.
- If you think the effect of this medicine is too strong or too weak, consult your doctor or pharmacist.
- To avoid possible spread of infection, the spray should only be used by one person.
- Avoid spraying in or around the eyes. Be careful not to spray in the eyes.
- The effect occurs within 5-15 minutes.
Procedures and treatment changes
Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1) (2) (3)
Missed dose
If you forget to use this medicine, do not take an extra dose to make up for a forgotten one. Ask your doctor or pharmacist if you are unsure.
Overdose
If you, or someone else, have used or swallowed more of this medicine than you should, contact your doctor, hospital or emergency room straight away for assessment of the risk, and take the leaflet, bottle or pack with you. This is particularly important for children, who are more likely to develop adverse effects than adults. Symptoms of overdose include severe dizziness, sweating, severely lowered body temperature, headache, slow or rapid heartbeat, impaired breathing, coma, convulsions, and high blood pressure that may be followed by low blood pressure; other symptoms may be dry mouth, difficulty focusing the eyes and hallucinations. Treatment is given under medical supervision and includes observation for at least 6 hours. (1) (2)
Xylometazoline hydrochloride / ipratropium bromide side effects
Like all medicines, this medicine can cause side effects, although not everybody gets them. The most commonly reported adverse reactions are epistaxis (nose bleeding), occurring in 14.8%, and nasal dryness, occurring in 11.3% of patients. Many of the adverse events reported are also symptoms of common cold.
Nose bleeding (epistaxis)
What to notice: Bleeding from the nose. This is a very common side effect (may affect more than 1 in 10 people).
What to do: Talk to your doctor or pharmacist if it occurs or is troublesome. (1) (2)
Nasal dryness, nasal discomfort, congestion of the nose, pain in the nose
What to notice: Dryness, discomfort, congestion or pain in the nose. Common (may affect up to 1 in 10 people).
What to do: Talk to your doctor or pharmacist if persistent or troublesome. (1) (2)
Dry mouth, dry or irritated throat, altered taste sensation, headache, dizziness, local burning sensation, nausea
What to notice: Common side effects (may affect up to 1 in 10 people).
What to do: Talk to your doctor or pharmacist if persistent or troublesome. (1) (2)
Uncommon effects including nasal ulcer, sneezing, throat pain, cough, hoarseness, stomach upsets, altered smell sensation, shakiness, discomfort, tiredness, sleeplessness, eye irritation, dry eyes, swollen eyes, red eyes, palpitations and increased heart rate
What to notice: Uncommon (may affect up to 1 in 100 people).
What to do: Talk to your doctor or pharmacist if these occur or are troublesome. (1) (2)
Runny nose
What to notice: Rare (may affect up to 1 in 1,000 people).
What to do: Talk to your doctor or pharmacist if it occurs or is troublesome. (1) (2)
Reaction to the medicine such as swelling, rash, itching; visual impairment
What to notice: Very rare (may affect up to 1 in 10,000 people).
What to do: Talk to your doctor or pharmacist if these occur. (1) (2)
Frequency not known effects: hives; discomfort around the nose; difficulty swallowing, sudden spasm of throat muscle, swelling of throat; discomfort in the chest, thirst; irregular heart rhythm; difficulties focusing with the eyes, dilation of the pupils, flashing lights, increased eye pressure, glaucoma, blurred vision, haloes around bright lights and eye pain; difficulties emptying the bladder
What to notice: Frequency cannot be estimated from the available data.
What to do: Talk to your doctor or pharmacist if these occur. (1) (2)
Palpitations and increased heart rate
What to notice: Palpitations and increased heart rate (affects less than 1 in 100 people).
What to do: Seek medical help immediately. Let the clinician you see advise on whether to continue or stop the medicine. (2)
Signs of an allergic reaction
What to notice: Difficulty breathing, speaking or swallowing; swelling of the face, lips, tongue or throat; severe itching of the skin, with a red rash or raised bumps (frequency not known, cannot be estimated from available data). Immediate hypersensitivity including urticaria, angioedema, rash, bronchospasm, pharyngeal oedema and anaphylaxis may occur.
