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Medically reviewed by, Russell Braun RPH

It is happening, another stuffy nose and you resort to breathing through your mouth again. Good luck trying to stop your nose from running, much less smell anything. You grab a tissue and try to blow your nose hoping for an easy fix. However, you know that allergies have started to creep up and this difficulty breathing is not a short term problem. As far as a way to fix this problem, which is better Afrin or Flonase?

In the U.S. allergies affect more than 50 million people. In addition, the cost of those allergies is estimated to be 18 billion dollars!

Why do allergies cause a stopped up nose?

Our bodies can be allergic to a variety of different things in our environment. Inside the nose, allergens first come into contact with nasal tissues. The immune system reacts to these allergens resulting in release of histamine and other chemicals destined to destroy the offending allergen.

These chemicals cause blood vessels and tissue to become leaky and let fluid outside of cells. The result is the nasal passage becomes flooded with excess fluid release leaving the feeling of congestion and stuffiness.

Nasal sprays to the rescue?

Nasal sprays are a great way to reduce congestion in the nose, without taking pills that can cause problems in other parts of the body. They can work in several different ways to narrow or constrict the tissue(s) in the nose that that becomes leaky. As the blood flow to the area is reduced, swelling goes down and more air can flow through the nose.

What are Afrin and Flonase used for?

Afrin and Flonse are both nasal sprays that reduce nasal stuffiness in different ways. In both cases spraying these in the nose can work quicker than taking a pill by mouth.

Afrin

• Reduce sinus congestion
• Relieve nasal congestion

Flonase

• Relieve nasal congestion
• Nonallergic rhinitis symptoms, including itchy watery eyes and itchy nose with sneezing.

Key differences at a glance

Afrin

Afrin is the brand name of a product that contains oxymetazoline 0.05% as its active ingredient. This chemical is called an alpha-adrenergic agonist. That is a medical way of saying this product stimulates receptors in the blood vessels and tissues that cause them to constrict. Therefore, less fluid leaks out, resulting in less congestion of the nose making it easier to breath.

The good thing about using this product in the nose is the same effects would happen throughout the body if taken as a pill. This would mean symptoms such as increased heart rate, blood pressure, chest tightness and jitteriness.

Pros:

• Starts to work within 10-15 minutes.
• Sold Over The Counter (OTC), therefore no prescription is required.
• 12 hour duration, longer than other decongestants on the market.
• Can decrease snoring during sleep.

Cons:

• Not for long term use, 3 days in a row maximum.
• Does not prevent immune system changes that lead to allergy symptoms.
• For use in age 6+ only.
• Can cause irritation inside the nose with possible sneezing as a result.
• Potential for rhinitis medicamentosa, also called rebound congestion. This occurs when constriction in nose caused by Afrin cuts off blood supply. That leads to swelling which results in symptoms similar to the original nasal congestion.
• Can be dangerous if taken with medications for migraines known as ergot derivatives, example Migranal. Ask your doctor if you are taking one of these medication before using Afrin.

Side effects:

Side effects from applying the spray into the nose are usually mild and typically resolve shortly after use include:

• Dryness
• Stinging
• Sneezing
• Burning
• Dizziness

There may be side effects that occur in other areas of the body. A small amount of Afrin does get absorbed in the bloodstream. Those potential side effects are listed below.

Ask your doctor before using Afrin if:

Even though Afrin is sold OTC without a prescription that doesn’t mean it can be used by everyone without talking to your doctor. People with the conditions listed below would benefit from talking to the doctor before trying Afrin.

Cost:

Afrin is sold as an over the counter product only. Therefore, most insurance plans will not cover it. Rather they expect patients to pay for this out of pocket. However, funds from a Health Savings Account (HSA) could be used to purchase Afrin.

There are generic versions of Afrin and the best deal will be to buy a generic. OTC products are regulated by the FDA similar to prescription medications. Meaning they must show efficacy and safety studies to be approved for sale. That is NOT true for items at the pharmacy labeled as dietary supplements.

Afrin Original costs ~$9.40	Oxymetolazine ~$6.79

Pharmacy coupons can be found at many chain and independent stores that would bring the cost of the generic down even more.

In addition to the original Afrin product there are now many others with more than just one ingredient. The only differences are inactive ingredients, which are not proven to have effect or they would be required to be part of the active ingredient list. As you can see there is a lot of overlap. A best practice it so start with the generic of the original product and see how it works for you before spending more on marketing of fancy names.

Flonase

Flonase is the brand name for a product that contains fluticasone propionate as the active ingredient. Fluticasone propionate is a corticosteroid medication. This type of steroid works by slowing down parts of the immune system that react to offending agents in the body. When used as a nasal spray, Flonase helps prevent inflammation from allergens that cause nasal congestion.

Corticosteroid medications are available as pills and injections. However, when taken this way they can cause significant side effects if taken over a long period of time. However, because Flonase is a nasal spray this decreases the chances of the fluticasone being absorbed. Therefore, Flonase can safely be used for longer periods of time.

