Naphthyzine poisoning. Caution - nasal drops for children

According to Life, well-known pharmaceutical companies and Roszdravnadzor bombarded Russian pediatricians with warnings in 2016–2017. Their content is approximately the same: children are increasingly being poisoned by vasoconstrictor drops. We are talking about naphthyzin, sanorin, otrivin and others similar drugs. If you overdo it with treatment, the child may get heart problems or even fall into a coma. As Roszdravnadzor notes, many parents do not know this and therefore allow their children to bury them uncontrollably. As a result, thousands of children across the country end up in hospitals every year.

At the beginning of 2017, one-year-old Seryozha from the city of Tchaikovsky, Perm Territory, caught a cold, and his mother, leaving for work, instructed his grandmother how to treat the baby. And although the boy sniffled, his mother did not leave any drops. The grandmother decided that this was not a problem and gave her grandson naphthyzin. She didn’t even drip it, but, one might say, poured it in, so as not to give the snot a chance. That day Vanya fell asleep earlier than usual after lunch.

Grandma woke him up and dropped more drops. After which the child slept all day.

The mother, returning from work, could not wake up her son. In a panic, she called an ambulance. The arriving brigade possible ways I tried to bring the child to his senses. With a normal heart rate of about 110–120 beats per minute, Serezha’s heart beat at a speed of only 30 beats. The boy was pale and reacted only to strong painful stimuli. At the hospital they said: naphthyzine poisoning.

The doctors managed to save Seryozha, a day later he was already running around the department, and four days later he was discharged home. The fact that the boy almost died was not the fault of the drops, but of the adults who used them incorrectly.

How the drops work

During flu and colds, our nose becomes stuffy because the mucous membrane in the nasal sinuses swells and “swells.” To relieve swelling, millions of our compatriots use naphthyzine-type drops. They constrict the vessels of the mucous membrane, the swelling subsides, and the nasal passages expand.

Sanorin, naphthyzin, xylene, rhinostop are drugs of one pharmacological group, explains the pediatrician, candidate medical sciences Tuyara Zakharova.

The problem is that with an overdose, not only the capillaries in the nose begin to narrow. The effect extends to large vessels carrying blood to the kidneys, heart and brain. This is fraught dangerous consequences: a person’s pulse drops, blood pressure rises, and signs of anemia appear. The adult body is able to “swallow” large doses no drops serious consequences. But for children, an overdose is extremely dangerous. The worst thing that can happen is heart problems.

For example, sanorin is used only from the age of two, says Tuyara Zakharova. - This is due to the fact that children early age not even a large number of The drug may cause spasms in the heart muscle.

Drug poisoning

Roszdravnadzor sounded the alarm and from June 2016 to May 2017 sent 12 official letters to all regional medical institutions about the dangers of using vasoconstrictors. Life has copies of them at its disposal. These documents are ordered to be distributed in all pharmacies and among pediatricians. The letters mention nine names of drops. This is almost the entire “vasoconstrictor” range of Russian pharmacies.

Analyzing information about side effect [vasoconstrictor drops and sprays], Roszdravnadzor specialists learned about a significant number of overdoses in pediatric practice,” the department’s documents say. - We have recorded a large number of acute and subacute drug poisonings in children under 15 years of age [after using the drugs].

A source in the department told Life that they began to study the problem after reports from children's hospitals in the central region.

We received data from one of the children's hospitals. Over the course of two years, their toxicology department treated 892 children under the age of 15 due to [vasoconstrictor] poisonings,” a source told Life. - All poisonings were accidental and occurred due to excess dosages, as well as due to non-compliance with age-related contraindications. However, the documents do not indicate how many children in Russia were poisoned by the drops.

Life sent a request to Roszdravnadzor asking for statistics, but has not yet received a response. The scale of the problem can be assessed using the example of a specific Moscow hospital. Every year due to improper treatment only to the hospital. N.F. Filatova receives 250–300 children under the age of four years.