What to do: Seek medical help immediately. Let the clinician you see advise on whether to continue or stop the medicine. (1) (2)
Disturbances of vision or eye problems
What to notice: Disturbances of vision (including blurred vision, worsening of glaucoma or increased pressure in the eye), rainbow-coloured circles/haloes around bright lights and/or eye pain (frequency not known, cannot be estimated from available data).
What to do: Seek medical help immediately. Let the clinician you see advise on whether to continue or stop the medicine. (2)
Serious warnings
Immediate hypersensitivity / severe allergic reaction — emergency
Symptoms: Itchy red rash with raised inflammation of the skin (hives), difficulty breathing or speaking, difficulty swallowing due to swelling of the lips, face or throat; these symptoms may appear individually or all combined as a severe allergic reaction. Angioedema, rash, pruritus, bronchospasm, pharyngeal oedema and anaphylaxis may occur.
Action: Seek medical help immediately. This is an emergency — call emergency services as appropriate. Let the clinician you see advise on whether to continue or stop the medicine. (1) (2)
Palpitations and increased heart rate — urgent
Symptoms: Palpitations and increased heart rate.
Action: Seek medical help immediately. Let the clinician you see advise on whether to continue or stop the medicine. (2)
Visual disturbance, worsening of glaucoma or raised eye pressure — urgent
Symptoms: Disturbances of vision including blurred vision, worsening of glaucoma or increased pressure in the eye, rainbow-coloured circles/haloes around bright lights, and/or eye pain. If the product gets in contact with the eyes, temporary blurred vision, irritation, pain and red eyes may occur, and aggravation of angle closure glaucoma may develop.
Action: Seek medical help immediately. If the product gets in direct contact with the eyes, rinse the eyes with cold water and contact a doctor if you experience pain in the eyes or blurred vision. Let the clinician you see advise on whether to continue or stop the medicine. (1) (2)
Rebound nasal congestion (rhinitis medicamentosa) with prolonged use — precaution
Symptoms: Swelling of the nasal mucosa and hypersecretion because of increased sensitivity in the cells, causing nasal stuffiness to return or worsen.
Action: The treatment duration should not exceed 7 days. Stop treatment as soon as symptoms improve, even before 7 days. Talk to a doctor or pharmacist if symptoms get worse or do not improve after 7 days. (1) (2)
Interactions
| Medicine or test | Effect | Action |
|---|---|---|
| Monoamine oxidase inhibitors (MAOIs) | Concomitant use, or use within the last 2 weeks, of sympathomimetic preparations may induce severely elevated blood pressure and is therefore not recommended. Sympathomimetics release catecholamine, resulting in a major release of noradrenaline with a vasoconstrictive effect and elevated blood pressure. | In critical cases of elevated blood pressure, treatment with this product should be discontinued and the elevated blood pressure treated; consult a doctor before using this medicine if you take or have taken MAOIs in the last two weeks. (1) (2) |
| Tri-cyclic and tetra-cyclic antidepressants | Concomitant use, or use within the last 2 weeks, of sympathomimetic preparations may induce severely elevated blood pressure and is therefore not recommended. | Consult a doctor before using this medicine if you take or have taken these medicines in the last two weeks. (1) (2) |
| Beta 2-agonists | Concomitant use with ipratropium may cause an increased risk of acute glaucoma in patients with a history of angle closure glaucoma. There have been isolated reports of ocular complications (mydriasis, increased intraocular pressure, narrow-angle glaucoma and eye pain) when aerosolised ipratropium bromide, alone or in combination with an adrenergic beta 2-agonist, has come into contact with the eyes. | Consult a doctor before using this medicine if you use beta 2-agonists such as for asthma or COPD. (1) (2) |
| Other anticholinergic medicines | Concomitant administration of other anticholinergic drugs may enhance the anticholinergic effect. Examples include medicines used for travel sickness and medicines used for gut disorders (particularly those for abnormal motility). | Consult a doctor before using this medicine if you use any of these medicines. (1) (2) |
| Interaction study limitation | The interactions above have been studied individually for both active substances, not in combination. No formal interaction studies with other substances have been performed. | Tell your doctor or pharmacist about all medicines you take, have recently taken or might take. (1) |
