Is Afrin Addictive?

What does Afrin do?

Afrin^® is a topical decongestant meant for nasal use. Afrin is available in both nasal spray and mist formulations, and can be used to treat nasal and sinus congestion associated with allergies and upper respiratory infections. The active ingredient in Afrin, oxymetazoline, is a vasoconstricting agent. When oxymetazoline is sprayed into the nose, it causes narrowing of nasal blood vessels, which results in a temporary improvement in nasal swelling and congestion. Oxymetazoline is also an ingredient in some prescription eye drops for droopy eyelids, and is also present in certain topical facial creams used to treat rosacea.

How do you use Afrin?

Afrin is indicated for use in adults and in children more than six years of age. Two to three sprays of Afrin can be applied to each nostril once or twice daily, for a maximum of three days. Keeping the head in an upright position may reduce the risk of accidental swallowing of Afrin, which can lead to unwanted side effects. Use of Afrin while lying flat or while tilting the head backward also increases the risk of accidental swallowing and should be avoided. Because nasal congestion can actually worsen with prolonged or continuous use of Afrin, it should only be used for a maximum of three days at a time.

Is Afrin bad for you?

Overuse of Afrin or other topical nasal sprays that contain oxymetazoline can cause a medical condition called “rhinitis medicamentosa”. Symptoms of rhinitis medicamentosa include nasal stuffiness or congestion, swelling, and pain.  Excessive use of Afrin may also cause low blood pressure and heart rate, dizziness, or fainting.

What are the side effects of Afrin?

Side effects of Afrin include a temporary burning or stinging sensation in the nose, as well as sneezing. If Afrin is accidentally swallowed, unpleasant side effects such as nausea, vomiting, dizziness, or fainting may occur. Because young children are more likely to experience side effects after Afrin use due to their smaller size, most Afrin products should not be used in children less than six years of age.

Is Afrin addictive?

Afrin addiction is known as rhinitis medicamentosa or rebound congestion. It occurs after repeated use of Afrin and can cause individuals to use the nasal spray on an increasing basis to treat the recurrent symptoms. Afrin causes the release of chemicals that cause blood vessel narrowing, and prolonged or repeated use of Afrin can alter the balance of these chemicals within the body. This chemical imbalance results in blood vessel expansion and worsening nasal congestion when Afrin is discontinued after long-term use. People who experience these worsening symptoms often restart their use of Afrin to treat those symptoms. This is often described as “Afrin addiction” but is actually an example of a physical dependence on medication. The primary treatment of rhinitis medicamentosa related to Afrin overuse involves discontinuation of nasal spray use, although topical nasal steroids are sometimes prescribed to affected patients to alleviate the worsening symptoms that may occur after stopping Afrin.  

Is Afrin safe for children to use?

Most Afrin products are not safe to use in children less than six years of age, but there is one formulation of Afrin that is specifically designed for use in children as young as two years of age. Afrin should be used with caution, as it may cause toxicity if swallowed or if too much is sprayed into the nose. Children may accidentally swallow Afrin that drips from the nose into the back of the throat. As little as half a teaspoon of Afrin can cause life-threatening toxicity if swallowed by a young child. Signs and symptoms of Afrin overdose may include low blood pressure, a slow heart rate and abnormally slow breathing.

Is Afrin safe during pregnancy?

Afrin use during pregnancy may be harmful to the fetus. One investigation of decongestant use during pregnancy noted a potential link between fetal kidney abnormalities and use of oxymetazoline in the second trimester of pregnancy. In another report, maternal use of oxymetazoline nasal spray during pregnancy was associated with changes in fetal heart rate. Because of this, pregnant women should talk with a doctor before use of Afrin or other nasal decongestant sprays.

What should I do if I use too much Afrin?

If you develop unexpected or worrisome symptoms after using Afrin or if you take too much Afrin, get guidance from Poison Control immediately. Help from Poison Control is available at www.poison.org and by phone at 1-800-222-1222. Both options are free, confidential, and available 24 hours a day. 

Afrin^® is a registered trademark of Bayer Healthcare LLC.

Kelly Johnson-Arbor, MD
Medical Toxicologist

For media inquiries, please contact Krista Osterthaler at osterthaler@poison.org.