In 2015, 244 children came to us, and in 2016, 250 children were treated. Basically, in cases of poisoning, all liquid-type drugs and even household chemicals. For example, these are vasoconstrictor nasal drops,” Dmitry Dolginov, head of the hospital’s toxicology department, told Life.

Parents can recognize vasoconstrictor poisoning by several basic signs.

The main sign of vasoconstrictor poisoning is changes in the nervous system. The child becomes restless or, on the contrary, inhibited,” Boris Blokhin, chief freelance pediatrician of the Moscow Department of Health, told Life. - Poisoning can be avoided if you strictly follow the recommendations written on the drugs. And understand that any medicine is not only a treatment for the child, but also possible development side effects.

Life sent requests to major pharmaceutical companies in Russia and Germany, which produce drops, with a request to comment on the situation. These are the Moscow Endocrine Plant, the German Bayer and Merkle GmbH. At the time of publication, only representatives of the Bayer company, which produces Nazol drops, responded.

To provide correct application drops, Bayer informed doctors and pharmacists about strict adherence dosage regimen, contraindications and precautions when using medications,” company representative Svetlana Meleshko told Life. - Bayer carefully processes all information about cases of misuse of drugs, adverse events and overdoses and provides this information to regulatory authorities.

Pavel Kochegarov

With a common runny nose and nasal congestion in children, not all parents consider it necessary to seek medical help. They use proven and inexpensive medicines that have been used for treatment for more than one generation. Among them, the most popular are naphthyzin drops. Meanwhile naphthyzine poisoning in children is quite common. The situation of poisoning is further aggravated by the fact that parents do not always associate taking naphthyzine with a deterioration in the child’s well-being.

Let's consider how dangerous naphthyzin is, in what cases poisoning occurs and what to do if it does happen.

Causes of poisoning

Naphthyzin belongs to vasoconstrictor drugs. It is effective in the treatment of rhinitis, pharyngitis, sinusitis, laryngitis and other diseases of the nasal cavity. The use of the drug eliminates swelling, constricts blood vessels, allows air to enter nasal cavity and make the baby's breathing easier. Naphthyzin is effective for chronic conjunctivitis, allergies, and nosebleeds. The medicine contains the main component naphazoline and auxiliary ingredients: boric acid and distilled water.

Despite all the effectiveness of the medicine, statistics inexorably show frequent poisoning in children. To answer the question whether naphthyzin is harmful and how justified its use is, it should be remembered that children are more sensitive to the effects of this medicine. Naphthyzine is prohibited for use in children infancy. When treating older children, the dosage must be strictly observed.

A well-known factor is that long-term use The product is addictive and somewhat addictive. Therefore, even adults are not recommended to take the drug for more than five days.

It is a mistaken belief that poisoning occurs only if a child drinks naphthyzine. When taken as usual, an overdose of naphthyzine leads to rapid entry of the drug into the blood through the developed vascular system mucous membranes of the nasal cavity. This causes general intoxication of the baby’s body.

Thus, we can distinguish following reasons Naphthyzine poisoning in children:

1. Inappropriate children's age percentage of solution. Often parents use a 0.1% solution. In adults, this dose does not cause side effects, but for a baby it can become dangerous. Recommended solution for children is 0.05%. On the recommendation of a doctor, a 0.025% solution can be used. To obtain it, 0.05% of the product is diluted with distilled water.
2. Uncontrolled use of the drug or its use to treat children under one year of age.
3. Insufficiently thought-out form of release of the drug. Naphthyzine is produced in plastic vials, which does not always allow you to accurately measure the required number of drops.
4. Over-the-counter sales of the product, adults’ attitude to the drug as “innocent” drops.

The low price of the drug and its popularity are often the main factors in parents’ choice. Having decided to use naphthyzin, not all parents are aware of what the consequences of poisoning may be. Since naphthyzin is characterized by a short action (approximately 4-6 hours), it requires frequent use. By dripping the product into our child 4-6 times a day, parents, without even realizing it, bring the concentration of the active substance in their baby’s body to a dangerous point.

