oxymetazoline ophthalmic (Rx)

Brand and Other Names:Upneeq
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Dosing & Uses


Dosing Form & Strengths

ophthalmic solution

  • 0.1% (as HCl salt [0.09% as base])


Indicated for acquired blepharoptosis in adults

Instill 1 gtt to affected eye(s) qDay

Safety and efficacy not established



Interaction Checker

and oxymetazoline ophthalmic

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      Serious - Use Alternative

        Significant - Monitor Closely


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            Contraindicated (0)

              Serious - Use Alternative (0)

                Monitor Closely (1)

                • safinamide

                  oxymetazoline ophthalmic and safinamide both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Monitor patients for hypertension if safinamide is prescribed concomitantly with prescription or nonprescription sympathomimetics, including nasal, oral, or ophthalmic decongestants and cold remedies.

                Minor (0)


                  Adverse Effects


                  Punctate keratitis (1-5%)

                  Conjunctival hyperemia (1-5%)

                  Dry eye (1-5%)

                  Blurred vision (1-5%)

                  Instillation site pain (1-5%)

                  Eye irritation (1-5%)

                  Headache (1-5%)






                  Alpha-adrenergic agonists may impact blood pressure; caution with severe or unstable cardiovascular disease, orthostatic hypotension, and uncontrolled hypertension or hypotension

                  Caution with cerebral insufficiency, coronary insufficiency, or Sjögren syndrome

                  May increase risk of angle-closure glaucoma in patients with untreated narrow-angle glaucoma

                  Advise patients to seek medical care if signs and symptoms of cardiovascular disease, vascular insufficiency, or acute angle-closure glaucoma develop

                  Ptosis may be associated with neurologic or orbital diseases such as stroke and/or cerebral aneurysm, Horner syndrome, myasthenia gravis, external ophthalmoplegia, orbital infection and orbital masses; give consideration to these conditions in the presence of ptosis with decreased levator muscle function and/or other neurologic signs

                  Drug interaction overview

                  • Alpha-adrenergic agonists, as a class, may impact blood pressure; caution if coadministered with beta-blockers, antihypertensives, and/or cardiac glycosides
                  • Caution in patients taking MAO inhibitors, which can affect metabolism and uptake of circulating amines

                  Pregnancy & Lactation


                  Data are not available regarding use during pregnancy to inform a drug-associated risk for major birth defects and miscarriage

                  Animal studies

                  • No adverse developmental effects observed after oral administration in pregnant rats and rabbits at systemic exposures up to 7 and 278 times the maximum recommended human ophthalmic dose


                  Data are unavailable to assess effects on breastmilk quantity or production, or to establish the level of oxymetazoline present in human breastmilk

                  Pregnancy Categories

                  A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

                  B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

                  C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

                  D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

                  X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

                  NA: Information not available.



                  Mechanism of Action

                  Alpha-adrenergic agonist

                  Targets a subset of adrenoreceptors in Mueller muscle of the eyelid for use to treat acquired blepharoptosis


                  Ocular administration

                  • Peak plasma time: 2 hr
                  • Peak plasma concentration: 30.5 pg/mL
                  • AUC: 468 pghr/mL


                  Protein bound: 56.7-57.5%


                  Minimally metabolized; 95.9% of parent compound remained after 120-minute incubation with human liver microsomes


                  Half-life: 8.3 hr



                  Ophthalmic Administration

                  Do not touch tip of applicator to eye or any surface, in order to avoid eye injury or contamination of ophthalmic solution

                  Remove contact lenses before instilling drops; may reinsert 15 minutes after administration

                  If >1 ophthalmic preparation administered, separate instillation by at least 15 minutes

                  Discard single-use container immediately after dosing


                  Store foil-pouched single patient-use containers in the original child-resistant zipper bag

