Oxymetazoline
Oxymetazoline hydrochloride
One of only two drugs approved for the redness of rosacea, and the weakest primary endpoint in this register — honestly measured and honestly published.
The marker is the strength the trials were actually run at. The bar is the span this register has recorded, approved and compounded together. Anything below the marker is a dose nobody has tested; anything above it is an assumption about a dose–response curve nobody has drawn.
The shaded band is the depth this molecule is understood to reach. Anything below it is out of scope, whatever the label says.
Mechanism
Constricts the superficial cutaneous vessels for a number of hours. It changes how the skin looks while it is working and does nothing to the underlying vascular hyperreactivity.
HOUSE NOTES
- The endpoint was deliberately hard: two grades, on both the clinician's and the subject's scale, at four timepoints across twelve hours. At its best timepoint it reached 18%.
- 1% of subjects reported worsening inflammatory lesions of rosacea — small, specific, and the failure mode people fear with vasoconstrictors.
- Three warning categories narrow the eligible population sharply, and they land on exactly the group most likely to want it.
- The label offers no guidance at all on stopping.
Layering
- Uncontrolled cardiovascular disease
- Raynaud's, scleroderma, Sjögren's
- Narrow-angle glaucoma
- Ivermectin
- Azelaic acid
- Daily sunscreen