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Drug vs. Drug

Afrin vs. Flonase: Differences, similarities, and which is better for you

Kristi Torres writer headshot By | Updated on April 6, 2020

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

Nasal congestion occurs when blood vessels and surrounding tissues of the nasal passageway become overwhelmed by excess fluid. This creates a “stuffy” or plugged feeling in the nose, which may make it difficult to breathe. Nasal congestion may be accompanied by a runny nose, sneezing, cough, or headache.

Afrin (oxymetazoline) and Flonase (fluticasone propionate) are each nasal sprays that can provide a relief of symptoms related to nasal congestion. Though they are both nasal sprays, the mechanism by which they relieve congestion is very different.

What are the main differences between Afrin and Flonase?

The active ingredient in Afrin, oxymetazoline, is an alpha-adrenergic agonist. When used topically in nasal passages, it is a vasoconstrictor. This results in decreased fluid flow into the tissue and blood vessels of the nasal passageway, as well as an opening of the airway.

Afrin is effective in as little as 10 minutes, and its effects may last up to 12 hours. Although it is a very effective decongestant, there is evidence that it may cause rebound congestion when used for more than three days. Therefore, long-term use is not recommended. Afrin is available in various types of nasal spray solutions containing 0.05% oxymetazoline. There are 15 ml and 30 ml package sizes available. Afrin is available over-the-counter (OTC) without a prescription. Afrin is not indicated for children under 6 years of age, as well as adults.

Flonase, fluticasone propionate, is a corticosteroid. When corticosteroids are applied topically in the nasal passages, they exhibit antipruritic, anti-inflammatory, and vasoconstrictive properties. Corticosteroids induce peptides known as lipocortins, which then decrease the formation and release of inflammatory mediators. The effect of Flonase builds overtime after consistent use, and therefore it may take several days or weeks to realize the full benefit of Flonase. Flonase is available as a prescription and over-the-counter. As a prescription, it is a nasal spray bottle containing 120 sprays. The over-the-counter version is available as 60 spray or 120 spray bottles. Flonase can be used in children 4 years of age or older, as well as adults.

Main differences between Afrin and Flonase
Afrin Flonase
Drug class Alpha-adrenergic agonist Corticosteroid
Brand/generic status Brand and generic available Brand and generic available
What is the generic name? Oxymetazoline Fluticasone propionate
What form(s) does the drug come in? Nasal spray Nasal spray
What is the standard dosage? Two to three sprays in each nostril every 12 hours One to two sprays in each nostril daily
How long is the typical treatment? 3 to 5 days Several days to months
Who typically uses the medication? Adults, Children 6 years of age or older Adults, Children 4 years of age or older

Conditions treated by Afrin vs. Flonase

Afrin is indicated to treat nasal congestion. It is used off-label to induce vasoconstriction in nasal procedures. Afrin has no direct effect on inflammatory or allergic mediators, which may lead to sinus congestion.

Flonase is a prescription is indicated to treat allergic and nonallergic (perennial) rhinitis. The over-the-counter product is labeled to treat upper respiratory allergy symptoms related to hay fever or allergic rhinitis. These symptoms include stuffy nose, sneezing, runny nose, itchy nose, and itchy, watery eyes. It is the only over-the-counter nasal spray that carries an indication for all of these symptoms.

Condition Afrin Flonase
Sinus congestion Yes Yes
Vasoconstriction for nasal procedures Off-label No
Allergic rhinitis No Yes
Nonallergic rhinitis No Yes
Upper respiratory allergy symptoms No Yes

Is Afrin or Flonase more effective?

Afrin’s onset of action is 10 minutes, which provides patients with quick relief of nasal symptoms. Unfortunately, it is only recommended for use short term: three days or less. The full effect of Flonase may not be realized for a week or longer, but it is safe to be used long term. Flonase is also indicated to treat more than nasal congestion. It relieves multiple symptoms of the allergic response, including runny nose, sneezing, and itching eyes. Afrin has no effect on these allergic response factors.

One study looked at the concurrent use of oxymetazoline and fluticasone to determine if they could augment the response of each on congestion. It compared three treatment groups: placebo, oxymetazoline alone, and fluticasone with oxymetazoline. In this study, oxymetazoline was used for longer than the recommended duration of three days. Nasal air volume was significantly higher in the group using both oxymetazoline and fluticasone. It was also noted that rebound congestion was not present, suggesting that effect with oxymetazoline alone should be studied further. Your healthcare provider can help determine which product(s) are best for you.

Coverage and cost comparison of Afrin vs. Flonase

Afrin is typically not covered by insurance because it is not a prescription product. This is true for both Medicare and commercial plans. The retail cost for a 15 ml bottle could be as high as about $11. Your doctor can issue a prescription for Afrin, and with a SingleCare coupon, you could get the generic version for as low as $5.11.

Flonase, or its generic, is typically covered by commercial and Medicare drug plans. The retail price for Flonase in a bottle containing 120 sprays can be as much as $28 but with a coupon, patients could pay as little as $11-$12 with a prescription.

Afrin Flonase
Typically covered by insurance? No Yes
Typically covered by Medicare? No Yes
Standard dosage 15 ml bottle 16 g bottle
Typical Medicare copay n/a Varies, but typically less than $10
SingleCare cost $5-$14 $11-$32

Common side effects of Afrin vs. Flonase

Afrin is known to cause a temporary, local irritation to the nasal mucosa, and this can induce sneezing. This should pass within a few minutes of administration. If Afrin is used for more than three days, patients may experience rebound congestion. This phenomenon, also known as rhinitis medicamentosa, is believed to be caused when the vasoconstriction induced by Afrin cuts off blood supply to the local tissues. This leads to swelling and inflammation. The sensation of the rebound congestion is said to feel worse than the original congestion Afrin was treating.

