Vicks Sinex

Document: Vicks Sinex nasal spray, solution ENG SmPC change

1. NAME OF THE MEDICINAL PRODUCT

Vicks Sinex, 0.5 mg/ml, nasal spray solution

2. QUALITATIVE AND QUANTITATIVE COMPOSITION

Oxymetazoline hydrochloride 0.5 mg/ml

1 spray (50l) contains approximately 25 micrograms oxymetazoline hydrochloride.

Excipients with known effect: Benzalkonium chloride 0.2 mg/ml

For the full list of excipients, see section 6.1.

3. PHARMACEUTICAL form

Nasal spray, solution

A clear liquid preparation

4. Clinical particulars

4.1 Therapeutic indications

Symptomatic treatment of nasal congestion.

4.2 Posology and method of administration

Posology

Adults and children over 10 years: 1-2 sprays up each nostril maximum 2-3 times daily.

Children aged 6-10 years: 1 spray up each nostril maximum 2-3 times daily.

The preparation should not be used for more than 5 – 7 days in a row.

Method of administration: nasal use.

4.3 Contraindications

Vicks Sinex should not be used:

in case of hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
by patients taking monoamine oxidase inhibitors (MAOIs) or in patients who have taken MAOIs in the previous two weeks.
in patients with narrow-angle glaucoma. Vicks Sinex should not be used by patients after trans-sphenoidal hypophysectomy.
by children under 6 years of age.
where there is inflammation of the skin and mucosa of the nasal vestibule and encrustation (rhinitis sicca).
by patients with acute coronary disease or cardiac asthma.

4.4 Special warnings and precautions for use

Caution should be exercised in case of hypertension, cardiac diseases including angina, hyperthyroidism, diabetes mellitus and prostatic hypertrophy.
Do not exceed the recommended dose.
If symptoms worsen or do not improve after 3 days, physician should re-evaluate clinical situation.
Vicks Sinex should be used for a maximum of 7 consecutive days to avoid rebound-effect and drug-induced rhinitis.
The preservative (benzalkonium chloride) contained in Vicks Sinex can cause swelling of the nasal mucosa, especially during long-term use. If such a reaction (persistent nasal congestion) is suspected, a product for nasal administration which contains no preservative should be used if possible. If such products for nasal administration are not available without preservative, the use of another dosage form should be considered.

4.5 Interaction with other medicinal products and other forms of interaction

This product should not be used in combination with MAOIs, or for up to 2 weeks after taking MAOIs as there is a risk of interactions leading to hypertension.

This product is known to interact with tricyclic antidepressants with a possible increased risk of hypertension and arrhythmias.

The effects of beta-blockers or other antihypertensive drugs e.g. methyl dopa, Bethanidine, Debrisoquine and Guanethidine may be antagonised.

Possible additive cardiovascular toxicity may occur when sympathomimetics are given with anti-parkinsonian drugs such as bromocriptine.

4.6 Fertility, pregnancy and lactation

Pregnancy

For oxymetazoline no clinical data on exposed pregnancies are available.

Animal studies do not indicate direct or indirect harmful effects with respect to pregnancy, embryonal/foetal development, parturition or postnatal development.

Breast-feeding

It is unknown whether oxymetazoline hydrochloride is excreted into breast milk.

The recommended dose should not be exceeded because overdosing can decrease placental blood flow and reduce milk production.

Caution should be exercised during pregnancy and lactation as oxymetazoline may be systemically absorbed.

4.7 Effects on ability to drive and use machines

Vicks Sinex has no influence on the ability to drive and use machines.

Undesirable effects

Within the system organ classes, adverse reactions are listed under headings of frequency (number of patients expected to experience the reaction), using the following categories: very common (≥1/10); common (≥1/100 to <1/10); uncommon (≥1/1000 to <1/100); rare (≥1/10,000 to <1/1,000); very rare (<1/10,000) and not known (cannot be estimated from the available data).

System Organ Class	Adverse Drug Reaction
Respiratory, thoracic and mediastinal disorders
Uncommon (1/100 - 1/1000):	sneezing, dryness and irritation in nose, mouth and throat
Nervous system disorders
Rare (<1/1000):	anxiety, sedative effect, irritability, sleep disorders in children
Cardiac and Vascular disorders
Rare (<1/1000):	tachycardia, palpitations, increased blood pressure
General disorders and administration site conditions
Rare (<1/1000):	reactive hyperaemia, headache, nausea, exanthema and visual disturbances

Use for longer than recommended may lead to reduced effect and/or rebound congestion.

Reporting of suspected adverse reactions

Reporting of suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the national reporting system listed in Appendix V*.

4.9 Overdose

Symptoms of overdose:

Symptoms of moderate or severe overdose can be mydriasis, nausea, cyanosis, fever, spasms, tachycardia, cardiac arrhythmia, cardiac arrest, hypertension, oedema of the lungs, dyspnoea, psychic disturbance. The inhibition of functions of the central nervous system such as somnolence, lowering of the body temperature, bradycardia, shocklike hypotension, apnoea and loss of consciousness is also possible.

Treatment of overdose:

Symptomatic treatment of overdose is required. A nonselective alpha-lytic such as phentolamine may be administered to depress the increased blood pressure, Intubation and artificial respiration may be necessary in serious cases.

In the case of moderate or severe inadvertent oral consumption, the administration of activated carbon (absorbent) and sodium sulphate (laxative) or perhaps gastro-lavage in the case of large amounts should be undertaken.

Further treatment is supportive and symptomatic.

Vasopressor drugs are contraindicated.

5. PHARMACOLOGICAL PROPERTIES

5.1 Pharmacodynamic properties

Pharmacotherapeutic group: Sympathomimetics, plain.

ATC code: R01AA05

Mechanism of action

Oxymetazoline is a direct-acting sympathomimetic amine. It acts on alpha-adrenergic receptors in the vessels of the nasal mucosa producing vasoconstriction and decongestion.

Onset of action is within minutes and lasts 6-8 hours.

5.2 Pharmacokinetic properties

Absorption

With local use on the nasal mucosa, there is no clinically relevant absorption of oxymetazoline hydrochloride.

5.3 Preclinical safety data

Preclinical data reveal no special hazard for humans based on conventional studies of repeated dose toxicity or toxicity to reproduction. Vicks Sinex Nasal Spray has not been tested for genotoxicity or carcinogenicity.

Preclinical data suggest that benzalkonium chloride can produce a concentration- and time-dependant toxic effect on cilia, including irreversible immobility, and can induce histopathological changes in the nasal mucosa.

6. PHARMACEUTICAL PARTICULARS

6.1 List of excipients

Sorbitol

Sodium citrate (for pH-adjustment)

Polysorbate 80

Benzyl alcohol

Citric acid, anhydrous (for pH-adjustment)

Benzalkonium chloride solution

Acesulfame potassium

Levomenthol

Cineole

Disodium edetate

Aloes dry extract

Levocarvone

Water, purified.

6.2 Incompatibilities

Not applicable.

6.3 Shelf life

Glass bottle 15 ml: 3 years

6.4 Special precautions for storage

Do not store above 25 ^oC.

Nature and contents of container

Brown Type III glass bottle 15 ml with a metering pump (polypropylene).

6.6 Special precautions for disposal

No special requirements.

7. MARKETING AUTHORISATION HOLDER

8. MARKETING AUTHORISATION NUMBER(S)

9. DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION

Date of first authorisation: 22 August 1997

Date of last renewal: 16 June 2015

10. DATE OF REVISION OF THE TEXT

2016-01-27