Fluticasone vs Beclomethasone: Which Nasal Spray is Best?

Both fluticasone and beclomethasone are prescribed as nasal sprays to treat allergic rhinitis. They reduce inflammation that causes symptoms like congestion, sneezing, and runny nose.

Though they share a similar mechanism of action, there are essential distinctions between these two intranasal corticosteroid sprays. This article provides an overview and comparison of fluticasone versus beclomethasone for managing allergies.

1. Mechanism of Action

Corticosteroids like fluticasone and beclomethasone fight inflammation through similar pathways but have critical differences in formulation and delivery methods. Let's take a closer look.

Fluticasone

Fluticasone, a nasal steroid, exerts its therapeutic effects by engaging in anti-inflammatory actions. As a synthetic corticosteroid, fluticasone inhibits the release of inflammatory substances within the nasal passages. When administered as a nasal spray, it acts locally to suppress the immune response, specifically targeting the cells responsible for generating inflammation.

Upon nasal application, fluticasone penetrates the cells in the nasal lining and binds to glucocorticoid receptors. This interaction triggers a cascade of events that ultimately hinder the synthesis and release of inflammatory mediators, such as histamines and cytokines. By dampening the inflammatory response, fluticasone reduces the symptoms associated with allergies, including:

• Nasal congestion
• Sneezing
• Itching

The local application of fluticasone nasal spray allows for targeted anti-inflammatory effects in the tissues, minimizing systemic exposure and potential side effects associated with oral corticosteroids. The gradual reduction of inflammatory mediators contributes to alleviating allergic symptoms over time.

Beclomethasone

Like fluticasone, beclomethasone nasal spray operates through a mechanism centered on anti-inflammatory actions. As a corticosteroid, beclomethasone works locally within the nasal passages to curb the release of inflammatory substances responsible for allergy symptoms.

When administered as a nasal spray, beclomethasone enters nasal cells and binds to glucocorticoid receptors. This binding initiates a process that suppresses the activity of inflammatory cells, preventing the release of cytokines, histamines, and other mediators that contribute to nasal inflammation.

By mitigating the inflammatory response, beclomethasone effectively reduces symptoms associated with seasonal or year-round allergies such as:

• Nasal congestion
• Sneezing
• Runny nose

The localized action of beclomethasone minimizes systemic exposure, limiting the potential for systemic side effects commonly associated with oral corticosteroids.

2. Dosage and Administration

Proper usage ensures optimal relief and safety. Let's compare the dosage guidelines.

Fluticasone

The dosage and administration of fluticasone nasal spray depend on factors such as the following:

• Specific brand
• Strength
• Individual's age

It is crucial to follow healthcare provider recommendations and instructions provided with the medication.

The usual adult dose for fluticasone furoate is two sprays (27.5 mcg/spray) in each nostril once a day. Fluticasone propionate may be administered as one or two sprays (50 mcg/spray) in each nostril once a day, as needed.

For pediatric use, children between 2 and 11 years old may be prescribed fluticasone furoate at a dose of one spray (27.5 mcg/spray) in each nostril once a day. Children aged 4 to 11 years using fluticasone propionate may be advised to take one spray (50 mcg/spray) in each nostril once a day. The dosage may be adjusted based on the response, and the dose may be reduced when maximum benefit is achieved.

Patients are instructed to shake the nasal spray bottle before each use, ensuring proper dispersion of the medication. If individuals switch from another steroid medicine to fluticasone, sudden discontinuation is discouraged, and a tapering approach under the guidance of a healthcare provider is recommended.

Symptoms may take several days to improve, and individuals are advised to continue using the medication as directed. The nasal spray should be stored upright at room temperature, away from moisture and heat. The spray bottle should be discarded after 120 sprays, even if there is remaining medicine.

Beclomethasone

Beclomethasone nasal spray is administered based on the prescribed dosage and individualized recommendations from healthcare providers. The typical dose involves 1 to 2 sprays into each nostril once per day. The patient is instructed to carefully follow the dosing instructions provided by the doctor.

Beclomethasone nasal spray, such as Beconase AQ, should be shaken well before each use to ensure uniform medication distribution. The steroid's immunosuppressive properties necessitate caution, and long-term users may require regular medical tests to monitor potential side effects.

Individuals are advised to continue using beclomethasone as directed, and if symptoms do not improve or worsen, consultation with a healthcare provider is recommended. The nasal spray should be stored upright at room temperature, away from moisture and heat. Once the prescribed number of sprays is completed, the medication should be discarded, even if some medicine remains in the pump or canister.

3. Efficacy in Allergy Symptoms

How about their effectiveness in alleviating allergy symptoms? Let's delve into the studies' efficacy and key variances below.

Fluticasone

Fluticasone furoate nasal spray represents a novel glucocorticoid targeted at treating allergic rhinitis. Developed specifically for this purpose, fluticasone furoate exhibits high systemic clearance, low oral bioavailability, and low absolute bioavailability after intranasal administration, minimizing systemic exposure to the drug.

Administered once daily at a dose of 110 mcg, fluticasone furoate has significantly alleviated nasal and ocular symptoms in clinical studies, positioning itself as a valuable option for patients with seasonal and perennial allergic rhinitis.

A comparative study with beclomethasone showcases the efficacy and tolerability of fluticasone furoate. Significant improvements in nasal and ocular symptoms affirm its effectiveness compared to other intranasal corticosteroids.

Furthermore, a study comparing as-needed use versus regular use of fluticasone furoate reveals similar improvements in total nasal symptom score and quality of life. Notably, as-needed use is associated with half the intranasal corticosteroid exposure of regular use, providing flexibility in treatment approaches.

The drug's fast onset of action, with therapeutic effects observed as early as 8 hours after initial administration, further supports its effectiveness in rapidly addressing allergic rhinitis symptoms.