Flonase has a relatively high incidence of headaches with as much as 16% of patients experiencing headache after Flonase administration. Another very common side effect is nose bleeds or epistaxis.

Both Afrin and Flonase can cause local irritation of the nasal mucosa.

The following chart is not intended to be a complete list of all possible side effects. Please consult your doctor or pharmacist for a list of all possible side effects.

Afrin Flonase
Side effect Applicable? Frequency Applicable? Frequency
Headache No n/a Yes 4%-16%
Dizziness No n/a Yes 1%-3%
Nausea/ Vomiting No n/a Yes 3%-5%
Local irritation Yes Not defined Yes 4%-6%
Increased intraocular pressure No n/a Yes 1%-3%
Epistaxis No n/a Yes 6%-12%
Nasal mucosal ulcer No n/a Yes 3%-8%
Nasopharyngitis No n/a Yes 8%
Acute sinusitis No n/a Yes 5%
Blood in nasal mucosa No n/a Yes 1%-3%
Dry nose Yes Not defined Yes 1%-3%
Rebound nasal congestion Yes Not defined No n/a
Sore throat No n/a Yes 1%-3%

Source: Afrin (DailyMed)  Flonase (DailyMed).

Drug interactions of Afrin and Flonase

Although both Afrin and Flonase have primarily a local effect where they are applied topically in the nose, there are some other medications that may interact with them.

Ergot derivatives are a class of medications that may be used to treat migraines. Migranal is a nasal spray ergot derivative that works by causing marked vasoconstriction. The concurrent use of Afrin, which also causes vasoconstriction, would result in an extreme amount of vasoconstriction. This combination should be avoided.

Esketamine is an antidepressant nasal product administered once or twice weekly. Both Afrin and Flonase may decrease the effects of esketamine. If a nasal decongestant is necessary on an esketamine dosing day, the nasal decongestant should be administered at least one hour prior to esketamine.

The following table is not intended to be a complete list of possible drug interactions. Please consult your medical professional for a complete list.

Drug Drug Class Afrin Flonase
Atomoxetine Norepinephrine reuptake inhibitor Yes No
Cannabinoids Yes No
Desmopressin Vasopressin analog No Yes
Ergot derivatives Yes No
Esketamine NMDA receptor antagonist Yes Yes
Fentanyl (nasal serum) Opioid Yes No
Antibiotics Yes No
Tricyclic antidepressants Yes No

Warnings of Afrin vs. Flonase

Afrin is only intended to be used in a dosing increment of every 12 hours for not more than three days. Use of this product for any longer than recommended may result in extreme rebound congestion. Afrin may cause temporary discomfort such as stinging, itching, or burning in the nasal passage.

Flonase could slow healing after a nasal procedure or surgery and should not be used until approved by your doctor. If you take systemic steroids or immunosuppressant drugs, such as HIV drugs, talk to your doctor or pharmacist before using Flonase. Stinging or sneezing may occur immediately after administration. If your symptoms do not improve after seven days of use of Flonase, consult your physician.

Nasal spray containers are intended to be used by a single person. Sharing a nasal spray container may result in infection. Nasal sprays should not be sprayed in the eyes or mouth.

Frequently asked questions about Afrin vs. Flonase

What is Afrin?

Afrin is an over-the-counter nasal spray decongestant. It contains oxymetazoline, which is an alpha-adrenergic agonist that causes local vasoconstriction. Afrin is fast-acting, but should not be used for more than three consecutive days.

What is Flonase?

Flonase is a corticosteroid nasal spray available both as a prescription and over-the-counter. It contains the active ingredient fluticasone, which decreases the production of inflammatory mediators in the nasal passageway. Flonase reaches its full effect after several days or weeks and is safe to use long term.

Are Afrin and Flonase the same?

While both Afrin and Flonase are both nasal sprays that relieve the symptoms of nasal congestion, they are not the same. Afrin is a local vasoconstrictor that limits fluid infiltration to the nasal passage. Flonase is a steroid that mediates the inflammatory response brought on by an allergic response.

Is Afrin or Flonase better?

Afrin provides a faster response to congestion with an onset of action within 10 minutes. It is not recommended for use longer than three days, however. Flonase is slower to relieve congestion symptoms but can be used safely long term. Flonase is effective against other allergy symptoms such as runny nose, sneezing, and itchy eyes.

Can I use Afrin or Flonase while pregnant?

There have been adverse fetal events associated with Afrin use in the first trimester of pregnancy. Although one-time use in late pregnancy has not been shown to be harmful, Afrin is not a preferred nasal decongestant in pregnancy. Flonase may be safe to use during pregnancy, however other decongestant or steroid sprays may have more safety data available. Consult your physician for the preferred nasal decongestant choice.

Can I use Afrin or Flonase with alcohol?

Afrin and Flonase may be safely administered in patients who consume alcohol.

Is Afrin a steroid nasal spray?

Afrin is not a steroid. It is an alpha-adrenergic agonist that works by inducing vasoconstriction in the nasal passage.

Is flonase an antihistamine or decongestant?

Flonase is not an antihistamine or direct decongestant. It helps to relieve the symptoms of nasal congestion by slowing the infiltration of inflammatory mediators released during the allergic response.

When should I take Flonase morning or night?

Flonase may be dosed in one of two ways. A patient can either administer one spray in each nostril in the morning and/or evening (up to four total sprays in a 24-hour period), or patients may administer two sprays in each nostril at the same time, morning or evening.