10 mg of naphthyzine can lead to fatal outcome in children of the first two years of life!

In some cases, poisoning occurs when using an expired product. Parents should be very careful with packaging and throw away the medicine immediately after its expiration date.

Symptoms

In case of poisoning with vasoconstrictor drugs, parents first pay attention to extreme weakness and lethargy in children. Most children fall asleep quickly, and the duration of sleep is much longer than usual. But these signs may not always be alarming; sometimes they are regarded as symptoms of an underlying disease. Parents begin to sound the alarm when, in addition to weakness and increased sleepiness, children exhibit the following symptoms:

• headache and dizziness;
• a sharp decrease in body temperature (up to 35 C and below);
• cold and damp skin;
• blue lips, heavy breathing;
• decreased appetite;
• horse racing blood pressure;
• profuse sweating;
• reduction in heart rate.

There are 3 stages of naphthyzine poisoning: mild, moderate and severe.. With a significant overdose, the pulse and pressure drop to a critical level, and coma is possible.

Treatment

Even if there is minor signs poisoning requires urgent health care. Of particular danger are cases when a child, due to the neglect of adults, drinks naphthyzine or other vasoconstrictors. Before the doctors arrive, you need to rinse your stomach boiled water with enterosgel. Manganese solution is contraindicated in these cases. You can give your child activated charcoal.

The baby must be wrapped in a warm blanket, calmed down and provided with drinking plenty of fluids. You should not give milk, as it helps accelerate the entry of the drug into the blood.

At mild degree poisoning, hospitalization is not necessary. Symptoms of intoxication of the body disappear after discontinuation of the drug. A moderate and especially severe overdose of naphthyzine requires treatment in a hospital.

To eliminate the symptoms of the disease and normalize the well-being of children, in the first minutes of doctors’ arrival, the antidote naphthyzine is used. The victim is administered atropine sulfate, taking into account the weight and age of the child. Children also need subcutaneous injection prednisone. The dosage of medications is prescribed by the doctor. In order to exclude Negative consequences poisoning, all manifestations of intoxication of the body must be stopped within 40-60 minutes. Further course of treatment and recovery in medical institution ranges from one to three days.

In some cases, doctors prescribe naphthyzine inhalations for children. They are indicated for complicated laryngitis, bronchitis, tracheitis. To carry them out, 0.05% naphthyzine is diluted with saline solution. The safe duration of inhalation is 3 minutes when carried out no more than 3 times a day. The procedure is quite effective if the prescribed dosage is followed. If you have a runny nose or nasal congestion, inhalation with naphthyzine will not help desired result, so the risk in carrying them out is absolutely not justified.

How to prevent poisoning

If parents, for one reason or another, still decide to use naphthyzine to treat their children, they must comply the following measures precautions:

• use only the solution intended for children, warn pharmacists about this before purchasing;
• drip the drug no more than once every 6-8 hours;
• use a pipette to avoid errors in maintaining the exact dose;
• alternate the drug with other vasoconstrictor drugs;
• do not use the drug in infants , limit its use in preschool children;
• in case of negative reaction child's body Call emergency medical help immediately.

Instead of instillation, naphthyzin can be used for lotions. Cotton swabs are soaked in a 0.05% solution and placed in each nostril for 2 minutes. A new swab is used for each sinus.

Doctors recommend using naphthyzine analogues. Its main active ingredient is included in such drugs as Sanorin (regular and based on eucalyptus oil) and Naphazoline Ferein. The products relieve swelling and inflammation of the nasopharyngeal mucosa, facilitate breathing and eliminate signs of intoxication in infectious and viral diseases. Eucalyptus oil provides an additional anti-inflammatory effect.

For the treatment of acute respiratory viral infections, chronic rhinitis, and the prevention of influenza, the Aqua Maris Baby spray is used. The drug is made on the basis of natural sea ​​water sterilized. The nasal passages are washed with Aqua Maris twice a day. The drug can be used for a long time. Provided that the instructions are followed, manufacturers guarantee the absence of side effects.

