Nasal Spray and Eye Drop Poisoning in Pets

Laurie Anne Walden, DVM

Over-the-counter (nonprescription) nasal sprays and eye drops can pose a serious risk to animals that ingest them. The problem ingredients—imidazoline decongestants, phenylephrine, and xylitol—are common in products to treat allergies, colds, flu, and red eyes.
 
If your pet chews a nasal spray or eye drop bottle, call your veterinarian or an animal poison control hotline immediately. This type of poisoning is a medical emergency. Even small amounts of ingested product can be dangerous.
 
Pet poison hotlines (consultation fees apply):

• ASPCA Animal Poison Control: 888-426-4435, https://www.aspca.org/pet-care/animal-poison-control
• Pet Poison Helpline: 855-764-7661, https://www.petpoisonhelpline.com

 
Imidazoline Decongestants
Decongestants in the imidazoline class are found in many nasal sprays and eye drops that reduce nasal congestion and eye redness. Some of the drugs in this group are oxymetazoline, naphazoline, tetrahydrozoline, tolazoline, and xylometazoline. A few of the many brands that contain imidazolines are Afrin, Clear Eyes, Mucinex, Opcon, Privine, Sinex, Visine, and Zicam.
 
Imidazolines affect the heart, circulation, digestive system, and nervous system. They decrease nasal congestion and eye redness by narrowing small blood vessels in the nose and eyes.
 
Symptoms of imidazoline poisoning appear as soon as 15 minutes after ingestion of a large amount or a few hours after ingestion of a small amount. The symptoms last from about 12 to 36 hours and include the following:

• Vomiting
• Slow heart rate
• Abnormal heart rhythm
• Weakness
• Depression/drowsiness
• Tremors
• Coma[1]

 
Animals with imidazoline poisoning need to be hospitalized for treatment and monitoring. Reversal agents for imidazolines are available.
 
Phenylephrine
Imidazolines and phenylephrine have similar effects on the body. Like imidazolines, phenylephrine acts as a decongestant by shrinking small blood vessels in the nose.
 
Phenylephrine is available in oral forms, nasal sprays, eye drops, and hemorrhoid creams. Two brands of nasal spray that contain phenylephrine are Little Remedies and Neo-Synephrine. Ingestion can cause vomiting, agitation, hyperactivity, and increased blood pressure.[2]
 
Xylitol
Some nasal sprays, including some with labels reading “natural saline,” contain xylitol. One example is Xlear nasal spray. Xylitol is harmless in humans, but in dogs it causes a dangerous, rapid drop in blood sugar and can also cause liver damage. The best approach is to keep all remedies (prescription, nonprescription, and “natural”) out of reach of pets and never assume that a product that’s safe for children is also safe for animals.
 
References
1. Almgren C. Clear eyes, dry nose, no problem? Wrong! Intoxications due to eye drops and nasal sprays. Pet Poison Helpline webinar. November 14, 2017. Accessed March 21, 2021. https://www.petpoisonhelpline.com/webinar/november-2017-intoxications-due-eye-drops-nasal-sprays/
2. Khan SA. Decongestants (toxicity). Merck Veterinary Manual. Updated August 2014. Accessed March 21, 2021. https://www.merckvetmanual.com/toxicology/toxicities-from-human-drugs/decongestants-toxicity
 
Photo by Diana Polekhina

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