Dymista vs. Flonase: differences, similarities, and which is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Coughing, sneezing, runny nose (or nasal congestion), itchy and watery eyes, oh my! Every year, more than 50 million Americans suffer from these bothersome allergy symptoms. It can be overwhelming to decide what medication(s) to use to treat your symptoms.

Dymista and Flonase (fluticasone propionate) are medications used in treating allergy symptoms in children and adults. Dymista is a combination medication that contains both an antihistamine and a steroid (corticosteroid), and Flonase contains a steroid only. While Dymista is available in brand name only, Flonase is available by prescription in generic form, and over the counter (OTC) in brand name as well as generic. While they both treat allergies, there are differences in the two medications.

What are the main differences between Dymista and Flonase?

Dymista (What is Dymista?) contains two medications, azelastine hydrochloride (an antihistamine) and fluticasone propionate (a steroid). Dymista is indicated to treat seasonal allergic rhinitis in patients six years and older who need treatment with both azelastine and fluticasone to relieve symptoms. It is currently available in brand name only, and by prescription only. Each actuation (one spray) contains 50 mcg of fluticasone and 137 mcg of azelastine.

Flonase (What is Flonase?) is a nasal steroid and contains fluticasone propionate. It is indicated for the management of perennial nonallergic rhinitis (chronic symptoms of postnasal drip, runny or stuffy nose, sneezing) symptoms in adults and children four years and older. It is available in generic form by prescription, and over the counter in both brand (as Flonase Sensimist, Children’s Flonase Sensimist, and Children’s Flonase Allergy Relief) and generic form. Each actuation (one spray) contains 50 mcg of fluticasone.

Conditions treated by Dymista and Flonase

Dymista is indicated for the relief of symptoms of seasonal allergic rhinitis in patients six years and older who need both azelastine and fluticasone treatment for relief of symptoms.
Flonase is indicated in patients four years and older for the management of nasal symptoms of perennial nonallergic rhinitis.

Is Dymista or Flonase more effective?

In a clinical study of the safety and efficacy of Dymista in adults and adolescents 12 years of age and older, Dymista was found to have a significant effect on nasal symptoms as compared to each component (azelastine, fluticasone) alone as well as placebo.

In an analysis of fluticasone nasal spray, patients in two out of three trials experienced a significant decrease in nasal symptoms as compared to placebo.

Generally, either Dymista or Flonase can be very helpful in managing symptoms. The most effective medication should be determined by your doctor taking into account your medical condition(s) and medical history, as well as other medications you are taking.

Coverage and cost comparison of Dymista vs. Flonase

Dymista is available by prescription in brand name only. The cost without insurance is approximately $231. Insurance usually covers Dymista; copays will vary but you can use a SingleCare coupon and get Dymista for around $183. Medicare Part D generally does not cover Dymista.

Some insurances require a prior authorization for Dymista, and your doctor will have to provide more details to the insurance as to why you need this medication. If your insurance does not cover Dymista at all or denies the prior authorization request, your doctor may instead call in separate prescriptions for Flonase (fluticasone) and Astepro (azelastine), which are the two components of Dymista, both available in generic, and should be covered by insurance.

Flonase is available by prescription in generic form only, and OTC in brand or generic. You can buy the brand name drug over the counter; it is generally not covered by insurance or Medicare Part D. However, you can get generic fluticasone propionate for around $17 by using a SingleCare savings card or coupon.

Common side effects of Dymista and Flonase

Because both drugs contain fluticasone, the possible side effects of Dymista and Flonase are similar. Most patients tolerate both drugs very well; serious side effects are rare. The most common side effects of Flonase are headache, sore throat, nosebleeds, nasal irritation, nausea/vomiting, asthma symptoms, and cough. The most common side effects of Dymista are altered sense of taste, nosebleeds, and headache. Consult your healthcare provider for a complete list of side effects.