Another effective and safe means is "Aqualar Baby". Its main advantage is that it can be used from the first days of children’s lives. The release form of the product is a spray in a bottle, equipped with a convenient tip with a limiter. The medicine is also available in the form of drops. The drug has no contraindications or restrictions on use.

The listed drugs belong to more expensive drugs, but their relatively high price is compensated by safety and effectiveness.

Wanting to alleviate the baby’s condition, parents must weigh everything possible risks and be extremely careful! The ability to purchase a vasoconstrictor without a prescription and at a low price cannot justify its uncontrolled use without first consulting a doctor and following the instructions for use.

Not all, of course, because not all vasoconstrictors are the same. What are the differences and what should you be wary of, pediatrician Sergei Butriy explained in detail.

Every year, as soon as the ARVI season begins, messages appear on the Internet: small children end up in the hospital in in serious condition simply because it was used to treat... a runny nose! No, he was not placed with his legs in a basin with hot water. Didn't rub it with mustard. Not subjected to other Chinese torture. They just dropped naphthyzine into the nose. Or even a product that you bought at the pharmacy for yourself, without even thinking that its concentration could be dangerous for the baby. After all, this is a common runny nose, people don’t die from it.

“The mother of one-year-old Vanyushka is forced to work because she is raising her son alone. The baby stays with his grandmother while his mother is at work. And then Vanyusha fell ill. The grandmother was given clear instructions, and the mother went to work. But my grandmother thought that the snot needed to be treated more actively, and my mother, as luck would have it, did not leave any drops. Grandmother dropped naphthyzine 0.1%. Yes, more so that you can heal well. The grandmother noticed that the baby went to bed very early nap. Sick, she thought. During the day I woke her up several times to again treat her with naphthysine. And when the mother returned home late in the evening and could not wake up the child who had been sleeping all day, then she called an ambulance,” the doctor Vanyusha saw described one such case.

The boy was in extremely serious condition. First degree coma, heart beating four times slower than it should. That time everything worked out, the baby was saved. But the danger has not gone away.

“Other drops for runny nose are not candy either, but naphthyzin is just rat poison. Stop putting it on the children already!” – calls the pediatrician Sergey Butriy.

According to the doctor, often the problem is that people buy cheap analogues instead of the products recommended by the doctor. Is the active ingredient the same? So there is no difference!

“The Mazda CX5 is the same as a Lada-five, don’t overpay! The Lada also has a steering wheel and pedals, and it drives! Its level of safety, speed, comfort and functionality are absolutely comparable to imported analogue, and whoever says otherwise has simply sold out to car dealerships and is receiving kickbacks from them!” - the doctor makes an analogy.

As Sergei Butriy explained, it’s not just a matter of active substance, but also in its purity, dosage accuracy, delivery method, side effects. Moreover, pharmacies often advise customers to buy a cheap generic (copy) instead of the expensive original. Is Nazivin expensive? Take naphthyzine!

“In fact, naphthyzine nasal drops are an absolutely hellish drug, outdated and toxic,” says the doctor. And that's why.

1. Naphthyzin causes a rebound symptom - it relieves nasal swelling well, but after the end of the action (after 2-3 hours) the nose swells even more, this leads to too frequent instillation and drug-induced rhinitis or even poisoning.

2. Causes medicinal (atrophic) rhinitis within 1-2 weeks of constant use.

3. Naphthyzin easily causes poisoning when instilled into the nose. In addition, a child can easily drink it - this is how the product is packaged. The severity of poisoning depends on the dose. Some will get away with a little drowsiness, but in other cases the baby may die.

“The situation is aggravated by the fact that parents do not understand how dangerous naphthyzine poisoning is. They will hide grandma's blood pressure pills, even mom's harmless ones. hormonal contraceptives They’ll hide it, but they’ll leave naphthyzin in plain sight – it’s just droplets in your nose,” Sergei Butriy is indignant.

