Afrin (Oxymetazoline) Dosing
For adults and children 6 years and older, use 2-3 sprays in each nostril every 10-12 hours, not exceeding 2 doses in 24 hours, and critically, limit use to no more than 3 consecutive days to prevent rebound congestion. 1
Standard Dosing by Age
- Adults and children ≥6 years: 2-3 sprays per nostril every 10-12 hours (maximum 2 doses per 24 hours) 1
- Children under 6 years: Consult a physician before use 1
Administration Technique
- Squeeze the bottle quickly and firmly to spray 1
- Do not tilt head backward while spraying 1
- Wipe the nozzle clean after each use 1
Critical Duration Limitation
The most important aspect of Afrin use is the 3-day maximum duration rule. Rebound congestion (rhinitis medicamentosa) can develop as early as the third or fourth day of continuous use, creating a vicious cycle of worsening nasal obstruction that paradoxically requires more frequent dosing 2. This occurs through tachyphylaxis to vasoconstrictive effects and reduced mucociliary clearance 2.
Why the 3-Day Limit Matters
- Onset of rebound congestion occurs as early as days 3-4 of continuous use 2
- Prolonged use leads to nasal mucosal damage and persistent obstruction despite continued decongestant use 2
- Benzalkonium chloride preservative in these sprays may augment pathologic effects when used for 30 days or more 2
- Rarely, nasal septal perforation can develop in severe cases 2
When Longer Use Is Needed
If nasal congestion persists beyond 3 days, switch to an intranasal corticosteroid (such as fluticasone or mometasone) rather than continuing Afrin 2. Intranasal corticosteroids do not cause rebound congestion and are the most effective medication class for controlling nasal symptoms 2, 3.
Combination Strategy for Severe Congestion
For severe congestion requiring immediate relief while starting long-term treatment, you can safely combine Afrin with an intranasal corticosteroid for 2-4 weeks without causing rebound congestion 2:
- Apply Afrin first
- Wait 5 minutes
- Then apply the intranasal corticosteroid 2
This allows the decongestant to open nasal passages for better corticosteroid penetration 2.
Common Pitfall to Avoid
Never continue Afrin beyond 3-5 days as monotherapy, even if congestion persists. Patients often fall into the trap of increasing frequency and dose when the decongestive effect wanes, which only worsens the underlying problem 2. If you've already been using Afrin for more than 3 days, stop immediately and start an intranasal corticosteroid to break the rebound cycle 2.