                  Store at 20-25ºC (68-77ºF); protect from excessive heat



                  Afrin (oxymetazoline) nasal
                  0.05 % liquid
                  Afrin (oxymetazoline) nasal
                  0.05 % solution
                  Ephrine nasal
                  1 % drops
                  Anefrin nasal
                  0.05 % liquid
                  Sinus Nasal Spray nasal
                  0.05 % liquid
                  Vicks Sinex 12-Hour nasal
                  0.05 % liquid
                  No Drip nasal
                  0.05 % liquid
                  Afrin No Drip (oxymetazoline) nasal
                  0.05 % solution
                  Afrin No Drip (oxymetazoline) nasal
                  0.05 % solution
                  Afrin No Drip (oxymetazoline) nasal
                  0.05 % solution
                  Nasal Spray (oxymetazoline) nasal
                  0.05 % liquid
                  Nasal Spray (oxymetazoline) nasal
                  0.05 % liquid
                  Nasal Spray (oxymetazoline) nasal
                  0.05 % liquid
                  Rhofade topical
                  1 % cream

                  Copyright © 2010 First DataBank, Inc.


                  Patient Handout

                  Patient Education
                  oxymetazoline nasal

                  DECONGESTANT DROPS - NASAL

                  USES: This medication is used for temporary relief of congestion in the nose caused by various conditions including the common cold, sinusitis, hay fever, and allergies. It works by narrowing the blood vessels in the nose area, reducing swelling and congestion.

                  HOW TO USE: Use this medication in the nose as directed. Follow all directions on the product package, or use as directed by your doctor. If you have any questions, ask your doctor or pharmacist.To apply nasal drops, wash your hands first. To avoid contamination, do not touch the dropper tip or let it touch your nose or any other surface. If needed, have another person place the drops in your nose.Gently blow your nose before using this drug. Tilt your head back while sitting on a chair or lying down. Hold the dropper over the affected nostril and apply the directed number of drops. Keep your head tilted for a few minutes. Repeat these steps with the other nostril if needed. Do not swallow the medication if it drips into the throat.This medication provides only temporary relief. Do not use more medication or use it more often or for longer than directed because doing so may increase the risk of side effects. Also, do not use this medication for more than 3 days because doing so may cause a condition called rebound congestion. Symptoms of rebound congestion include long-term redness and swelling inside the nose and increased runny nose. If this occurs, stop using this medication and consult your doctor or pharmacist.Inform your doctor if your condition gets worse or lasts after 3 days.

                  SIDE EFFECTS: Temporary burning, stinging, dryness in the nose, runny nose, and sneezing may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.If your doctor has directed you to use this medication, remember that your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: slow/fast/pounding heartbeat, dizziness, nausea, headache, mental/mood changes, trouble sleeping, shaking (tremors), unusual sweating, unusual weakness.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

                  PRECAUTIONS: Before using this nasal decongestant, tell your doctor or pharmacist if you are allergic to it; or to other sympathomimetics (such as pseudoephedrine); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.If you have any of the following health problems, consult your doctor or pharmacist before using this product: heart/blood vessel disease (such as coronary artery disease), overactive thyroid (hyperthyroidism), diabetes, high blood pressure, difficulty urinating (due to enlarged prostate).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Children may be more sensitive to the side effects of this drug. Check the product package or consult with your doctor or pharmacist about whether these nasal drops can be used by children.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is not known whether this drug passes into breast milk. Consult your doctor before breast-feeding.

                  DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before treatment with this medication. Ask your doctor when to start or stop taking this medication.Some products have ingredients that could raise your heart rate or blood pressure. Tell your pharmacist what products you are using, and ask how to use them safely (especially cough-and-cold products or diet aids).

                  OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: drowsiness, slow heartbeat, dizziness, fainting.

                  NOTES: Do not share this medication with others. Use of this container by more than one person may spread infection.There are many nasal decongestants available, many without a prescription. Talk with your doctor or pharmacist about which product is best for you.

                  MISSED DOSE: Not applicable.

                  STORAGE: Refer to storage information printed on the package. Protect from heat and light. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

                  Information last revised November 2022. Copyright(c) 2022 First Databank, Inc.

                  IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.



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                  Tier Description
                  1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
                  2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
                  3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
                  4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                  5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                  6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                  NC NOT COVERED – Drugs that are not covered by the plan.
                  Code Definition
                  PA Prior Authorization
                  Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
                  QL Quantity Limits
                  Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
                  ST Step Therapy
                  Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
                  OR Other Restrictions
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