From the Guidelines
Flonase (fluticasone) is the preferred treatment for allergic rhinitis symptoms, while Atrovent (ipratropium bromide) is more effective for non-allergic rhinitis symptoms, particularly rhinorrhea. When considering the treatment of allergic rhinitis, it is essential to prioritize medications that address the underlying inflammation.
- Flonase, as a corticosteroid, is the most effective medication class in controlling symptoms of allergic rhinitis, including sneezing, itching, and congestion 1.
- It works gradually over days to weeks and is typically used once or twice daily.
- Atrovent, on the other hand, is an anticholinergic medication that blocks acetylcholine receptors to reduce nasal secretions, making it more effective for runny nose (rhinorrhea), especially from non-allergic causes like common colds or vasomotor rhinitis 1.
- It works within hours and is usually used 2-3 times daily. Some patients with mixed symptoms might benefit from using both medications as they target different aspects of nasal symptoms.
- The concomitant use of ipratropium bromide nasal spray and an intranasal corticosteroid is more effective than administration of either drug alone in the treatment of rhinorrhea without any increased incidence of adverse events 1. Both medications are generally well-tolerated, though Flonase may cause nasal dryness or irritation, while Atrovent can cause nasal dryness and rarely nosebleeds.
- Intranasal corticosteroids, like Flonase, have been shown to be more effective than the combined use of an antihistamine and LT antagonist in the treatment of seasonal allergic rhinitis 1.
- Atrovent has been approved for use in patients 6 years of age and older for rhinorrhea associated with perennial allergic and nonallergic rhinitis 1.
From the Research
Comparison of Flonase and Atrovent Nasal Sprays
- Flonase (fluticasone propionate) is a corticosteroid nasal spray used to treat allergic rhinitis, while Atrovent (ipratropium bromide) is an anticholinergic nasal spray used to treat rhinorrhea [ 2 ].
- A study comparing azelastine nasal spray to fluticasone propionate (Flonase) found that azelastine had a faster onset of action and a better safety profile, with at least comparable efficacy to fluticasone propionate [ 2 ].
- Another study evaluated the efficacy and safety of a fixed-dose combination of fluticasone furoate and oxymetazoline nasal spray, which was found to be superior to fluticasone furoate alone in relieving nasal congestion and reducing total nasal symptom score in patients with allergic rhinitis [ 3 ].
- There is no direct comparison between Flonase and Atrovent nasal sprays in the provided studies, but both medications are used to treat symptoms of allergic rhinitis.
Mechanism of Action
- Flonase (fluticasone propionate) works by reducing inflammation in the nasal passages, while Atrovent (ipratropium bromide) works by blocking the action of acetylcholine, a neurotransmitter that stimulates nasal secretions [ 4 ].
- Azelastine nasal spray, on the other hand, has a multifaceted mechanism of action, including H1-receptor antagonism, mast-cell stabilization, and anti-inflammatory properties [ 2 ].
Efficacy and Safety
- Flonase (fluticasone propionate) has been shown to be effective in reducing nasal symptoms associated with allergic rhinitis, with a rapid onset of action and a good safety profile [ 5 ].
- Atrovent (ipratropium bromide) is also effective in reducing rhinorrhea, but its efficacy in reducing other nasal symptoms is not well established [ 4 ].
- The combination of fluticasone furoate and oxymetazoline nasal spray was found to be well-tolerated, with no increase in rebound congestion or rhinitis medicamentosa [ 3 ].