Date of Award


Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant


Physician Assistant Studies

Department Chair

John Cavenagh, PhD, PA-C


OBJECTIVE: The objective of this selective EBM review is to determine whether or not, “Is Afrin (Oxymetazoline) a safe and effective drug in normal, healthy adults with reference to nasal congestion and the nasal response?”

STUDY DESIGN: Review of three English language primary studies published in 1997, 1999, 2003.

DATA SOURCES: Randomized, controlled studies (double-blind, placebo-controlled) testing the efficacy and safeness of Afrin in comparison to a placebo group, were found using the PubMed database.

OUTCOMES MEASURED: Nasal patency, congestion, degree of nasal blockage, and symptoms (quantity, consistency, color of nasal secretions, turbinate size/color) were measured through patient diary card symptom scores, visual analogue scales, and clinical nasal visual examinations.

RESULTS: The Morris et al and Watanabe et al studies found that the subjective measurements and nasal examinations did not show clinically significant signs of rhinitis or differences between treatment groups after using Afrin. A clinically significant decongestant effect of Afrin was noted at each visit in all three RCT’s. Bickford et al reports that symptoms of congestion decreased significantly after using Afrin but not after using the placebo. Morris et al and Watanabe et al found no signs of increased tolerance to Afrin, but evidence of rebound nasal congestion was reported after 3 days of Afrin treatment in the Morris study and no significant rebound nasal congestion was discovered by Watanabe et al after 4 weeks treatment.

CONCLUSIONS: All three RCT’s showed that Afrin is effective in treating nasal congestion in normal, healthy adults. After subjects were treated with various doses of Afrin nasal spray, no clinically significant nasal congestion was found in any of the treatment groups. Morris et al and Watanabe et al found that there was no tolerance to the medication after using repeated doses. However, Morris et al found rebound nasal congestion after 3 days of use, whereas Watanabe et al found no rebound congestion after using various doses of Afrin for 4 weeks. Further research is needed to determine the appropriate length of treatment and possible side effects (rebound congestion) of Afrin.