Pros:

• In addition to helping with nasal congestion, Flonase actually has an FDA indication for sneezing and itchy, watery eyes.
• It only needs to be taken once per day.
• The beneficial effects of Flonase on symptoms can increase the longer it is used.
• Flonase blocks the effects of six different types of cells in the nose known to be involved in allergic responses.

Cons:

• Steroids do not relieve symptoms of stuffy nose right away, it can take days up to a week for full benefits to be realized.
• Headaches after use are much more common with Flonase than with Afrin.
• Corticosteroids have been shown to slow the healing process, so use after injury such as surgery should be discussed with your doctor first.
• If used with other drugs that suppress the immune system, fluticasone can increase the risk of infection.

Side effects:

Side effects from applying the spray into the nose are usually mild and typically resolve shortly after use. Examples include:

• Burning in the nose
• Sneezing
• Itchy or runny nose
• Post nasal drip that can cause coughing
• Nasal congestion

There may be side effects that occur in other areas of the body. A small amount of Flonase does get absorbed in the bloodstream. Those potential side effects are listed below.

Ask your doctor before using Flonase if:

Even though Flonase is sold OTC without a prescription that doesn’t mean it can be used by everyone without talking to your doctor. People with the conditions or taking medications listed below would benefit from talking to the doctor before trying Flonase.

Cost:

Flonase is sold as an over the counter product and via prescription. Some insurance plans will cover it and some will not because you can buy it OTC. Funds from a Health Savings Account (HSA) could be used to purchase Flonase OTC.

There are generic versions of Floase and the best deal will be to buy a generic. OTC products are regulated by the FDA similar to prescription medications. Meaning they must show efficacy and safety studies to be approved for sale. This includes generic products. That is NOT true for items at the pharmacy labeled as dietary supplements.

Flonase 50mcg 120 sprays $22.47	Fluticasone 50mcg 120 sprays $15.19

Both prescription and OTC products contain 50mcg per spray. They are also both used the same way, one spray in each nostril daily. Finally, they both contain the same number of sprays per bottle at 120. Therefore, you need to determine if your copay using your insurance will be lower than the cost of buying the generic product.

What about Flonase Sensimist?

Flonase has been on the market since 1994. During that time millions of patients have used it and some had side effects. One problem many patients observed that the manufacturer tried to eliminate was post nasal drip. They theorized that the alcohol and scent of the original product was partially responsible for this problem.

The newer product also has a gentle mist inhalation along with fluticasone furoate salt instead of proprionate found in the original product. This change from proprionate to furoate made this a new product in the eyes of the Food and Drug Administration (FDA). Therefore, Veramyst and Flonase Sensimist were created as new brand products. Veramyst is the prescription only product and Flonase Sensimist is sold OTC.

At this point there is no generic available for either one, meaning they are more expensive.

Flonase Sensimist 27.5mcg 120 sprays $30.75

Does Flonase work as good as Afrin?

It is important to remember that Flonase and Afrin are not the same type of drug. They work in different ways to clear up nasal congestion. This is important because nasal symptoms caused by allergies are due to an immune response.

Flonase blocks the immune response and Afrin does not.

Guidelines suggest that for nasal congestion due to allergic response inhaled corticosteroids, such as Flonase are the most effective at treating this condition.

Is Flonase better than Afrin?

Determining which product is “better” is probably not the right question to ask. Instead, patients should ask, based on my symptoms which product should I use.

Afrin is going to provide faster response, which could be important if trying to fall asleep for example. Most people have a response to Afrin quickly and it is maintained for 10 to 12 hours. That is great if congestion is due to a cold or other problem.

However, if you have allergies that last for several weeks certain times of year, Afrin is not going to be the best for you. Remember you should not use Afrin for more than three days without taking a few days off of it. In that case you will need to take a corticosteroid like Flonase to prevent symptoms. This requires routine use and the effects build over time.

Can I use Afrin and Flonase together?

Taking Afrin and Flonase together is often the answer to stubborn, ongoing nasal congestion problems. Afrin is great for the first few days to relieve symptoms while the Flonase is kicking in.

In fact, studies have shown positive effects of using both medications together. The Journal of Allergy and Immunology published a study showing that taking Afrin and Flonase together increased nasal air volume. This simply means it was easier for the participants to breath when taking both medications.

Key Takeaways

1. Afrin can help when symptoms first arise.

2. Do not use Afrin for more than three days in a row.

3. Afrin can be used again, but at least two days without Afrin is required to prevent rebound congestion.

4. Flonase should be used if allergies are suspected.

5. Daily use of Flonase is required for it to provide maximum benefit.

6. Afrin and Flonase can be taken together, if one alone is not providing relief.

7. Buy generics to save money!

8. Flonase Sensimist is a good option if you have post nasal drip, but it is expensive!

9. If you take both for nasal congestion be sure to let your doctor and pharmacist know!

Click here to get Dr. Jason Reed’s exclusive list of medication questions you MUST ask your doctor, for FREE!

Share your story

Have you used Flonase or Afrin? Also, please share how they worked for you. Chime in below with your thoughts and comments.

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