Episode 88: Decongestants - When Nasal Sprays and Eye Drops Become Toxic

This week on The Tox Lab, we're taking a look at the dark side of decongestants and exploring how seemingly harmless over-the-counter nasal sprays and eye drops can cause severe toxicity.We begin by discussing the pharmacology of imidazoline decongestants, including their effects on alpha-adrenergic receptors and how systemic exposure can lead to cardiovascular and central nervous system toxicity.We then examine a fatal case involving xylometazoline, in which exposure was associated with a haemorrhagic stroke. We explore the possible mechanisms underlying this rare but serious complication, including the effects of sympathomimetic decongestants on vascular tone and blood pressure.Finally, we turn to tetrahydrozoline, an ingredient found in products such as Visine eye drops and some nasal decongestants. We discuss accidental and intentional ingestions, severe bradycardia, hypotension, CNS depression, and cardiac conduction abnormalities, as well as the challenges associated with recognising and detecting tetrahydrozoline toxicity. We also explore the darker forensic history of tetrahydrozoline, including its involvement in cases of drug-facilitated sexual assault and murder, and consider why the role of these compounds in unexpected deaths and criminal investigations may be underestimated.Join us as we examine how everyday over-the-counter decongestants can cause coma, profound cardiovascular toxicity, and even death, and explore the toxicological and forensic challenges posed by compounds that are not routinely included in standard drug screening.Hope you enjoy!Links to the papers we discussed:https://onlinelibrary.wiley.com/doi/abs/10.1111/1556-4029.15416 https://link.springer.com/article/10.1007/s12024-023-00680-9 https://pmc.ncbi.nlm.nih.gov/articles/PMC8118060/ Disclaimer: All opinions are our own.Find us on instagram: @the_tox_labEmail us here: [email protected] out our new website: https://thetoxlab.co.uk/ Support us here: https://buymeacoffee.com/thetoxlab