The doctor advises, in principle, to be wary of vasoconstrictor drops for children. In some countries, it is generally prohibited to give them to children under two to five years of age. If you can't afford expensive medicines that the doctor prescribes, do not hesitate to ask him to prescribe cheaper analogues. But under no circumstances listen to the pharmacist at the pharmacy! In addition, one family member must give medications to the child. So that it doesn’t turn out that mom drips, dad drips, and grandma doesn’t stand aside either.

“If you injected a child by mistake adult dosage naphthyzine, or when pressing on a plastic dropper, the tip fell off and a lot of the drug poured into the child’s nose, or if the child drank at least a small amount of vasoconstrictor drops, call immediately ambulance, this is very dangerous,” the doctor warns.

Symptoms of naphthysine poisoning:

Inappropriate sleepiness

Bradycardia (slow pulse),

Pallor,

Cold sweat,

Child's lethargy.

A runny nose in children is often a manifestation of respiratory viral disease, and parents want to rid their baby of this disease as soon as possible. But be careful, some nasal drops may cause serious complications in children, especially if you do not follow the instructions.

May appear as copious discharge mucus from the nasal passages and nasal congestion. And in children of the first years of life, in any case, a runny nose leads to sleep disturbances and difficulty eating. Therefore, very often vasoconstrictor nasal drops are used to treat rhinitis. These drops contain special substances– alpha2-adrenergic agonists, which constrict the vessels of the nasal mucosa, and thereby temporarily reduce swelling and the amount of discharge. Such drugs are easy to buy at a regular pharmacy, and they are almost always available in home medicine cabinet. Adults often use them on children without a doctor's prescription. But not everyone knows about the complications that arise from such drugs.

What complications occur in children?

First of all, it should be noted that alpha2-adrenergic agonists are easily absorbed into the blood, and thus they can have not only a local effect on the nasal mucosa, but also affect the baby’s body. First of all, it has an effect on the cardiovascular system.

Unfortunately, parents do not always follow the instructions that are available for everyone medicine. Often, neither the frequency of use of drops nor their dosage is observed. Also in some cases, drops of “adult” concentration are used.

The first signs of an overdose are a decrease in blood pressure and a decrease in heart rate (bradycardia). They manifest themselves as weakness and dizziness. However, babies in the first years of life will not be able to tell you about these symptoms.

In case of an overdose of vasoconstrictor drops, the most common reason for contacting a doctor is lethargy and drowsiness of the child. Parents note that it is difficult to wake the baby from sleep, he is lethargic and apathetic, and there may be pallor of the skin. IN severe cases parents call when they cannot wake up their child. This is already hypotonic shock. Skin These children are pale, there is blueness around the lips, cold extremities, and sweating. Any movement is difficult for the child, breathing becomes rare and barely noticeable to the eye.

Poisoning with vasoconstrictor drops is not so rare; according to statistics, 23% of all poisonings medicines falls specifically on alpha2-adrenergic agonists.

For children of what age are nasal drops most dangerous?

Vasoconstrictor nasal drops pose the greatest danger to children of the first two years. The younger the baby, the lower the dose of alpha2-adrenergic agonist is needed for the development of complications. In children over 3 years of age, such complications are much less common.

Causes of overdose of vasoconstrictor nasal drops

Most dangerous reason- This is an overdose of the drug. It can be observed in the following cases:

• The frequency of use of the drug is greater than required by the instructions
• Applies more high concentration drug (for example, adult drops are used)
• Nasal drops are reused: that is, drops are instilled, after which the child has mucus removed from the nasal passages and the drops are instilled again
• Accidental poisoning (if a child finds medicine and drinks it, or drips it into the nose in a large dosage)

Which nasal drops most often cause complications in children?

1. Xylometazoline (Dlyanos, Xilen, Ximelin, Rinostop, Tizin)
2. Nafozalin (Sanorin)
3. Oxymetazoline (Nazol, Nazivin, Fervex spray)