In October the FDA issued a warning bringing to parents’ attention the unrecognized dangers of  agents that cause cause significant toxicity in small amounts–which is exactly the way these medications come.  The bulletin involved over-the-counter eyedrops and nosesprays that come in packaging that is not child-resistant and are more much potent than most families realize.  These drops are used locally  in small amounts–drops–in the eyes or nose, depending on the product, to cause constriction of blood vessels and relief of some local symptoms.  But when swallowed by children there is the risk of severe injury, as even a small volume is actually a dangerously high amount, and the agent is now systemic rather than local.  According to the FDA,  the ingestion of less than 1/5 teaspoon can cause serious harm to a young child.

The active ingredients involved include tetrahydrozoline, naphazoline and oxymetazoline– be part of the working vocabulary of many people.  All members of the imidazoline chemical  family, they are better known by their brand names, including several products in Opcon, the Visine groups, and the corresponding generic eye drops, and such nose sprays as the  Afrin, Dristan and related nasal products.

An advisory from the CPSC (Consumer Products Safety Council) comments that symptoms can present within an hour, peak at about eight hours, and last some 12-36 hours.  These symptoms, caused by the agents  “can result in severe life-threatening consequences, such as decreased breathing, decreased heart rate, and loss of consciousness,” and that hospitalization may be required. 

The CPSC has proposed childproof packaging for these products, but this is preliminary and is not likely to offer protection soon.  To avoid injury to their children from ingestion of these products so common in many homes, the FDA underscores the usual sensible precautions:  high, out-of-reach storage,  use of safety caps on all products that have them, and reminding babysitters, guests, and  visitors to take care to keep purses, coats or bags with any medication out of sight and reach when visiting homes with children.

There is also the general warning not to leave any medications (or vitamins) on the kitchen counter, children’s bedsides, or other  accessible spot.  But the specific point of this advisory was to point out the danger  this specific danger because, as  FDA pharmacist Yelena Mazlov notes, “children who swallow even miniscule amounts of these products can have serious adverse effects.”