Nasonex vs. Flonase: Differences and Alternatives

Corticosteroid nasal sprays are a big help for allergy sufferers — they work by easing inflammation in the nose. They’re often the go-to solution for easing congestion, sneezing, and runny nose.

Nasonex and Flonase share the same goal, which is to relieve allergies, but they each have unique features that set them apart. Their differences could make one more suitable for your needs.

In this article, we’ll help you determine which one might be better for you, and even explore a helpful alternative if neither fits your needs.

Related: How Long Does It Take for Allergy Medicine to Work?

What is Nasonex?

Nasonex is a prescription nasal spray used to treat nasal symptoms such as congestion, sneezing, and a runny nose caused by allergic rhinitis (hay fever) or other environmental allergies. Its active ingredient is mometasone furoate, which is a type of corticosteroid.

Mometasone furoate works by reducing swelling and irritation inside the nose. It blocks certain chemicals in the body that cause inflammation. This action not only relieves allergy symptoms like congestion and sneezing but has also been found effective in managing daytime cough associated with allergies [*].

Nasonex 24HR Allergy targets irritated sinuses and nasal passages for all-day, non-drowsy relief. For kids aged 2 to 11, there’s a gentle, scent-free option with Children’s Nasonex 24HR Allergy Nasal Spray.

What is Flonase?

Flonase is an over-the-counter nasal spray that relieves allergy symptoms. Its active ingredient, fluticasone propionate, is a corticosteroid that reduces inflammation in the nose [*].

Unlike some medications, Flonase blocks multiple inflammatory substances like histamine, prostaglandins, and leukotrienes. This helps ease nasal congestion, sneezing, runny nose, and itchy eyes.

Flonase is available in several options to suit different needs.

FLONASE Allergy Relief is designed for adults and children 12 years and older and is also indicated for relieving itchy, watery eyes. FLONASE Sensimist features Patented MistPro Technology, which delivers a fine, gentle, scent-free mist with virtually no drip, and is also suitable for itchy, watery eyes in those 12 and older. For younger users, Children’s FLONASE Sensimist is a kid-friendly option specifically made for ages 2 and up to offer effective relief in a gentle mist.

Related: Afrin vs. Flonase: Differences and Alternatives

Nasonex vs. Flonase

Now that we’ve explored the basics of Nasonex and Flonase individually, it’s time to take a closer look at how they compare across key factors like effectiveness, side effects, and precautions. Let’s dive into a side-by-side comparison using the table below.

