What is the difference between Flonase (fluticasone propionate) and Nasonex (mometasone furoate)?

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From the Guidelines

Flonase (fluticasone propionate) and Nasonex (mometasone furoate) are both effective prescription nasal steroid sprays used to treat allergic rhinitis symptoms, but the most recent evidence suggests that Flonase may be preferred due to its availability over-the-counter and similar efficacy to Nasonex 1.

Key Differences

  • Flonase is available over-the-counter, while Nasonex typically requires a prescription.
  • The standard adult dose for Flonase is 1-2 sprays per nostril daily, while Nasonex is typically 2 sprays per nostril daily.
  • Flonase may work slightly faster, often within 12 hours, while Nasonex usually takes 1-2 days for noticeable effects.

Mechanism of Action

Both medications work by reducing inflammation in nasal passages by suppressing the activity of inflammatory cells and chemicals.

Side Effects

Side effects for both are similar and may include:

  • Nasal irritation
  • Headache
  • Nosebleeds

Efficacy

Both medications are generally considered equally effective, so the choice between them often depends on individual response, insurance coverage, and whether you prefer an over-the-counter option 1.

Recommendations

Based on the most recent evidence, Flonase is a suitable option for patients with allergic rhinitis due to its efficacy, safety, and availability over-the-counter 1. However, it's essential to consult with a healthcare professional to determine the best treatment option for individual patients.

From the FDA Drug Label

FLUTICASONE PROPIONATE NASAL SPRAY, USP #Compare to the active ingredient in Flonase® Allergy Relief *Fluticasone propionate is a steroid medicine known as a glucocorticoid.

Package/Label Principal Display Panel Rugby® Compare to the active ingredient in Nasonex® 24HR Allergy Non-Drowsy | Scent-Free Mist Mometasone Furoate Nasal Spray, 50 mcg Per Spray Allergy Symptom Reliever (Glucocorticoid)*

The main difference between Flonase and Nasonex is the active ingredient.

  • Flonase contains fluticasone propionate 2, 2
  • Nasonex contains mometasone furoate 3 Both are glucocorticoids, a type of steroid medicine.

From the Research

Comparison of Flonase and Nasonex

  • Flonase (fluticasone propionate) and Nasonex (mometasone furoate) are both intranasal corticosteroids used to treat allergic rhinitis.
  • A study published in 1997 4 compared the effectiveness of mometasone furoate (Nasonex) and fluticasone propionate (Flonase) in patients with perennial rhinitis, and found that both treatments were effective in controlling symptoms, with no significant difference between the two.
  • Another study published in 1998 5 found that mometasone furoate (Nasonex) was as effective as fluticasone propionate (Flonase) in treating perennial allergic rhinitis, and had a similar safety profile.

Efficacy and Safety

  • Both Flonase and Nasonex have been shown to be effective in reducing nasal symptoms associated with allergic rhinitis, including congestion, runny nose, and sneezing 4, 5.
  • A study published in 2003 6 found that mometasone furoate (Nasonex) was effective in relieving cough and nasal symptoms associated with seasonal allergic rhinitis.
  • Both treatments have been found to be well-tolerated, with a low incidence of adverse events 4, 5, 6.

Onset of Action

  • A study published in 1998 7 found that budesonide (another intranasal corticosteroid) had a faster onset of action than fluticasone propionate (Flonase), with significant improvement in symptoms observed within 36 hours.
  • The onset of action of mometasone furoate (Nasonex) has been reported to be approximately 7 hours in patients with seasonal allergic rhinitis 5.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Comparison of once daily mometasone furoate (Nasonex) and fluticasone propionate aqueous nasal sprays for the treatment of perennial rhinitis. 194-079 Study Group.

Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 1997

Research

Relief of cough and nasal symptoms associated with allergic rhinitis by mometasone furoate nasal spray.

Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 2003

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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