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Reporting a Medication Error

Over-The-Counter Eye Drop and Nasal Spray Danger

Published August 11, 2023

Allergies, colds, and the flu often cause symptoms such as a stuffy nose, sinus pressure, and red, itchy, watery eyes. To treat these symptoms, over-the-counter (OTC) eye drops and nasal sprays are often used. These products work by shrinking or constricting the blood vessels. The active ingredients in these products include vasoconstrictors such as tetrahydrozoline, oxymetazoline, or naphazoline. Serious harm may result from swallowing even a small amount of the medicine. For example, severe side effects such as drowsiness, confusion, slowed breathing, and a slow heart rate can occur after swallowing as little as a half teaspoonful.

Figure 1. The Drug Facts label warns to keep out of reach of children in very small print.

Most people keep these products on hand and frequently store them in purses, drawers, and on countertops where a child may easily access. A parent or caregiver may not realize how dangerous these products can be if swallowed. They are extremely hazardous to small children. The drops are colorless, odorless, and tasteless. The warning statements on the Drug Facts label (Figure 1) are extremely small. To avoid accidental ingestion, always store these drops, and all medicines, up and away and out of reach.

In 2012, the Consumer Product Safety Commission issued a rule requiring companies to add child-resistant packaging on over-the-counter (OTC) and prescription eye drops and nasal sprays that contain 0.08 milligrams or more of a vasoconstrictor. While child-resistant caps provide an extra layer of safety, they do not always prevent a child from opening the container. When purchasing drops and sprays, always look for products that come with a child-resistant cap, such as the eye drops shown in Figure 2. On the outer carton, it states that it has a “Child Safety Cap.” We are not sure if all products have safety caps, even though they are required. For example, the product in Figure 3 does not indicate on the outer carton that it has a safety cap. If you are not sure a child-resistant cap is included, do not purchase the product.

Figure 2 (left). The eye drop packaging above indicates the drops have a child-resistant cap on the bottle. Figure 3 (right). The eye drop packaging above does NOT indicate the drops have a child-resistant cap on the bottle.

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