What are alternative medications or nasal sprays to Flonase (fluticasone) for allergic rhinitis?

From the Guidelines

Intranasal corticosteroids, such as triamcinolone acetonide (Nasacort Allergy 24HR) or fluticasone furoate (Veramyst), are recommended alternatives to Flonase (fluticasone) for allergic rhinitis, as they have been shown to be effective in reducing symptoms of allergic rhinitis, including nasal congestion, rhinorrhea, and sneezing 1.

Key Points:

• Intranasal corticosteroids are the most effective medication class for controlling symptoms of allergic rhinitis 1.
• Triamcinolone acetonide (Nasacort Allergy 24HR) and fluticasone furoate (Veramyst) are available over-the-counter and by prescription, respectively 1.
• Azelastine (Astelin, Astepro) and olopatadine (Patanase) are intranasal antihistamines that can be used as alternatives to intranasal corticosteroids, but may have a bitter taste and cause somnolence 1.
• Combination therapy with an intranasal corticosteroid and an intranasal antihistamine may be considered for initial treatment of moderate to severe seasonal allergic rhinitis in persons aged 12 years or older 1.

Important Considerations:

• Patients should be instructed to direct sprays away from the nasal septum and to periodically examine the nasal septum for mucosal erosions 1.
• Local side effects of intranasal corticosteroids, such as nasal irritation and bleeding, are generally minimal, but may occur 1.
• Patients who do not respond to intranasal corticosteroids or have severe symptoms may require additional treatment, such as oral corticosteroids or immunotherapy 1.

From the Research

Alternative Medications to Flonase (fluticasone) for Allergic Rhinitis

• Azelastine nasal spray is a fast-acting, efficacious, and well-tolerated H1-receptor antagonist for the treatment of rhinitis, with a rapid onset of action and improved tolerability profile compared to fluticasone propionate 2, 3.
• Azelastine nasal spray has been shown to be effective in alleviating nasal congestion, a symptom that is often bothersome for rhinitis sufferers, and is effective even in patients who did not respond to previous oral antihistamine therapy 2.
• Other alternatives include:
  • Second-generation H1 antihistamines (e.g., cetirizine, fexofenadine, desloratadine, loratadine) 4.
  • Intranasal corticosteroids (e.g., triamcinolone, budesonide, mometasone) 4.
  • Olopatadine nasal spray, another intranasal antihistamine 4.

Comparison of Azelastine with Other Medications

• Azelastine nasal spray has been shown to have a faster onset of action and a better safety profile compared to intranasal corticosteroids, with at least comparable efficacy to fluticasone propionate 2.
• Azelastine nasal spray has been shown to be more effective than oral antihistamines (e.g., desloratadine and cetirizine) and other intranasal antihistamines (e.g., levocabastine) 3.
• However, budesonide nasal spray has been shown to offer superior symptom relief in perennial allergic rhinitis compared to azelastine nasal spray 5.

Combination Therapy

• Combination therapy with intranasal fluticasone propionate and azelastine nasal spray has been shown to exhibit greater efficacy than either agent used alone, and may provide benefit for patients with difficult to treat seasonal allergic rhinitis 2, 3.