Comprehensive medication guide to Synarel including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$50–$200 copay per month for most insured patients; specialty Tier 4–5 on most formularies; prior authorization required; step therapy may apply for endometriosis indication.
Estimated Cash Pricing
$3,100–$3,500 retail for the brand-name 8 mL bottle (30-day supply at endometriosis dose); no generic available, so no generic pricing applies. Check GoodRx for current pharmacy comparisons — prices vary by several hundred dollars by location.
Medfinder Findability Score
55/100
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Synarel is the brand name for nafarelin acetate, a prescription nasal spray medication manufactured by Pfizer (G.D. Searle LLC). First FDA-approved in February 1991, Synarel is a synthetic analog of gonadotropin-releasing hormone (GnRH) — a naturally occurring hormone that regulates sex hormone production in the brain and reproductive system.
Synarel is classified as a GnRH agonist and belongs to the same drug class as leuprolide (Lupron), goserelin (Zoladex), and triptorelin (Triptodur). It is uniquely available as a nasal spray — the only GnRH agonist in the US administered intranasally.
Each bottle of Synarel contains 8 mL of nafarelin acetate nasal solution (2 mg/mL), delivering 200 mcg of nafarelin per spray actuation. There is no FDA-approved generic version of Synarel available in the United States as of 2026.
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Synarel works by acting as a continuous GnRH agonist — it binds to GnRH receptors on the pituitary gland and maintains constant (rather than pulsatile) stimulation. While the natural pituitary system responds to pulsatile GnRH signals with LH and FSH release, continuous stimulation causes the pituitary to downregulate its receptors and stop responding.
After approximately 4 weeks of twice-daily dosing, the pituitary dramatically reduces LH and FSH secretion. Without these signals, the ovaries stop producing estrogen (and testosterone), dropping levels by up to 95%. This produces a temporary, reversible state of hormonal suppression similar to menopause.
An initial hormone flare occurs in the first few weeks before suppression takes hold. When treatment is stopped, hormone levels typically return to normal within 4–8 weeks as pituitary sensitivity is restored.
200 mcg/spray — nasal spray (2 mg/mL solution, 8 mL bottle)
Standard bottle delivers at least 60 sprays. Endometriosis dose: 400 mcg/day (2 sprays). CPP dose: 1,600–1,800 mcg/day (8–9 sprays).
Synarel is not on the FDA's official drug shortage list in 2026, but it remains genuinely difficult to find at most pharmacies. As a brand-only specialty medication costing $3,100–$3,500 per bottle with no generic equivalent, most community pharmacies choose not to stock it. Localized availability gaps are common even without a formal shortage.
Most patients need to use specialty pharmacies or mail-order options to fill Synarel reliably. The medication is most consistently stocked at CVS Specialty, Walgreens Specialty, and Accredo. Fertility clinic pharmacies are another reliable source.
Rather than calling pharmacies one by one, use medfinder to find which pharmacies near you have Synarel in stock. medfinder calls pharmacies on your behalf and texts you the results.
Synarel is not a controlled substance and has no DEA scheduling restrictions, so any licensed prescriber can technically write a prescription. However, because GnRH agonist therapy requires specialized monitoring and insurance PA typically requires specialist involvement, Synarel is most commonly prescribed by:
Obstetrician-Gynecologists (OB/GYNs) — primary prescribers for endometriosis
Reproductive Endocrinologists (REIs) — for endometriosis and IVF off-label use
Pediatric Endocrinologists — required (or strongly preferred by insurers) for CPP prescribing
Pediatricians and Family Medicine Physicians — may manage ongoing therapy under specialist guidance
Nurse Practitioners (NPs) and Physician Assistants (PAs) — in gynecology and endocrinology practices
Telehealth options for initial Synarel prescribing are limited since diagnostic workup (hormone testing, bone age imaging) typically requires in-person evaluation. However, monitoring visits and refill consultations can often be done via telehealth at established practices.
No. Synarel (nafarelin acetate) is not classified as a controlled substance by the DEA. It is a prescription-only medication that requires a valid prescription from a licensed healthcare provider, but it is not subject to the scheduling restrictions that apply to controlled substances.
This means Synarel prescriptions can be refilled without the quantity limitations or early refill restrictions that apply to Schedule II–V medications. However, most insurance plans still require prior authorization before covering Synarel, regardless of its non-controlled status.
Most side effects of Synarel stem from the low-estrogen state the medication creates. Common side effects include:
Hot flashes and night sweats
Vaginal dryness
Mood changes, emotional lability, irritability
Headaches
Decreased libido
Acne
Muscle pain
Reduced breast size
Nasal irritation from the spray
Serious side effects — seek medical attention:
Seizures or convulsions
Pseudotumor cerebri (increased intracranial pressure): severe headache, vision changes, ringing in the ears
Depression or thoughts of self-harm
Significant bone density loss with extended use
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Leuprolide (Lupron Depot)
Monthly or 3-month IM injection; most widely used GnRH agonist for endometriosis, CPP, and uterine fibroids; generic available
Goserelin (Zoladex)
Monthly subcutaneous implant; FDA-approved for endometriosis; no CPP indication
Elagolix (Orilissa)
Oral daily GnRH antagonist for endometriosis; no initial hormone flare; manufacturer savings program available
Triptorelin (Triptodur)
6-month IM injection for CPP; reduces dosing frequency burden for children and families
Histrelin (Supprelin LA)
Annual subcutaneous implant for CPP; 12 months of hormone suppression; ideal for compliance challenges
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Nasal decongestant sprays (e.g., oxymetazoline/Afrin)
moderateMay reduce nafarelin absorption; use at least 2 hours after Synarel dose
SSRIs (fluoxetine, sertraline, paroxetine, escitalopram)
moderateIncreased risk of seizures when combined with GnRH agonists; inform prescriber of all antidepressants
Bupropion (Wellbutrin, Zyban)
moderateIncreased seizure risk; bupropion lowers seizure threshold, additive effect with nafarelin
Hormonal contraceptives (pills, patch, ring, implant, injection)
moderateSynarel may reduce contraceptive efficacy; use non-hormonal birth control during treatment
Synarel (nafarelin acetate) is an effective and well-established GnRH agonist that has been in clinical use since 1991. For patients with endometriosis, it offers 6 months of meaningful pain relief and lesion reduction. For children with central precocious puberty, it provides reliable hormonal suppression to allow age-appropriate development. Its unique nasal spray delivery — twice daily instead of monthly injections — is a genuine advantage for patients who prefer non-injectable options.
The main challenges with Synarel are practical: it is brand-only with no generic equivalent in the US, it's expensive ($3,100–$3,500 per bottle), requires prior authorization on most insurance plans, and is not stocked by most community pharmacies. These access hurdles require proactive management from both patients and providers.
If you're having difficulty finding Synarel at a pharmacy near you, medfinder can help by calling pharmacies in your area to locate one that has it in stock — so you spend your time on treatment, not on hold.
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Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
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