Afrin vs. Flonase: Which nasal spray is right for you?

In this article:

• Main differences
• Conditions treated
• Efficacy
• Cost and coverage
• Side effects
• Interactions
• Warnings
• FAQs

In this article

• Main differences
• Conditions treated
• Efficacy
• Cost and coverage
• Side effects
• Interactions
• Warnings
• FAQs

 

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 3 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.

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 over time 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 in 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?	1 to 3 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 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 ten minutes which provides patients with quick relief of nasal symptoms. Unfortunately, it is only recommended for short-term use, for 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 furoate, a product to fluticasone propionate, to determine if they could augment the response of each on congestion. It compared four treatment groups: placebo, oxymetazoline alone, fluticasone alone, and fluticasone with oxymetazoline. In this study, oxymetazoline was used for longer than the recommended duration of 3 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 the combination 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 30 ml bottle could be as high as about $16. Your doctor can issue a prescription for Afrin, and with a SingleCare coupon, you could get the generic version for as low as $3.

Flonase, or its generic, is typically covered by commercial and Medicare drug plans. The retail price for Flonase in a bottle containing 60 sprays can be as much as $19 but with a coupon, patients could pay as little as $8 with a prescription.

	Afrin	Flonase
Typically covered by insurance?	No	Yes
Typically covered by Medicare?	No	Yes
Standard dosage	15 ml bottle	9.9 mL bottle
Typical Medicare copay	n/a	Varies, but typically less than $10
SingleCare cost	$3+	$8+

Common side effects of Afrin vs. Flonase

Afrin is known to cause temporary, local irritation to the nasal mucosa. 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 wears off, resulting in rebound vasodilation. 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 headaches after Flonase administration. Another very common side effect is nosebleeds 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 healthcare provider or pharmacist for a list of all possible side effects.

	Afrin		Flonase
Side effect	Applicable?	Frequency	Applicable?	Frequency
Headache	No	n/a	Yes	7%-16%
Dizziness	No	n/a	Yes	1%-3%
Nausea/ Vomiting	No	n/a	Yes	3%-5%
Local irritation	Yes	Not defined	Yes	2%-3%
Increased intraocular pressure	No	n/a	Yes	Not defined
Epistaxis	No	n/a	Yes	6%-7%
Nasal mucosal ulcer	No	n/a	Yes	Not defined
Pharyngitis	No	n/a	Yes	6%-8%
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	Not defined

Source: Afrin (DailyMed) Fluticasone propionate (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.

Flonase is metabolized by the liver’s CYP3A4 enzyme. Drugs that strongly inhibit this enzyme could cause increases in the blood concentration of fluticasone. Examples include Ketodan (ketoconazole), Sporanox (itraconazole), Paxlovid (nirmatrelvir and ritonavir), and clarithromycin

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
Cannabidiol Cannabis	Cannabinoids	Yes	No
Desmopressin	Vasopressin analog	No	Yes
Dihydroergotamine Ergotamine	Ergot derivatives	Yes	No
Esketamine	NMDA receptor antagonist	Yes	Yes
Fentanyl (nasal serum)	Opioid	Yes	No
Linezolid Tedizolid	Antibiotics	Yes	No
Amitriptyline Nortriptyline Doxepin	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

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.

Which is better, Afrin or Flonase?

Afrin provides a faster response to congestion with an onset of action within ten minutes. It is not recommended for use longer than 3 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 you use Afrin and Flonase together?

Afrin and Flonase can typically be used together, and their different mechanisms of action could provide additive benefits. Restricting Afrin use to three days would still be the general recommendation. Get the medical advice of your healthcare provider before starting such a regimen.

Can I use Afrin or Flonase while pregnant?

There have been adverse fetal events associated with large doses or extended use of Afrin 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 healthcare provider 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 4 total sprays in a 24 hour period), or patients may administer 2 sprays in each nostril at the same time, morning or evening.