	Nasonex	Flonase
Drug Class	Corticosteroids	Corticosteroids
Generic Name	Mometasone Furoate	Fluticasone Propionate
Indications	Used to treat and manage symptoms of nasal allergies, such as a stuffy or runny nose, sneezing, and itching. It is effective for both seasonal allergies, like those caused by pollen, and year-round allergies, such as those triggered by dust mites, pet dander, or mold. May also reduce and treat nasal polyps ( small growths inside the nose that can cause congestion and discomfort). Additionally, it may be used preventively before exposure to known allergens.	Effective in managing nasal symptoms for both perennial nonallergic rhinitis and allergic rhinitis, such as sneezing, runny or stuffy nose, and nasal itching. May be prescribed for adults to help alleviate symptoms associated with chronic rhinosinusitis, which may include nasal congestion and discomfort from nasal polyps.
Side Effects	Common side effects include headaches, nosebleeds, sore throat, cough, and irritation in the nasal passages. In rare cases, it can cause more serious side effects, such as nosebleeds, signs of an allergic reaction, and nasal septum perforation (a small hole in the wall between the nostrils). If you experience these side effects, seek immediate medical attention.	May cause some common side effects, including nasal irritation such as burning, dryness, or discomfort in the nasal passages, as well as occasional nosebleeds (epistaxis). Users might also experience headaches, sore throat, or a mild cough. Gastrointestinal symptoms like nausea and vomiting can occur, although they are less common. While rare, serious side effects may include allergic reactions such as a rash, swelling in the face, throat, or tongue, and difficulty breathing. If any severe symptoms occur, immediate medical attention should be sought.
Duration/Course	24 hours (all day relief) with a once-daily dose	Provides 24-hour (all day) relief
Onset	Within 12 hours after the first dose. However, maximum benefit is usually achieved after a few days of consistent use.	Can provide symptom relief within 12 hours after the first dose, with some patients experiencing relief as early as 2 to 4 hours. Note that maximum benefit from Flonase typically requires 2 to 3 days of consistent daily use.
Dosage	For adults and children 12 years and older: The typical starting dose is 2 sprays in each nostril once daily. For children aged 2 to 11 years: The usual dose is 1 spray in each nostril once daily, under adult supervision.	For both FLONASE Allergy Relief and FLONASE Sensimist, the recommended starting dose for adults and children aged 12 years and older is 2 sprays in each nostril once daily for the first week. Once symptoms improve, the dose can be reduced to 1 spray in each nostril once daily for maintenance. For Children’s FLONASE Sensimist, the recommended dosage for children aged 2 to 11 years is 1 spray in each nostril once daily, under adult supervision.
Drug Interaction	Strong inhibitors of the CYP3A4 enzyme, such as ketoconazole, itraconazole, clarithromycin, and ritonavir, can increase plasma concentrations of mometasone, which raises the risk of systemic corticosteroid side effects. Other moderate interactions involve medications like antifungals (ketoconazole, itraconazole), macrolide antibiotics (erythromycin, clarithromycin), and other corticosteroids (prednisone, dexamethasone), as well as HIV protease inhibitors (atazanavir, darunavir) and other common drugs such as albuterol, montelukast, loratadine, ibuprofen, and various vitamins and supplements. Additionally, Nasonex may interact with certain diseases, including active or untreated infections, systemic fungal infections, and ocular herpes simplex, which require caution due to the potential exacerbation of these conditions.	May interact with certain medications, particularly CYP3A4 inhibitors, which can affect its metabolism and increase its levels in the body. For example, ketoconazole, ritonavir, erythromycin, and clarithromycin can all raise fluticasone levels, which heightens side effects. Ritonavir, in particular, can significantly increase plasma concentrations of fluticasone, which leads to reduced cortisol levels and potential systemic corticosteroid effects, including Cushing's syndrome and adrenal suppression. Combining Flonase with desmopressin may increase the risk of low sodium levels or water retention. Additionally, using Flonase alongside other corticosteroids may heighten the risk of corticosteroid-related side effects.
Warnings/Precautions	First, it should not be used by individuals who have recently had nasal surgery, trauma, or nasal ulcers until they have healed, as it may cause further irritation. Long-term use of Nasonex, especially in children, may affect growth, so regular monitoring of growth in pediatric patients is advised. Lastly, if you experience unusual symptoms such as severe nasal irritation, a constant whistling sound from your nose, nosebleeds, or breathing difficulties, seek medical attention right away.	Patients with recent nasal ulcers, surgery, or trauma should avoid Flonase until the affected area has healed, as it may exacerbate these conditions. Flonase can worsen infections, such as tuberculosis or ocular herpes simplex, and should be used cautiously in individuals with active or latent infections. Long-term use may increase the risk of glaucoma and cataracts, which requires regular monitoring for changes in vision. Growth suppression has been observed in pediatric patients using intranasal corticosteroids like Flonase, so monitoring growth is recommended.

What’s the Best Alternative to Nasonex and Flonase?

If you're looking for a more effective alternative to Nasonex and Flonase, Allermi nasal spray is a great option. Unlike single-ingredient sprays, Allermi combines a corticosteroid, decongestant, antihistamine, and anticholinergic.

Each of these ingredients works together to address different allergy symptoms, including inflammation, congestion, and excess mucus. The active ingredients in Allermi nasal spray are FDA-approved and commonly used to treat nasal allergies (rhinitis or hay fever).

This makes Allermi a more complete solution compared to the single-action sprays like Nasonex and Flonase. Plus, Allermi is safe for long-term daily use, and your formula can be adjusted as needed to fit your progress!

Related: What to Do When Allergy Medicine Doesn't Work?

The Bottom Line

Nasonex, with its corticosteroid mometasone furoate, is designed to reduce inflammation and manage symptoms like congestion and sneezing. Flonase, with fluticasone propionate, tackles multiple inflammatory substances.

However, for a more comprehensive treatment, Allermi nasal spray combines multiple active ingredients, such as a corticosteroid, decongestant, antihistamine, and anticholinergic, to target various symptoms of rhinitis.

It's important to speak with your doctor before trying a new treatment to make sure it's suitable for your condition.

References:

1. Passali, D., Spinosi, M. C., Crisanti, A., & Bellussi, L. M. (2016). Mometasone furoate nasal spray: A systematic review. Multidisciplinary Respiratory Medicine, 11, 18. https://doi.org/10.1186/s40248-016-0054-3
2. Fluticasone. ScienceDirect. https://www.sciencedirect.com/topics/veterinary-science-and-veterinary-medicine/fluticasone