Pregnancy, breastfeeding, kidney/liver function, age
Children and adolescents
This medicine is not recommended for use in children and adolescents below 18 years of age due to lack of sufficient documentation. It should not be given to children under the age of 18. Small children are more sensitive to xylometazoline toxicity than adults. (1) (2)
Elderly
There is only limited experience of use in patients above 70 years of age. It is not recommended for use in the elderly above 70 years of age, as adequate information on safety and efficacy is not available. Caution is recommended in patients predisposed to epistaxis, e.g. the elderly. (1) (2)
Pregnancy
There are insufficient data on the use of this product in pregnant women. Animal studies are insufficient with respect to reproductive toxicity. It is advisable not to take this product during pregnancy unless your doctor recommends it. Xylometazoline: the available data indicate the potential for a systemic vasoconstrictor effect, and it is advisable not to take xylometazoline during pregnancy. Ipratropium: the clinical safety of ipratropium bromide during human pregnancy has not been established; non-clinical data have demonstrated embryotoxicity following administration to rabbits via inhalation at doses greater than the clinical dose. (1) (2)
Breastfeeding
There are insufficient data to determine if this product is excreted in human breast milk. This product should only be used while breastfeeding under medical advice, and only if the expected benefit to the mother is greater than the possible risk to the infant; the lowest effective dose and duration of treatment should be considered. There is no evidence of any adverse effect of xylometazoline on the breast-fed infant, but it is unknown whether xylometazoline is excreted in breast milk. It is not known whether ipratropium bromide is excreted in breast milk. (1) (2)
Fertility
There are insufficient data on the impact of this product on fertility. There are no adequate data for the effects of xylometazoline hydrochloride on fertility and no animal studies are available. Non-clinical data have demonstrated no evidence of impaired fertility following oral administration of ipratropium bromide to rats at doses greater than the clinical dose. (1)
Monitoring
Before starting
- Confirm the patient is an adult (18 years or older) and that this medicine is appropriate for the symptoms; it is not recommended in children and adolescents below 18 years or in the elderly above 70 years.
- Assess for contraindications: hypersensitivity to the active substances, excipients, atropine or atropine-like substances; recent trans-nasal or trans-sphenoidal surgery; glaucoma; rhinitis sicca or atrophic rhinitis.
- Assess for warnings and precautions: sensitivity to adrenergic substances, hypertension, cardiovascular disease (including long QT syndrome), hyperthyroidism, diabetes mellitus, prostatic hypertrophy, bladder-bar stenosis, phaeochromocytoma, cystic fibrosis, MAOI or tri/tetra-cyclic antidepressant use in the last two weeks, beta 2-agonist treatment, and predisposition to angle closure glaucoma, epistaxis or paralytic ileus.
- Review all concomitant medicines, including other anticholinergic medicines, travel-sickness medicines and gut-disorder medicines.
- Confirm pregnancy or breastfeeding status and give appropriate advice.
During treatment
- Advise use of the lowest effective dose for the shortest duration; treatment duration should not exceed 7 days.
- Advise stopping treatment when symptoms have diminished, even before 7 days, to minimise the risk of adverse reactions.
- Advise the patient to consult a doctor if symptoms worsen or do not improve after 7 days.
- Watch for adverse reactions including nose bleeding, nasal dryness, hypersensitivity, palpitations/tachycardia and visual disturbances.
- Reinforce that patients should avoid spraying in or around the eyes and should rinse with cold water and contact a doctor if the product gets in the eyes.
- Advise patients affected by visual disturbances, dizziness or fatigue to avoid driving, operating machinery or taking part in activities where these symptoms may put themselves or others at risk.
Storage
Keep this medicine out of the sight and reach of children. Do not use this medicine after the expiry date stated on the label after EXP; the expiry date refers to the last day of that month and applies even if the packaging has been opened. Do not store above 25°C. Do not throw away any medicines via wastewater or household waste — ask your pharmacist how to dispose of medicines you no longer use.
