Child Poisonings From Eye Drops, Nose Sprays

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By Daniel J. DeNoon
WebMD Health News
Reviewed by Louise Chang, MD
Oct. 25, 2012 -- Over-the-counter eyedrops and nose sprays contain powerful drugs that are poisonous in surprisingly small amounts if swallowed, the FDA warns.
Unwary parents often leave these products within easy reach of curious children. From 1997 through 2009, eyedrops injured more than 4,500 children under the age of 5 and nasal sprays injured more than 1,100, according to the U.S. Consumer Product Safety Commission (CPSC).
Injury reports show that children can easily open the products, which do not come in child-resistant packages.
The drugs are surprisingly powerful. Swallowing less than a fifth of a teaspoon can seriously harm a child, the FDA says.
The eyedrops in question soothe redness by causing blood vessels in the eye to constrict. Visine is a popular brand; there are many generic versions. Nose drops work in a similar way, tightening blood vessels in the nose. Afrin, Dristan, and Mucinex are popular brands, and there are many generic versions.
The products contain the active ingredients tetrahydrozoline, naphazoline, or oxymetazoline.
All three drugs are in the class of drugs called imidazolines. When placed in the eye or nose as directed, the drugs only affect that part of the body. But if swallowed, they quickly have effects throughout the body.
"Generally, symptoms can occur in as little as one hour, peaking at eight hours, and resolving after 12-36 hours," a CPSC briefing paper notes. "Even though the symptoms resolve in a relatively short amount of time, ingestion of imidazolines can result in severe life-threatening consequences, such as decreased breathing, decreased heart rate, and loss of consciousness that require hospitalization to ensure recovery."
The CPSC has proposed a new rule requiring child-resistant packaging for these products. That rule has yet to be finalized. Even when it's final, the rule will give manufacturers at least a year to comply. Meanwhile, many homes have at least one of the products in medicine cabinets.
To avoid accidental poisonings, the FDA says parents and caregivers should:

• Store medicines in a safe location that is too high for young children to reach or see.
• Never leave medicines or vitamins out on a kitchen counter or a child's bedside.
• If a medicine bottle has a safety cap, relock it each time you use it.
• Remind babysitters, houseguests, and visitors to keep purses, bags, or coats that have medicines in them away and out of sight when they are in your home.
• Avoid taking medicines in front of young children because they like to mimic adults.

The FDA lists several specific products in its warning. Here's the list, which includes some but by no means all store and generic brands:

Products containing tetrahydrozoline	Products containing naphazoline	Products containing oxymetazoline
Visine Original	Visine A	Visine L.R.
Visine A.C.	Ak-Con Ophthalmic Solution	12 Hour Nasal Decongestant Nasal Spray
Visine Advanced Relief	Napha Forte Ophthalmic Solution	Afrin Extra Moisturizing Nasal Spray
Visine Totality	Naphazoline HCl Ophthalmic Solution	Afrin No Drip Severe Congestion Nasal Spray
Visine Maximum Redness Relief Formula	All Clear Ophthalmic Solution	Afrin No Drip Sinus Nasal Spray
Walgreens Redness Reliever Advanced Eye Ophthalmic Solution	All Clear AR Maximum Strength Ophthalmic Solution	Afrin No Drip Sinus Extra Moisturizing Nasal Spray
Tyzine Nasal Spray	Opcon-A Ophthalmic Solution	Afrin Original Nasal Spray
GNP Original Eye Drops	Naphcon A Ophthalmic Solution	Afrin Severe Congestion Nasal Spray
Opti-clear Ophthalmic Solution	Walgreens Eye Allergy Relief Drops	Dristan 12 Hour Nasal Spray
Tetrahydrozoline HCl Ophthalmic Solution	*	Equaline 12 Hour Nasal Spray
Today’s Health Original Eye Drops	*	Equaline 12 Hour Extra Moisturizing Nasal Spray
Leader Eye Drops Regular Formula Ophthalmic Solution	*	Equate Nasal Spray
*	*	GNP 12 Hour Nasal Spray
*	*	GNP 12 Hour No Drip Nasal Spray
*	*	GoodSense 12 Hour Nasal Spray
*	*	Leader 12 Hour Nasal Spray
*	*	Maximum Strength Nasal Decongestant Nasal Spray
*	*	Mucinex Full Force Nasal Spray
*	*	Mucinex Moisture Nasal Spray
*	*	Nasal Relief Spray
*	*	Neo-Synephrine 12 Hour Nasal Spray
*	*	Publix Nasal Spray
*	*	Select Brand Nasal Spray
*	*	Sinex Nasal Spray
*	*	Sudafed OM Nasal Spray
*	*	Today’s Health Nasal Relief Nasal Spray
*	*	Tope Care 12 Hour Nasal Spray
*	*	Walgreens Anefrin Nasal Spray