Flonase vs Nasonex: Comparing Two Nasal Steroid Sprays for Allergy Relief

Flonase and Nasonex, FDA-approved nasal sprays for allergies, are glucocorticoids that alleviate nasal symptoms by reducing inflammation. Despite both being nasal steroids, their distinctions are evident.

Flonase, rated 3.3/10 on Drugs.com, showed mixed reviews (25% positive, 75% negative). In contrast, Nasonex, rated 5.3/10, had more favorable feedback (41% positive, 44% negative).

This article aims to dissect these distinctions comprehensively, exploring the specifics of their mechanisms, efficacy, dosage, and cost.

1. Mechanism of Action

Flonase and Nasonex work in similar ways to treat allergy symptoms but contain different active ingredients. Let's look closer at how each one works.

Flonase

Flonase contains fluticasone propionate as its active ingredient, which belongs to the corticosteroid class.

Fluticasone propionate prevents the release of substances in the body that cause inflammation. Specifically, it inhibits the production of inflammatory mediators, thereby reducing symptoms caused by seasonal or year-round allergies such as:

• Nasal congestion
• Sneezing
• Runny nose
• Itchy or watery eyes

Flonase is suitable for adults and children aged four and older. It is important to note that Flonase may take several days of regular use before symptoms improve. Additionally, caution is advised for individuals with certain medical conditions, as fluticasone can affect the immune system.

Nasonex

Nasonex contains mometasone as its active ingredient. Mometasone is also a glucocorticoid or steroid, working by preventing the release of substances that cause inflammation.

Like Flonase, Nasonex is indicated for treating nasal symptoms associated with hay fever or other upper respiratory allergies. It addresses symptoms such as:

• Nasal congestion
• Sneezing
• Runny nose
• Itchy nose

Nasonex is approved for use in adults and children as young as two. It's essential to use Nasonex specifically in the nose and avoid spraying it into the eyes or mouth. Like Flonase, Nasonex can also affect the immune system, so precautions should be taken in certain medical conditions.

2. Efficacy

Numerous studies have shown Flonase and Nasonex to relieve allergy symptoms effectively. Let's examine the evidence more closely.

Flonase

A study comparing Flonase to oral fluticasone propionate and placebo, involving 304 patients with seasonal allergic rhinitis, highlighted Flonase's effectiveness in relieving nasal symptoms. The study found that Flonase demonstrated significantly lower clinician- and patient-rated total and individual nasal symptom scores (obstruction, rhinorrhea, sneezing, itching) than oral fluticasone propionate or placebo.

Interestingly, even though oral fluticasone propionate led to detectable plasma concentrations, the efficacy of Flonase was attributed to direct topical effects rather than systemic absorption. This supports Flonase as an intranasal corticosteroid with efficacy primarily stemming from its localized action.

In another investigation focusing on the as-needed use of Flonase in treating seasonal allergic rhinitis, the study demonstrated its efficacy in reducing symptoms.

Using Flonase as needed, the active group exhibited a significant improvement in symptom scores, as indicated by a lower median symptom score and significant improvements in various domains of the Rhinitis Quality of Life Questionnaire compared to the placebo group. This suggests that Flonase when used as needed, is efficacious in relieving seasonal allergic rhinitis symptoms.

A comprehensive study comparing Flonase to loratadine, either alone or in combination, for treating seasonal allergic rhinitis showcased Flonase's efficacy in improving nasal symptoms.

In this multicenter, randomized, double-blind study involving 600 patients, both Flonase monotherapy and the Flonase plus loratadine combination demonstrated significantly lower clinician- and patient-rated total and individual nasal symptom scores after 7 and 14 days of therapy compared to loratadine alone or placebo groups.

The study emphasized Flonase's impact on the quality of life, as reflected in significantly greater improvements in the Rhinoconjunctivitis Quality of Life Questionnaire compared to loratadine alone or placebo.

Overall, Flonase consistently demonstrated efficacy in various studies, showcasing its effectiveness in relieving nasal symptoms associated with seasonal allergic rhinitis. Flonase is a reliable option for managing allergic rhinitis symptoms when used as needed or combined with other medications.