Professional information
Clinician-facing context only. Use the current UK Summary of Product Characteristics and patient leaflet for the exact product.
UK
Indication: Symptomatic treatment of nasal congestion and rhinorrhoea in connection with common colds (adults)
Dose summary: Adults: 1 puff in each nostril up to 3 times daily. At least 6 hours should elapse between two doses. Do not exceed 3 applications daily into each nostril. The treatment duration should not exceed 7 days. Use the lowest dose necessary to achieve efficacy for the shortest duration; stop treatment when symptoms have diminished, even before 7 days. Not recommended for children and adolescents below 18 years due to lack of sufficient documentation. Limited experience in patients above 70 years.
Renal context: Not established by the supplied sources. (1) (2)
Hepatic guidance
Not established by the supplied sources.
Overdose note
See overdose section. Xylometazoline overdose may cause severe dizziness, perspiration, severely lowered body temperature, headache, bradycardia, hypertension, respiratory depression, coma and convulsions; hypertension may be followed by hypotension. Small children are more sensitive to toxicity. Acute overdose with intranasal ipratropium bromide is unlikely because absorption is very small; symptoms would be dry mouth, accommodation difficulties and tachycardia. Treatment is symptomatic; considerable overdose may cause anticholinergic CNS symptoms such as hallucinations, treated with cholinesterase inhibitors. Supportive measures should be initiated, with observation for at least 6 hours; in severe overdose with cardiac arrest, resuscitation should be continued for at least 1 hour. Further management as clinically indicated or as recommended by national poison centres. (1)
Frequently asked questions
What is this nasal spray used for?
It is used for the symptomatic treatment of nasal congestion with runny nose (rhinorrhoea) in connection with common colds. Ipratropium bromide helps with the runny nose and xylometazoline hydrochloride has a decongesting effect. (1) (2)
How long can I use it for?
Do not use this medicine for more than 7 consecutive days. Prolonged or excessive use may cause nasal stuffiness to return or worsen and swelling of the nasal mucosa. It is recommended that you stop treatment as soon as your symptoms improve, even if this is sooner than 7 days, to minimise the risk of adverse reactions. If symptoms get worse or do not improve after 7 days, consult a doctor. (1) (2)
How quickly does it work?
The effect occurs within 5-15 minutes. (2)
Can children use it?
No. It is not recommended for use in children and adolescents below 18 years of age, as adequate information on safety and efficacy is not available. (1) (2)
What should I do if I forget a dose?
Do not take an extra dose to make up for a forgotten one. Ask your doctor or pharmacist if you are unsure. (2)
What should I do if it gets in my eyes?
Avoid spraying in or around the eyes. If it gets into the eyes, thoroughly rinse the eyes with cold water. Your vision may become temporarily blurred and the eye irritated, painful and red. Contact your doctor for advice. Worsening of narrow-angle glaucoma may also occur. (1) (2)
Can I use it during pregnancy or breastfeeding?
It should not be used during pregnancy unless your doctor recommends it. During breastfeeding it should not be used unless your doctor decides the advantages outweigh the potential risks to the infant. Ask your doctor or pharmacist for advice before taking this medicine. (1) (2)
What is the mechanism of action of xylometazoline hydrochloride / ipratropium bromide?
Not established by the supplied sources beyond the quoted section heading. The product is a combination of xylometazoline hydrochloride (a decongestant) and ipratropium bromide (an anticholinergic that helps with runny nose). (1)
References
- Otrivine Extra Dual Relief 0.5 mg/ml + 0.6 mg/ml nasal spray — Summary of Product Characteristicselectronic Medicines Compendium (UK) · United Kingdom · accessed 2026-10-13 · source 1
- Otrivine Extra Dual Relief Nasal spray — Package leaflet: Information for the userelectronic Medicines Compendium (UK) · United Kingdom · dated 2025-07 · accessed 2026-10-13 · source 2
- Otrivin Plus product pagehealthdirect Australia · Australia · accessed 2026-10-13 · source 3
Brand names by country
Single-ingredient xylometazoline hydrochloride / ipratropium bromide names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.