Flonase vs. Nasacort: 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

Runny nose, itchy, watery eyes—‘tis the season for seasonal allergies. If you suffer from seasonal or perennial allergies, you are not sneezing alone. More than 50 million Americans suffer from allergies each year.

Flonase (fluticasone propionate, or fluticasone) and Nasacort (triamcinolone acetonide, or triamcinolone) are two popular medications used for allergy relief. They are in a class of medications called glucocorticoids, more commonly known as steroids. Nasal steroids work by decreasing swelling and congestion in your nose, improving symptoms. Although both medications are known as steroids, they do have some notable differences, which we will outline below.

What are the main differences between Flonase and Nasacort?

Flonase (fluticasone) and Nasacort (triamcinolone) are both nasal corticosteroids used to treat allergies. Several years ago, both drugs were only available with a prescription, but now are available over-the-counter (OTC). Both drugs are available in adult and children’s formulations.

Flonase still available as a prescription drug, as its generic, fluticasone. Flonase is also available in a “Sensimist,” in adult and children’s formulations, which delivers a more gentle mist. Both drugs can be used in children and adults, but Nasacort can be used in children 2 years and older, while Flonase can be used in children 4 years and older.

Conditions treated by Flonase and Nasacort

Flonase and Nasacort are used to treat symptoms of nasal allergy. Both drugs can be used for seasonal or perennial allergy symptoms. Flonase and Nasacort can also be used off-label for several conditions like nasal polyps and chronic or viral rhinosinusitis (or bacterial rhinosinusitis in addition to antibiotics).

Is Flonase or Nasacort more effective?

A recent study found after 28 days of treatment that Flonase and Nasacort are similarly effective in treating nasal allergy symptoms and are both well-tolerated. Another study showed that Flonase and Nasacort are equally safe, effective, and well-tolerated.

The most effective medication for you should be determined by you, along with your doctor, who can take into account your medical condition(s), history, and other medications you take.

Coverage and cost comparison of Flonase vs. Nasacort

Flonase is typically covered by insurance as well as Medicare Part D in the prescription form of generic fluticasone, but the OTC version is not usually covered. The Medicare Part D copay for generic fluticasone ranges from $0-$20. Flonase can cost over $50 but can be purchased for as low as $12-$29 with a SingleCare pharmacy coupon.

Nasacort is only available OTC and is generally not covered by insurance (some state Medicaid plans may pay for generic) or Medicare Part D. The retail price for Nasacort commonly costs over $20 but you can get it at a participating pharmacy for as low as $13.50 with a SingleCare coupon.

Common side effects of Flonase vs. Nasacort

Both drugs are well tolerated. The most common symptoms of Flonase are headache, nausea/vomiting, asthma symptoms, and cough. The most common side effects of Nasacort are headache, asthma symptoms, and cough. Other side effects listed for both drugs occurred at around the same frequency as placebo (inactive medication), such as nosebleeds and sore throat.

This is not a complete list of side effects; other side effects may occur. Consult your healthcare provider for a full list of side effects.

Source: DailyMed (Flonase), FDA Label (Nasacort)

Drug interactions of Flonase vs. Nasacort

Flonase is processed by an enzyme called cytochrome-P 450 3A4, otherwise known as CYP3A4. Certain drugs inhibit this enzyme, and slow it down from processing Flonase, leading to a buildup of Flonase, and increased steroid side effects. Therefore, these strong inhibitors should not be taken with Flonase. Nasacort does not have any drug interaction information available. Other interactions may be possible; check with your healthcare provider for medical advice.

Warnings of Flonase and Nasacort

• Localized effects that may occur are nosebleeds, nasal ulceration, local Candida (yeast) infection, nasal septal perforation, and impaired wound healing.
• Steroids may cause glaucoma or cataracts. You should be closely monitored if you have any changes in vision or if you have a history of increased intraocular pressure, glaucoma, and/or cataracts. If you use Flonase or Nasacort long-term or have any eye symptoms, you should follow up regularly with an ophthalmologist.
• If a hypersensitivity reaction occurs (skin symptoms, trouble breathing, facial swelling), discontinue Flonase or Nasacort and seek emergency medical attention.
• Because steroids suppress the immune system, you are more prone to infections while using a steroid nasal spray.
• Children may experience a reduction in growth velocity; growth should be closely monitored. The lowest possible dose, for the shortest duration of time, should be used.
• Rarely, adrenal suppression may occur, and the nasal steroid should be slowly tapered to discontinuation (not stopped abruptly).
• Because there is not enough data about nasal steroids in pregnancy, you should consult with your doctor before taking Flonase or Nasacort if you are pregnant. If you are already taking Flonase or Nasacort and find out that you are pregnant, contact your healthcare provider for guidance.

Frequently asked questions about Flonase vs. Nasacort

What is Flonase?

Flonase is a nasal steroid that can help relieve allergy symptoms. The active ingredient is fluticasone propionate. It is available OTC as a brand and generic, and by prescription in its generic form. It can be used in adults and children ages 4 and older.

What is Nasacort?

Nasacort is a nasal steroid used to help relieve symptoms of allergy. The active ingredient in Nasacort is triamcinolone. It is available OTC in both brand and generic. Nasacort can be used in adults as well as children ages 2 and older.

Are Flonase and Nasacort the same?

Flonase and Nasacort are very similar and have many of the same uses and warnings. However, they have some notable differences, such as in the active ingredient, drug interactions, and price, as outlined above. Other medications in the nasal steroid category you may have heard of include Rhinocort (budesonide), QNasl (beclometasone), and Nasonex (mometasone). Fluticasone is also available as a combination drug in the form of brand-name Dymista, which contains azelastine along with fluticasone.

Is Flonase or Nasacort better?

Both drugs have been found in studies to be very well-tolerated, and effective in improving symptoms. It may take a bit of trial and error to figure out if Flonase or Nasacort is better for you.

Can I use Flonase or Nasacort while pregnant?

There is not enough data, so it is best to discuss your allergy symptoms with your doctor and see what he/she suggests. It may be safe to take Flonase or Nasacort if needed during pregnancy, but it depends on the individual case, so it is safest to ask your doctor.

Can I use Flonase or Nasacort with alcohol?

Flonase or Nasacort are safe to use with alcohol. However, if you are taking other medications for your allergy symptoms, check with your doctor or pharmacist to see if those medications are compatible with alcohol.

Which nasal allergy spray is most effective?

There are a variety of nasal allergy sprays, and some work in different ways. While drugs like Flonase and Nasacort are steroids, some nasal allergy sprays contain other ingredients such as azelastine, which is an antihistamine and works differently than a steroid. Many people like Afrin nasal spray; however, you have to be very careful to use this medication for only 3 days or less, otherwise it can cause rebound congestion. The most effective allergy spray is the one that works best for you, and it may take some trial and error to determine which allergy spray works best.

Is Nasacort good for sinus infection?

While Nasacort may help relieve some of the nasal symptoms caused by a sinus infection, it will not treat the infection itself. If you have a bacterial sinus infection, you will need to take antibiotics prescribed by your doctor.

Does Flonase help sinus pressure?

Flonase can be very helpful in managing sinus symptoms. However, if the sinus pressure is caused by a bacterial infection, Flonase may help the symptoms but will not clear the infection. If you have a bacterial infection, you will need to take prescription antibiotics.