Nasonex

A study evaluating Nasonex's efficacy and safety in patients aged 12 years or older with fall seasonal allergic rhinitis highlighted its effectiveness in symptom relief. The results indicated that Nasonex produced significantly more significant improvements than placebo in daily reflective total nasal symptom score, morning predose instantaneous total nasal symptom score, daily reflective total ocular symptom score, and patient-rated overall response to therapy.

The study emphasized Nasonex's fast onset of action, with therapeutic effects observed 8 hours after initial administration, providing rapid relief from symptoms. The treatment was well-tolerated, further supporting its safety profile.

In a separate investigation comparing Nasonex to fluticasone propionate aqueous nasal spray for treating perennial rhinitis, Nasonex demonstrated effectiveness in controlling symptoms. The study, involving 550 patients, found that Nasonex was significantly more effective than placebo and was not statistically different from fluticasone propionate in reducing total nasal symptom scores.

The treatments were well-tolerated, with no evidence of a rapidly diminishing response to a drug or treatment over time was observed. The study concluded that Nasonex adequately controlled symptoms of perennial rhinitis and was at least as effective as fluticasone propionate at equivalent doses.

Overall, Nasonex consistently effectively relieves nasal and ocular symptoms associated with seasonal and perennial allergic rhinitis. Its fast onset of action and safety profile make it a reliable choice for individuals seeking effective and well-tolerated treatment for allergic rhinitis symptoms.

3. Side Effects

When considering nasal sprays like Nasonex and Flonase, it's crucial to be aware of potential side effects. While effective in treating nasal symptoms, these medications may cause varying reactions. Here's an overview of the side effects associated with each:

Nasonex

Serious side effects:

• Allergic Reaction: Hives, difficult breathing, swelling of face, lips, tongue, or throat.
• Severe Nasal Symptoms: Severe bleeding, increased drainage, nose pain, headache.
• Respiratory and Vision Issues: Wheezing, trouble breathing, vision problems.
• Ear Problems: Ear pain, full feeling, trouble hearing, drainage from the ear.
• Systemic Effects: Weight gain, slow wound healing, thinning skin, increased body hair, irregular menstrual periods, changes in sexual function, muscle weakness,fatigue, depression, anxiety, irritability.

Common side effects:

• Nasal Irritation: Nosebleeds, stinging sensation.
• Upper Respiratory Symptoms: Headache, stuffy nose, sore throat, cough, flu-like symptoms.

Flonase

Serious side effects:

• Allergic Reaction: Hives, rash, difficulty breathing, swelling of face, lips, tongue, or throat.
• Severe Nasal Symptoms: Severe or ongoing nosebleeds, noisy breathing, runny nose, crusting around nostrils.
• Oral and Respiratory Issues: Redness, sores, or white patches in the mouth or throat, fever, chills, body aches, cough, trouble breathing.
• Vision and Hormonal Effects: Blurred vision, eye pain, seeing halos around lights, signs of hormonal disorder (worsening tiredness, muscle weakness, light-headedness, nausea, vomiting).

Common side effects:

• Nasal Irritation: Minor nosebleed, burning, itching in the nose, sores or white patches inside or around the nose.
• Systemic Effects: Headache, back pain, sinus pain, sore throat, fever, nausea, vomiting.

4. Dosage and Administration

When it comes to dosage and administration, Flonase and Nasonex have some similarities but also crucial differences. Here’s a breakdown.

Flonase

Flonase, with the generic name Fluticasone Propionate, is available as a metered nasal spray categorized under nasal steroids.

Administered intranasally, Flonase Nasal Spray requires priming before the first use or after a week of non-use. This is achieved by shaking the contents well and releasing 6 sprays away from the face. Gently shaking the nasal spray before each use is recommended.

For adults, the starting dosage is 2 sprays (50 mcg of fluticasone propionate each) in each nostril once daily, totaling 200 mcg. Alternatively, 1 spray in each nostril administered twice daily is effective. After the initial days, patients may reduce the dose to 1 spray in each nostril once daily for maintenance.

The recommended starting dosage in adolescents and children (4 years and older) is 1 spray in each nostril once daily (100 mcg). Non-responders may use 2 sprays in each nostril once daily. Once control is achieved, the dosage should be decreased to 1 spray in each nostril once daily.

