Is Nasonex (mometasone furoate) the same as Flonase (fluticasone propionate)?

Are Nasonex and Flonase the Same?

No, Nasonex (mometasone furoate) and Flonase (fluticasone propionate) are not the same medication—they are two different intranasal corticosteroids with distinct active ingredients, though they are clinically equivalent in effectiveness and safety for treating allergic rhinitis. 1, 2, 3

Key Differences Between the Medications

Active Ingredients

• Nasonex contains mometasone furoate as its active glucocorticoid 4
• Flonase contains fluticasone propionate as its active glucocorticoid 5
• Both are synthetic corticosteroids that work directly in the nose to block allergic reactions at the source 5

Age Approval Differences

• Mometasone furoate (Nasonex) is FDA-approved for children as young as 2 years old at 1 spray per nostril daily 1
• Fluticasone propionate (Flonase) is FDA-approved for children ≥4 years old at 1 spray per nostril daily 1
• This makes Nasonex the preferred option for younger children ages 2-3 years 1

Clinical Equivalence

Efficacy

• The clinical response does not vary significantly between these two medications—both are equally effective at controlling all four major symptoms of allergic rhinitis (sneezing, itching, rhinorrhea, and nasal congestion) 2
• A direct comparison study found mometasone furoate and fluticasone propionate produced equivalent symptom reductions (37% vs 39% reduction from baseline, respectively) with no statistical difference between them 3
• Both medications are superior to oral antihistamines and leukotriene receptor antagonists for nasal symptom control 6, 2

Onset of Action

• Both medications begin working within 3-12 hours after administration 2
• Mometasone furoate specifically shows clinically significant relief in 28% of patients by 12 hours, with median time to moderate relief of 35.9 hours 7
• Maximum efficacy for both medications takes days to weeks of regular use 1

Safety Profile

• Both medications have identical safety profiles at recommended doses 2
• Neither affects growth in children at recommended doses compared to placebo 1, 2
• Neither causes clinically significant effects on the hypothalamic-pituitary-adrenal axis, bone density, or ocular pressure 2
• Common side effects are the same for both: nasal irritation, epistaxis (nosebleeds), headache, and pharyngitis 1

Dosing Recommendations

Adults and Children ≥12 Years

• Mometasone furoate: 2 sprays per nostril once daily (200 mcg total) 1
• Fluticasone propionate: 2 sprays per nostril once daily (200 mcg total) 1

Children Ages 4-11 Years

• Fluticasone propionate: 1 spray per nostril once daily (100 mcg total) 1

Children Ages 2-11 Years

• Mometasone furoate: 1 spray per nostril once daily (100 mcg total) 1

Clinical Decision-Making

Choose mometasone furoate (Nasonex) when:

• Treating children ages 2-3 years (only option approved for this age) 1
• Patient preference for once-daily dosing is established 8

Choose fluticasone propionate (Flonase) when:

• Treating children ≥4 years or adults (both are equivalent) 1, 2
• Cost is a consideration (fluticasone is often less expensive as a generic)
• As-needed dosing is preferred for seasonal allergic rhinitis 2

Either medication is appropriate when:

• Treating moderate-to-severe allergic rhinitis in patients ≥4 years 3, 9
• Long-term daily use is needed (both are safe for indefinite use) 1
• Treating allergic rhinoconjunctivitis (both effectively treat ocular symptoms) 9

Important Clinical Considerations

Administration Technique

• Both medications require proper spray technique: direct the spray away from the nasal septum using the contralateral hand to reduce epistaxis risk by four times 1
• If using nasal saline irrigations, perform them before administering either steroid spray 1

Treatment Duration

• Both medications require regular daily use for at least 2 weeks to assess full benefit, not as-needed rescue therapy 1
• Long-term continuous use is safe and appropriate when symptoms persist 1
• For seasonal allergies, initiate treatment before symptom onset and continue throughout allergen exposure 1

When Monotherapy Fails

• If either medication alone provides inadequate relief after appropriate trial, add an intranasal antihistamine (azelastine) rather than switching between mometasone and fluticasone, as they are clinically equivalent 6, 2
• The combination of fluticasone propionate plus azelastine shows >40% relative improvement compared to either agent alone 6