Rhofade Side Effects: What to Expect and When to Call Your Doctor

Rhofade (oxymetazoline hydrochloride cream, 1%) is generally well-tolerated when used as directed, but like all medications, it can cause side effects. Most side effects are mild and occur at the application site, but some patients experience systemic reactions that require medical attention. Here's what to expect and how to use Rhofade safely.

How Rhofade Works (and Why It Can Cause Side Effects)

Rhofade is an alpha-1A adrenoceptor agonist — it causes blood vessels in the face to constrict, reducing facial redness. Although it's applied to the skin, a small amount is absorbed systemically. This is why Rhofade can, in rare cases, affect blood pressure and cardiovascular function beyond just the face.

Common Side Effects of Rhofade

Most side effects reported in Rhofade's clinical trials were mild and occurred at the site of application. In clinical studies at hours 3, 6, 9, and 12 on Day 29, between 12% and 18% of Rhofade patients showed improvement in redness — but a small percentage also experienced unwanted skin reactions.

Common side effects at the application site include:

Skin irritation or dermatitis: Some patients experience redness, dryness, or irritation where Rhofade is applied.

Worsening of rosacea pimples (papules/pustules): In about 1% of clinical trial participants, rosacea lesions worsened. If you notice your skin looks worse after starting Rhofade, contact your prescriber.

Itching (pruritus): Mild itching at or near the application site is among the most commonly reported reactions.

Redness at application site: Paradoxically, some patients notice temporary redness or flushing, particularly when Rhofade's effect wears off later in the day.

Pain at application site: A mild burning or stinging sensation may occur, especially if applied to irritated skin or open sores.

Serious Side Effects of Rhofade: When to Seek Medical Care

Because Rhofade acts on adrenergic receptors — the same receptors involved in blood pressure regulation — it can potentially affect cardiovascular function, particularly in patients with pre-existing conditions. The FDA prescribing information calls for caution in these groups:

Cardiovascular disease or uncontrolled blood pressure: Rhofade may worsen severe, unstable, or uncontrolled cardiovascular disease, orthostatic hypotension, or uncontrolled hypertension. Seek medical care immediately if your cardiovascular condition worsens after starting Rhofade.

Narrow-angle glaucoma: Rhofade may worsen narrow-angle glaucoma, potentially leading to blindness. If you have this condition, discuss the risks with your ophthalmologist before using Rhofade. Avoid contact with the eyes.

Vascular conditions: Use with caution in patients with Raynaud's phenomenon, thromboangiitis obliterans (Buerger's disease), scleroderma, or Sjögren's syndrome. Seek medical care if signs of vascular insufficiency develop or worsen.

Cerebral or coronary insufficiency: Use with caution. Contact your doctor immediately if you experience chest pain, shortness of breath, or neurological symptoms.

Who Should NOT Use Rhofade?

Avoid Rhofade or discuss risks with your doctor before using it if you have:

Open wounds, irritated skin, or active skin infections on the face

Uncontrolled or severe heart or blood vessel problems

Narrow-angle glaucoma

History of stroke or cerebrovascular disease

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Safety Tips for Using Rhofade

Apply only a pea-sized amount once daily — more is not better and increases side effect risk

Avoid contact with eyes and lips

Wash your hands immediately after applying Rhofade

Do not apply to irritated skin, open sores, or wounds

Keep out of reach of children — ingestion can cause serious harm

Store at room temperature (68°F–77°F); excursions to 59°F–86°F are acceptable for short periods

What Should I Do If I Experience Side Effects?

For mild application-site reactions, stop using Rhofade temporarily and contact your dermatologist for guidance. For any cardiovascular symptoms (chest pain, shortness of breath, severe headache), seek emergency care immediately. Report side effects to the FDA at 1-800-FDA-1088 or via fda.gov/medwatch. And be sure to review Rhofade drug interactions to make sure none of your other medications are increasing your risk.