Source: DailyMed (Dymista), DailyMed (Flonase)

Drug interactions of Dymista and Flonase

Because both drugs contain fluticasone, the adverse effects are similar. With desmopressin, which is used for bedwetting, concurrent use with Flonase or Dymista could lead to water retention and low sodium levels.

All of the drugs listed in the table below interact (with both Flonase and Dymista) in a way that significantly increases steroid levels in the body, which could increase the risk of steroid side effects. This is due to an enzyme called CYP3A4, which is involved in many drug interactions.

Warnings of Dymista and Flonase

Warnings of Flonase

Patients should be periodically monitored for adverse effects on the nasal mucosa, such as nosebleeds, fungal infection, and impaired wound healing. Flonase should not be used in patients with recent nasal ulcers, nasal surgery, or nasal trauma.

Other warnings to watch out for:

• Patients who notice vision changes, patients with a history of increased intraocular pressure, or patients who use Flonase long-term should see an ophthalmologist to check for glaucoma and cataracts.
• Hypersensitivity reactions, such as anaphylaxis or rash, have been reported. Flonase should be stopped if these effects occur.
• Use with caution in patients with existing tuberculosis; fungal, bacterial, viral, or parasitic infection; ocular herpes simplex, as Flonase could cause worsening of the infection. More serious or even fatal cases of chickenpox or measles can occur in susceptible patients.
• Patients should be monitored for adrenal suppression. When the body doesn’t make enough steroid hormone, symptoms may include tiredness, weakness, nausea, vomiting, low blood pressure. Flonase should be slowly discontinued if changes occur.
• Monitor the growth of pediatric patients due to the possibility of reduced growth velocity; use the lowest effective dose.

Due to the lack of available data, Flonase should only be used in pregnancy or while breastfeeding if the benefit to the mother outweighs the risk to the fetus. Consult your OB/GYN for advice.

Warnings of Dymista

Because Dymista also contains fluticasone, which is found in Flonase, all of the above Flonase warnings apply to Dymista as well. The following warnings also apply, due to the azelastine component of Dymista.

• Dymista may cause drowsiness; patients should use caution while driving or operating machinery.
• Avoid alcohol or other CNS depressants with Dymista because the combination may cause impairment and decreased alertness.

The manufacturer recommends only using Dymista during pregnancy if the benefit is greater than the risk. Consult your OB/GYN for guidance. Dymista is not recommended while breastfeeding; the manufacturer recommends either stopping Dymista or stopping breastfeeding.

Frequently asked questions about Dymista vs. Flonase

What is Dymista?

Dymista is a combination nasal spray that has an antihistamine and a steroid to help relieve symptoms of seasonal allergies in adults and children.

What is Flonase?

Flonase is a steroid nasal spray that helps manage nasal symptoms of perennial nonallergic rhinitis (chronic symptoms of postnasal drip, runny or stuffy nose, sneezing) in adults and children.

Are Dymista and Flonase the same?

No. Flonase contains the steroid fluticasone propionate; Dymista contains fluticasone propionate along with an antihistamine, azelastine.

Is Dymista or Flonase better?

It depends on your symptoms; everyone is different. Consult your healthcare professional for personalized advice based on your medical history and symptoms. Most people do well with one of these medications, or another similar medication such as Nasonex (mometasone) or Nasacort (triamcinolone).

How long should you use Dymista nasal spray?

The length of treatment varies by symptoms as well as side effects. Consult your physician for advice.

Can you use Flonase and Dymista together?

Generally, these drugs are not used together. One or the other would suffice.

What are the side effects of long term use of the antihistamine?

Dymista, which contains the antihistamine azelastine, was shown to be well-tolerated after one year of use. The FDA approval of Dymista was based on long-term safety data. The most common side effects were altered sense of taste, nosebleed, and headache. Consult your healthcare provider about the appropriate duration of treatment for you.

Remember, the most effective medication should only be determined by your doctor who will look at the whole picture of your medical condition(s), health history, and other medications that could interact with Flonase or Dymista.