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Conquer Persistent Allergy Symptoms with OTC Nasal Sprays

Wisconsin prairie free from allergies because of nasal spray

Flonase® vs. Afrin® vs. Nasonex® vs. Nasacort® and More

By Beth Coopman, Pharm. D.

In this three-month series of articles, we’ve been tackling the topic of seasonal allergies, giving you some tips and tricks to stay ahead of your allergy symptoms and keep you as healthy as possible.

You can revisit April’s article about allergen prevention and oral antihistamines by clicking here. This month we focus on nasal spray options for helping with allergy symptoms.

Which Nasal Spray Brand is the Best?

Flonase, Rhinocort, Nasonex and Nasacort are examples of steroid nasal sprays and a great starting point for addressing and minimizing uncomfortable allergy symptoms like sinus congestion, sneezing, itchy or runny nose and itchy/watery eyes.

In fact, for persistent allergy symptoms, nasal steroids are the most effective option. They all work similarly, have generic options and, excepting Nasonex, are available over-the-counter (OTC). Generic nasal steroids are comparable to brand name products and save you money.

For those with extra nasal sensitivities, Flonase Sensimist, Nasacort and Rhinocort are all scent- and alcohol-free. Flonase Sensimist and Rhinocort also have less liquid per spray, resulting in less nasal drip.

What is the Best Way to Use a Nasal Spray?

To limit nosebleeds and irritation, nasal sprays should be pointed slightly away from your septum (the middle hard part of your nose). The alternate-hand method of administration, spraying your left nostril with your right hand and your right nostril with your left hand, naturally tilts the nasal spray away from your septum to promote proper technique.

Are Allergy Pills or Nasal Sprays Better?

There are notable differences between using oral antihistamine allergy medications versus nasal steroids.

  • A nasal spray is absorbed exactly where it’s needed – directly into the sinus cavity. For this reason, warnings about oral steroids do not apply. Worried about swallowing some from it leaking down the back of your throat? Don’t be. If you do happen to swallow some nasal spray (very common), it is unlikely to wind up in the blood in any quantity. This is because the stomach absorbs most of it and the liver metabolizes the rest. In contrast, oral allergy medications are absorbed and metabolized to reach our bloodstream which can result in full-body side effects like tiredness, dry mouth, constipation, vomiting and headache.
  • Nasal steroids are effective for sinus congestion. Oral antihistamines are not. If congestion does persist after using a nasal steroid, however, a few days of the oral decongestant pseudoephedrine may be beneficial. Use caution with pseudoephedrine because of possible increases in blood pressure and heart rate.
  • If itchy, watery eyes persist with a nasal steroid, adding antihistamine eye drops is recommended. For most, adding an oral allergy medication to a nasal steroid does not work better. Ketotifen, and now Pataday, are allergy eye drops available OTC.
  • If quick relief is what you need, you’ll want to know that nasal steroids take longer to “kick in” than oral allergy medications. For this reason, using oral allergy medication short-term for immediate relief and nasal steroid sprays long-term for persistent allergies makes sense. Some may notice relief a few hours after starting a nasal steroid. However, the maximum benefit is seen after at least two weeks. Start nasal steroids about two weeks before allergen exposure.

Other Nasal Spray Options and How they Compare

Nasalcrom and Afrin are other popular allergy nasal sprays.

Afrin works quickly and is effective for congestion. However, Afrin should only be used for up to three days, as directed on the label. If used longer, recurrent and worsening nasal congestion may occur. Oral decongestants may be a better option due to the challenges with Afrin’s dosing guidelines.

Nasalcrom prevents sneezing, allergic sinus congestion and runny or itchy nose and should be started one to two weeks before allergen exposure. Nasalcrom is most useful for those with inadequate congestion relief with other treatments or if parents have safety concerns using other allergy medications.

Nasal saline solutions can be used to for nasal allergy symptoms to clear the nose of mucus, relieve nasal irritation and dryness. All ages can use nasal saline and because it has few side effects, it is a good first choice in pregnancy, breastfeeding and children with allergy-related sinus congestion.

Flonase vs. Nasonex vs. Afrin and others

Brand Name

Generic Name

Age Allowed

Onset of Effect

Peak

Duration

Common Side Effects

Cost/Bottle

Flonase

ClariSpray

Fluticasone Propionate

≥ 4 yrs

12 hrs

2 weeks

24 hrs

Headache

Nose irritation

Bloody nose

$14

Flonase Sensimist

Fluticasone Fumarate

≥ 2 yrs

12 hrs

2 weeks

24 hrs

Headache

Bloody nose

$23 (no generic)

Nasonex

Rx only

Mometasone

Rx only

≥ 2 yrs

12 hrs

 

2 weeks

24 hrs

Headache

Bloody nose

$50

Nasacort

Triamcinolone

≥ 6 yrs

12 hrs

 

2 weeks

24 hrs

Bloody nose

Sore throat

$13

Rhinocort

Budesonide

≥ 2 yrs

12 hrs

2 weeks

24 hrs

Bloody nose

Sore throat

$14

Afrin

Oxymetazoline

≥ 6 yrs

rapid

15 min

12 hrs

Nasal burning or stinging

$4

Nasalcrom

Cromolyn

≥ 2 yrs

1 wk

2-4 weeks

6-8 hrs

Nasal stinging

sneezing

$18

Ocean Saline

Sodium Chloride 0.65%

All

rapid

rapid

4-6 hrs

Nasal discharge

Nasal burning

$4

*Reference: Micromedex® and pricing estimates from Walmart.com and Goodrx.com

** Cost listed is for generic product and cost decreases per dose as package size increases.

The Best Nasal Spray is the Best Nasal Spray for You

Be an informed health care consumer. Know how your prescription choices impact your plan’s costs. Ask your doctor or pharmacist about cost alternatives for your prescriptions or OTC selections. If you have any questions pertaining to this article, email the pharmacy team at pharmacists@networkhealth.com.


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