Afrin (Oxymetazoline) Safe Off Label Drug for a Red Face


This paper from Hospital Pharmacy is giving a guarded approval for the use of Oxymetazoline topically for the redness of rosacea. Even though the FDA has not approved Oxymetazoline as a topical skin treatment, it is approved as a nasal decongestant.

Doctors are able to prescribe drugs for off-label use, that is once a drug has been approved for one condition, there is some freedom for doctors to propose it for other conditions.

What is Oxymetazoline

Oxymetazoline is the active ingredient in decongestant products like Afrin, Sudafed OM and Vicks Sinex as well as in eye drops like Visine LR.

A well known side effect of Visine is rebound redness, where continued use leads to the redness that you were originally treating. Extended usage of Afrin can also lead to rebound nasal congestion.

Oxymetazoline 0.05% solution, as mentioned in this paper is available as TopCare Sinus Nasal Spray and also Afrin Nasal Spray.

We know that Allergan are conducting trials to establish the best amount of active ingredient to include in their Oxymetazoline Cream.

Caution Needed

Given the question hanging over the rebound redness issues with Mirvaso, one should also be careful with products like Afrin as rebound issues may well arise.

Paper Extracts

Oxymetazoline (Topical): Rosacea

Hosp Pharm. 2013 Jul-Aug; 48(7): 558–559.

Joyce A. Generali, RPh, MS, FASHP, (Editor) and Dennis J. Cada, PharmD, FASHP, FASCP

Dosage and Duration

Intranasal oxymetazoline 0.05% solution applied topically once daily to affected facial areas for up to 17 months.


The topical use of oxymetazoline 0.05% solution in the management of rosacea has been primarily limited to data from case series involving fewer than 10 patients and demonstrating sustained improvements in both erythema and flushing. Alhough oxymetazoline is not recognized in national guidelines, an international consensus statement recognizes the possible therapeutic role of oxymetazoline in the management of rosacea, despite the limited evidence.


For symptoms of periodic flushing, vasoactive drugs are also recommended, including topical oxymetazoline and oral nadolol, ondansetron, or clonidine, despite limited evidence. The FDA-approved topical therapies are suggested as first-line treatment for persistent erythema or rosacea characterized by papules and pustules.

Case Reports

In 2 case reports of adults (aged 55 and 70 years) with a history of refractory erythema and flushing related to rosacea for several years, topical oxymetazoline 0.1% solution was applied once daily to affected facial areas. A decrease in facial erythema was noted within 1 hour after application, and a dramatic improvement was observed within 2 to 3 hours. The effects were sustained throughout the day. Continued use for several months was associated with marked improvement in erythema without episodes of flushing or flares. Both patients experienced sustained effects with prolonged use of 8 and 17 months.


This is a limited safety profile. Refer to package labeling for complete prescribing information (eg, warnings/precautions, adverse reactions, drug interactions).

Concerns with the use of intranasal alpha-agonist decongestants include the loss of efficacy with prolonged use (tachyphylaxis) and possible rebound vasodilation, although these effects have not occurred in the limited number of patients studied.

No stinging or burning was noted with application

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About the Author

About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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16 Reader Comments

  1. brenda says:

    not worried about the redness, what about burning,pain and stinging and flushing.

  2. Comment via email.

    “The research with the two patients was done back in 2007, and just now this “Hosp Pharm” is putting out a paper? What’s up with that?”

  3. KRC says:

    I tried AFRIN and it didn’t help me. I wish it would have for the portability factor.

  4. Comment from Facebook:.

    I started using afrin , applying it w a nutrigina face whips. It has really calmed my face down. In just 2 days!

    • KRC says:

      Oh gee. I did not allow that much time – 2 days. So, Dave when you say “calmed down” do you mean redness, swelling or pp’s, please? Perhaps I should give it another try as I only applied it twice, expecting immediate results. I thought it would act as a vasoconstrictor and immediately calm a flush. I still have it and might give it another try. Your clarification would be appreciated. I know it gets tiring all this explaining. : )

  5. marie says:

    I am trying this, I have used it 2 times and it seems to reduce my redness. I can feel my face trying to flush at times but when I look in the mirror it is not red! I have not noticed any rebound flushing. I really hope this continues to work, haven’t noticed any sensitivity either.

    • marie says:

      3rd day and it didn’t seem to work as well, I definitely had more redness than the previous 2 days using the Afrin, although not anymore than usual.

    • Ethel says:

      hey Marie, How has thebFrin worked long term for you? do you have considerable burning and stinging as I have??? Thx, Laura

  6. Ethel says:

    hey Dave,
    How are you doing with the Afrin? my daughter, Laura, has had these issues as well as myself from time to time. She would definitely try the Afrin so I am trying to get as much info as I can… Again I thank you…..:)

  7. Sue says:

    How do you useAfrin? I’ve had fairly good luck with breakout using tea tr= oil 2x day

  8. Sue says:

    Perhaps prn is eay to go with these products if relief appears to be so immediate?

  9. Denise Thomson says:

    Do you use the spray or cream ?
    I can’t find cream here in Canada.

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