The maximum daily dosage for adults and children should not exceed 2 sprays in each nostril (200 mcg/day). There is no evidence that exceeding the recommended dose is more effective.

Nasonex

Nasonex, with the generic name Mometasone Furoate Monohydrate, is a metered nasal spray falling under the nasal steroid category.

The instructions advise priming, spraying, and cleaning using supplies provided within the package. It should be used only once a day. Adults and children (12 years and older) are instructed to apply 2 sprays in each nostril once daily, while children (2 to 11 years) should use 1 spray in each nostril once daily.

5. Cost and Availability

Flonase and Nasonex have some significant differences regarding cost and availability. Here are the key points:

Flonase

Flonase nasal spray (50 mcg/inh) costs around $91.62 to $107.01 for a supply of 16 grams. A generic version of Flonase is available with prices starting from $11.97 for 9.9 milliliters.

Flonase offers various discounts, including printable coupons, rebates, savings, copay cards, trial offers, and free samples. The Drugs.com Discount Card can save customers up to 80% or more off the cost of Flonase and is accepted at major pharmacies nationwide. Coupons are available for different Flonase products, such as:

• Sensimist Allergy Relief Nasal Spray
• Allergy Relief Nasal Spray
• Children's Sensimist Allergy Relief Nasal Spray
• Children's Allergy Relief Nasal Spray
• Headache and Allergy Relief Caplet
• Nighttime Allergy Relief Tablet

Patient assistance programs, like Rx Outreach Medications, may provide cost-free or discounted Flonase for individuals with low income or who are uninsured/underinsured. Eligibility requirements are determined case-by-case and may require the patient to reside in the US.

Nasonex

The cost for Nasonex nasal spray (50 mcg/inh) is around $70.81 for a supply of 17 grams. A generic version of Nasonex is available with prices starting from $78.73 for 17 grams.

Nasonex offers discounts through the Drugs.com Discount Card, saving customers up to 80% or more off the cost of prescription medicines. No manufacturer promotions could be found for Nasonex.

Wrap Up

Flonase and Nasonex are effective intranasal corticosteroid sprays for treating allergy symptoms. Both contain active ingredients that reduce inflammation by inhibiting inflammatory mediators. The dosage and administration are similar - adults use 2 sprays per nostril daily while children use 1 spray. Flonase is approved for ages 4+ and Nasonex for ages 2+. While expensive, generic versions and patient assistance programs can reduce costs.

When used as directed, both Flonase and Nasonex relieve nasal allergy symptoms. If you or your child suffer from nasal allergies, discuss these treatment options with your healthcare provider to determine if Flonase or Nasonex may be right for you. With several effective therapies available, you can find an appropriate treatment plan to manage allergy symptoms.

Is it safe to use Nasonex nasal spray every day?

Yes, you can use Nasonex Allergy nasal spray daily for up to 6 months if needed. However, it's important not to use it continuously for more than 6 months without consulting your doctor or pharmacist.

Do these nasal sprays have a floral scent?

Some nasal sprays like Flonase contain an added floral scent, while others like Nasonex do not. The floral scent in certain nasal sprays has been reported as a deterrent for some patients and should be considered when choosing a nasal allergy medication.

What is the shelf life of Nasonex nasal spray?

Nasonex Allergy nasal spray has a shelf life of 36 months from manufacture.

Why do doctors recommend Flonase?

Doctors recommend Flonase to relieve nasal congestion, sneezing, runny nose, itchy nose, and itchy and watery eyes. The mechanism of action in Flonase nasal sprays targets multiple inflammatory substances, including histamine, prostaglandins, cytokine, tryptases, chemokine, and leukotrienes, differentiating it from most over-the-counter allergy pills.

What are the downsides of Flonase?

Possible downsides of Flonase include nasal dryness/irritation, nausea, or vomiting. If any of these effects persist or worsen, it's essential to inform your doctor or pharmacist promptly. If your doctor has prescribed this medication, they have weighed the benefits against the potential risks of side effects.

Why was Nasonex discontinued?

Nasonex (mometasone furoate nasal spray) was discontinued as a prescription product in March 2022 when the FDA changed its status to over-the-counter (OTC). OTC options have replaced the prescription brand Nasonex, while prescription generic products remain available.