Volume 29, Issue 163, September 2025

The efficacy of xylometazoline, the risk of rhinitis medicamentosa (RM), and treatment strategies: A review of published studies

Michał Klimas^1♦, Dominik Jucha¹, Martyna Winiarska¹, Dominika Wiśniewska¹, Arkadiusz Jamro², Sabina Krupa Nurcek³

¹Faculty of Medicine, Collegium Medicum, University of Rzeszów, Rzeszów, Poland
²Medical Center ZOZ 2 in Rzeszów, Rzeszów, Poland
³Professor, Faculty of Medicine, Collegium Medicum, University of Rzeszów, Rzeszów, Poland

^♦Corresponding author
Michał Klimas, Faculty of Medicine, Collegium Medicum, University of Rzeszów, Rzeszów, Poland

ABSTRACT

Rhinitis medicamentosa is a chronic condition of the nasal mucosa caused by the overuse of decongestants containing α-mimetic drugs such as xylometazoline or oxymetazoline. This paper focuses on the definition, pathomechanism, and risk factors for RM, based on a review of scientific literature available in medical databases (PubMed/Medline/NIH), which includes results from clinical trials, metaanalyses, and cohort studies on this topic. The pharmacological mechanism of action of α-mimetic drugs and their effect on α-adrenergic receptors, as well as their significance in the development of RM, are discussed. The efficacy of xylometazoline compared to ectoine in the treatment of viral sinusitis, as well as fixed-dose combinations of xylometazoline and nasal steroids in patients with allergic rhinitis, is analyzed. The section devoted to treatment discusses the use of conservative methods (reduction of decongestant dose, discontinuation of medication, or substitution therapy) and invasive interventions (reduction of the inferior turbinates, septoplasty, radioablation). In addition, the review addresses a potential link between RM and a predisposition to psychotropic substance dependence and unipolar affective disorder. The entire review emphasizes the necessity of an individualized approach to the RM treatment process and the need for further research into alternative treatment methods to maximize patients' quality of life.

Keywords: rhinitis medicamentosa; xylometazoline; α-agonists; substance abuse

Medical Science, 2025, 29, e152ms3702

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DOI: https://doi.org/10.54905/disssi.v29i163.e152ms3702

Published: 05 September 2025