Overall, fluticasone furoate nasal spray is an effective and well-tolerated treatment option for allergic rhinitis. Its novel formulation, once-daily dosing, and demonstrated efficacy in clinical studies, alongside a comparison with other corticosteroids, position it as a valuable therapeutic choice for patients experiencing nasal and ocular symptoms associated with allergic rhinitis.

Beclomethasone

The drug's localized action confines its effects to the application site, minimizing systemic exposure. This improvement in formulation, compared to earlier corticosteroids such as hydrocortisone, prednisolone, dexamethasone, and betamethasone, results in more rapid metabolism, reduced nasal mucosa irritation, and a longer duration of action.

Of particular note is its effectiveness in children, addressing concerns about potential systemic side effects in younger populations. In the pediatric population aged 4 to 11 years, beclomethasone dipropionate nasal aerosol at 80 μg/day has demonstrated both safety and efficacy in controlling nasal symptoms associated with perennial allergic rhinitis.

Real-world effectiveness is underscored by the BALANCE study, focusing on patients with perennial allergic rhinitis. Beclomethasone dipropionate nasal aerosol significantly improves symptoms, leading to high patient satisfaction, reduced productivity loss, and enhanced sleep quality.

Overall, beclomethasone dipropionate is a well-tolerated and effective treatment for allergic rhinitis in adults and children. Its localized action, improved formulation, and real-world effectiveness contribute to its standing as a standard in intranasal corticosteroid therapy.

4. Side Effects

While generally well-tolerated, both nasal sprays carry potential adverse effect risks requiring monitoring.

Fluticasone

Common side effects:

• Minor nosebleeds
• Burning or itching in the nose
• Sores or white patches inside or around the nose
• Cough, trouble breathing
• Headache, back pain
• Sinus pain, sore throat, fever
• Nausea, vomiting

Severe side effects:

• Signs of allergic reaction like hives, rash, difficulty breathing
• Noisy breathing, runny nose, or crusting around nostrils
• Redness, sores, or white patches in the mouth or throat
• Blurred vision, eye pain, or seeing halos around lights
• Any wound that does not heal
• Signs of hormonal disorder like worsening tiredness, muscle weakness, nausea, vomiting

Beclomethasone

Common side effects:

• Discomfort or irritation inside the nose
• Sneezing, runny or stuffy nose
• Nosebleed
• Fever, sore throat
• Headache, nausea
• Unpleasant taste or smell

Severe side effects:

• Signs of allergic reaction like hives, difficulty breathing
• Severe or ongoing nosebleeds
• Sores in the nose that won't heal
• Blurred vision, eye pain, or seeing halos around lights
• Signs of hormonal disorder like worsening tiredness, muscle weakness, nausea, vomiting, changes in appetite or weight

5. Cost

Branded nasal sprays carry high sticker prices, but savings programs can reduce out-of-pocket expenses. Let's compare.

Fluticasone

Fluticasone nasal is available under the brand name Flonase Allergy Relief. Fluticasone nasal spray (50 mcg/inh) costs approximately $12 for a supply of 9.9 milliliters, depending on the pharmacy you visit.

It's important to note that these prices are for cash-paying customers and may not be valid with insurance plans. However, the Drugs.com discount card can provide savings of up to 80% or more, making it a valuable option for cost-conscious individuals.

Beclomethasone

Beclomethasone, specifically in the form of Qvar RediHaler, is a corticosteroid inhaler used for long-term asthma control. It is inhaled twice daily through the mouth and is not intended to treat sudden asthma symptoms.

The GoodRx lowest price for Qvar RediHaler is $239.82, reflecting a 29.42% savings from the average retail price of $339.79. It's essential to consult with healthcare providers for potential assistance or copay programs, especially for low-income individuals or uninsured/underinsured.

For Beclomethasone nasal spray (Qnasl), used for Nasal Congestion and Allergic Rhinitis, the GoodRx lowest price is $257.04, providing a 28.61% savings from the average retail price of $360.05. Qnasl is a steroid nasal spray effective in treating nasal symptoms caused by allergies.

Wrap Up

Both fluticasone and beclomethasone are corticosteroid nasal sprays that suppress inflammation to relieve allergy symptoms. They have similar mechanisms of action and dosage guidelines.

Fluticasone furoate demonstrates high efficacy in studies, with a rapid onset of action and flexibility in use approaches. Beclomethasone is also effective, especially for pediatric patients, with its localized action minimizing systemic exposure. Common side effects for both include nasal irritation and discomfort. Fluticasone nasal spray costs about $12, while beclomethasone inhalers are far more expensive without insurance.

Overall, both intranasal corticosteroids are valuable options for managing allergic rhinitis, with some key differences in formulations, efficacy data, pediatric use, side effect risks, and cost considerations.

Are Fluticasone and Beclomethasone safe for long-term use?

Yes, nasal administered corticosteroids are generally considered safe for regular long-term use. It's still smart to use the lowest dose needed to control symptoms. Discuss any concerns with your doctor.

How long does it take for Fluticasone and Beclomethasone to begin working?

It typically takes between 1 to 2 weeks after starting regular use of these medications for their full effects to be felt. It is essential when starting on them not to quit usage early before seeing their complete benefits. Be consistent with the treatment regimen.

Should I rinse out my mouth after using Fluticasone or Beclomethasone inhalers?

Yes, it is recommended to rinse out your mouth thoroughly with water and spit after using these inhalers. While this practice is more common with inhaled steroids used for asthma treatment, it can still be beneficial for nasal-administered steroids like Fluticasone or Beclomethasone. Rinsing helps minimize the potential for any residual medication in the mouth and reduces the risk of issues like oral thrush.