Version July 2025
Intranasal congestion/infection: Intranasal: Two sprays in each nostril every 4 hours for 3 to 5 days (maximum: 12 sprays in each nostril daily).
Intranasal prophylaxis: Intranasal: Two sprays in each nostril twice daily. Note: The manufacturer's labeling does not specify a duration of use. Some guidelines recommend alternate antimicrobial agents (eg, mupirocin) for 5 to 10 days (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not defined. Systemic reactions are a possibility with high doses.
Cardiovascular: Cardiac arrhythmia, increased blood pressure, palpitations, tachycardia
Central nervous system: Central nervous system depression, dizziness, drowsiness, headache, insomnia, nervousness
Dermatologic: Burning sensation of the nose
Gastrointestinal: Dry mucous membranes (nasal)
Ophthalmic: Blurred vision
Respiratory: Sneezing, stinging sensation of the nose
Hypersensitivity to any component of the formulation or other aminoglycosides; concurrent use with monoamine oxidase (MAO) inhibitors; narrow angle glaucoma; rhinitis sicca; children <2 years
Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Concerns related to adverse effects:
• Local nasal effects: Temporary discomfort such as burning, stinging, sneezing, or an increase in nasal discharge may occur.
• Rebound nasal congestion: Frequent or prolonged use may cause nasal congestion to recur or worsen.
• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.
Disease-related concerns:
• Cardiovascular disease: Use with caution in patients with hypertension or heart disease.
• Diabetes mellitus: Use with caution in patients with diabetes mellitus.
• Thyroid disease: Use with caution in patients with thyroid disease.
• Prostatic hyperplasia/Urinary obstruction: Use with caution in patients with prostatic hyperplasia and/or GU obstruction.
Not available in the US
May be product dependent
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Nasal:
Soframycin: Framycetin 12.5 mg, gramicidin 0.05 mg, and phenylephrine 2.5 mg per mL (15 mL) [contains benzalkonium chloride, polysorbate 80]
Intranasal: To prevent rebound congestion, limit use to 3 to 5 days. Rinse spray tip in hot water after use.
Note: Not approved in the US
Intranasal congestion/infection: Treatment of nasal congestion and/or infection caused by susceptible organisms in acute rhinosinusitis, crusting rhinitis, nasal conditions accompanying the common cold; post-operative care following intranasal or sinus surgery
Intranasal prophylaxis of staphylococcus: Reduction of nasal colonization with staphylococci
Refer to individual components.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Atomoxetine: May increase hypertensive effects of Sympathomimetics. Atomoxetine may increase tachycardic effects of Sympathomimetics. Risk C: Monitor
Atropine (Systemic): May increase hypertensive effects of Alpha1-Agonists. Risk C: Monitor
Bornaprine: Sympathomimetics may increase anticholinergic effects of Bornaprine. Risk C: Monitor
Bromocriptine: May increase hypertensive effects of Alpha1-Agonists. Management: Consider alternatives to this combination when possible. If combined, monitor for hypertension and tachycardia, and do not coadminister these agents for more than 10 days. Risk D: Consider Therapy Modification
Cannabinoid-Containing Products: May increase tachycardic effects of Sympathomimetics. Risk C: Monitor
Cocaine (Topical): May increase hypertensive effects of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. Risk D: Consider Therapy Modification
Dihydralazine: Sympathomimetics may decrease therapeutic effects of Dihydralazine. Risk C: Monitor
Doxofylline: Sympathomimetics may increase adverse/toxic effects of Doxofylline. Risk C: Monitor
Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates): May increase vasoconstricting effects of Alpha1-Agonists. Risk X: Avoid
Esketamine (Injection): May increase adverse/toxic effects of Sympathomimetics. Specifically, the risk for elevated heart rate, hypertension, and arrhythmias may be increased. Risk C: Monitor
Esketamine (Nasal): Decongestants (Nasally Administered) may decrease therapeutic effects of Esketamine (Nasal). Management: Patients who require a nasal decongestant on an esketamine dosing day should administer the nasal decongestant at least 1 hour before esketamine. Risk D: Consider Therapy Modification
FentaNYL: Decongestants may decrease serum concentration of FentaNYL. Risk C: Monitor
Guanethidine: May increase hypertensive effects of Sympathomimetics. Guanethidine may increase arrhythmogenic effects of Sympathomimetics. Risk C: Monitor
Iobenguane Radiopharmaceutical Products: Alpha1-Agonists may decrease therapeutic effects of Iobenguane Radiopharmaceutical Products. Management: Discontinue all drugs that may inhibit or interfere with catecholamine transport or uptake for at least 5 biological half-lives before iobenguane administration. Do not administer these drugs until at least 7 days after each iobenguane dose. Risk X: Avoid
Kratom: May increase adverse/toxic effects of Sympathomimetics. Risk X: Avoid
Levothyroxine: May increase therapeutic effects of Sympathomimetics. Sympathomimetics may increase therapeutic effects of Levothyroxine. Levothyroxine may increase adverse/toxic effects of Sympathomimetics. Specifically, the risk of coronary insufficiency may be increased in patients with coronary artery disease. Risk C: Monitor
Linezolid: May increase hypertensive effects of Sympathomimetics. Management: Consider initial dose reductions of sympathomimetic agents, and closely monitor for enhanced blood pressure elevations, in patients receiving linezolid. Risk D: Consider Therapy Modification
Lisuride: May increase hypertensive effects of Alpha1-Agonists. Risk X: Avoid
Metergoline: May increase adverse/toxic effects of Alpha1-Agonists. Risk C: Monitor
Monoamine Oxidase Inhibitors: May increase hypertensive effects of Alpha1-Agonists. While linezolid is expected to interact via this mechanism, management recommendations differ from other monoamine oxidase inhibitors. Refer to linezolid specific monographs for details. Risk X: Avoid
Pergolide: May increase hypertensive effects of Alpha1-Agonists. Risk C: Monitor
Solriamfetol: Sympathomimetics may increase hypertensive effects of Solriamfetol. Sympathomimetics may increase tachycardic effects of Solriamfetol. Risk C: Monitor
Sympathomimetics: May increase adverse/toxic effects of Sympathomimetics. Risk C: Monitor
Tedizolid: May increase adverse/toxic effects of Sympathomimetics. Specifically, the risk for increased blood pressure and heart rate may be increased. Risk C: Monitor
Tricyclic Antidepressants: May increase therapeutic effects of Alpha1-Agonists. Tricyclic Antidepressants may decrease therapeutic effects of Alpha1-Agonists. Risk C: Monitor
Zavegepant: Decongestants (Nasally Administered) may decrease serum concentration of Zavegepant. Management: Avoid the concurrent administration of intranasal decongestants with zavegepant. If combined use is unavoidable, intranasal decongestants should be administered at least 1 hour after zavegepant administration. Risk D: Consider Therapy Modification
Refer to Phenylephrine (Nasal) monograph.
Refer to Phenylephrine (Nasal) monograph.
Framycetin is a broad spectrum aminoglycoside antibiotic that is usually bactericidal; appears to inhibit protein synthesis in susceptible bacteria by binding ribosomal subunits. Active against many aerobic gram-negative organisms and some aerobic gram-positive organisms.
Gramicidin is a cyclic polypeptide antibiotic that alters the cation content of the bacterial cell wall; primarily effective against gram-positive organisms.
Phenylephrine is a potent, direct-acting alpha-adrenergic agonist with virtually no beta-adrenergic activity; produces local vasoconstriction resulting in nasal decongestion.
