Key takeaways:
Astepro (azelastine) and Flonase (fluticasone propionate) are two over-the-counter (OTC) nasal sprays that can help treat allergy symptoms. They have several differences to consider when comparing them.
Astepro and Flonase differ in how they work in the body, how fast they kick in, and what age ranges they’re FDA approved for. They also have distinct dosages and side effects to keep in mind.
Astepro and Flonase are available OTC as brand-name medications. But you can also find Flonase as a lower-cost generic. GoodRx can help make your medication more affordable.
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Not all allergy medications are pills. Some of the most common treatments come as a nasal spray. But not all allergy nasal sprays are the same. Knowing their differences can help you choose the best one for you.
Astepro (azelastine) and Flonase (fluticasone propionate) are two popular allergy nasal sprays. They’re readily available over the counter (OTC). But you can also obtain them with a prescription from a licensed healthcare professional.
At first glance, Astepro and Flonase seem similar. They’re both effective for allergy relief, but they’re distinct in several ways.
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Astepro vs. Flonase at a glance
When comparing medications, it can help to see details of each one side by side. The table below highlights things to keep in mind when comparing Astepro versus Flonase.
| Astepro | Flonase | |
|---|---|---|
| Active ingredient | Azelastine |
|
| Medication class | Antihistamine | Corticosteroid (steroid) |
| When it starts working | Within 15-30 minutes | Initial effects within 2-4 hours for some people Up to 2 weeks for full effects |
| Approved age range | Ages 6 and older |
|
| Typical dosage |
|
|
| Mild side effects |
|
|
Below are more details about six differences between Astepro and Flonase.
1. Astepro and Flonase work in different ways
One of the main differences between Astepro and Flonase is that they treat allergies in different ways.
Astepro is an antihistamine. It works by blocking the effects of the chemical histamine. When our bodies come into contact with allergens, such as pollen or pet dander, certain immune cells release histamine. This chemical causes allergy symptoms, such as sneezing and runny nose. When Astepro blocks histamine, it lessens or stops allergy symptoms.
Flonase is a nasal corticosteroid (“steroid”). The way it works isn’t fully understood. But experts believe it works by lowering your immune cells’ response to allergens. Over time, this helps reduce swelling and irritation in the nose and sinuses.
2. Astepro starts working faster than Flonase
Another major difference between Astepro and Flonase is how long they take to start working.
Astepro starts working for allergy relief very quickly — in as little as 15 minutes. But it can also help prevent symptoms. If you know when you typically start having allergy symptoms, try starting daily Astepro about 2 weeks beforehand. This can stop allergies before they cause noticeable symptoms.
On the other hand, Flonase doesn’t usually work right away. Although you may notice some effects within 2 to 4 hours, it can take up to 2 weeks for it to work consistently. But once it fully kicks in, Flonase is one of the most effective medications for allergy symptom prevention.
3. There are differences between OTC and prescription-only Astepro
You can get Astepro and Flonase OTC or with a prescription from a healthcare professional.
With Flonase, the OTC and prescription versions are very similar. In fact, prescription Flonase and OTC Flonase Allergy Relief contain the same amount of the same active ingredient: fluticasone propionate.
OTC Flonase Sensimist contains a slightly different version of fluticasone, called fluticasone furoate. This active ingredient works the same way as fluticasone propionate. But Flonase Sensimist lasts slightly longer than Flonase Allergy Relief or prescription Flonase. Flonase Sensimist is also alcohol-free, making it safe for very young children to use.
OTC and prescription versions of Flonase have slightly different labeled uses. But this doesn’t typically affect how healthcare professionals choose between them. The choice between OTC and prescription Flonase often comes down to personal preference, accessibility, or cost.
OTC and prescription Astepro have more differences. The active ingredient is the same, but the concentration (the amount of medication per milliliter) is different. The two versions also have different FDA-approved uses.
This table highlights the differences between the OTC and prescription versions of Astepro and Flonase.
Medication name | Active ingredient and amount | Approved uses |
|---|---|---|
OTC Astepro Allergy (azelastine HCl) | Azelastine hydrochloride 205.5 mcg per spray | Temporary relief of common upper respiratory allergy symptoms, such as sneezing and runny nose |
Prescription azelastine HCl (brand-name Astelin no longer available) | Azelastine hydrochloride 1% (137 mcg per spray) | Treatment of upper respiratory symptoms caused by seasonal allergies Treatment of vasomotor rhinitis (year-round stuffy and runny nose that isn’t from allergies) |
OTC Flonase Allergy Relief (fluticasone propionate) | Fluticasone propionate 50 mcg per spray | Temporary relief of common upper respiratory allergy symptoms, such as sneezing and runny nose |
Prescription fluticasone propionate (brand-name Flonase no longer available by prescription) | Fluticasone propionate 50 mcg per spray | Management of year-round nasal symptoms that aren’t from allergies |
OTC Flonase Sensimist (fluticasone furoate) | Fluticasone furoate 27.5 mg per spray* | Temporary relief of common upper respiratory allergy symptoms, such as sneezing and runny nose |
Fluticasone furoate 27.5 mg per spray | Treatment of upper respiratory symptoms caused by seasonal or year-round allergies |
*This is equivalent to fluticasone propionate 50 mcg.
**Prescription product no longer available.
4. Astepro is approved for different age ranges than Flonase
An important part of choosing any medication is knowing what ages it’s safe for. Astepro and Flonase are both safe for adults to use. But when it comes to children, the safe age ranges vary for each nasal spray.
When self-treating allergies with Astepro OTC, it can be safely used by children ages 6 and older. The approved ages for prescription azelastine depends on why it’s being prescribed. For allergies, azelastine is approved for children ages 5 and older. For vasomotor rhinitis, it’s approved for adolescents ages 12 and older.
Flonase Allergy Relief and prescription fluticasone propionate are both approved for use in children ages 4 and older. Flonase Sensimist is safe for children as young as age 2.
Good to know: Both versions of OTC Flonase have a warning on them regarding long-term use in kids. It’s not recommended to use them for more than 2 months total per year. This is because nasal steroids may slow a child’s growth. Astepro doesn’t have a warning about long-term use.
5. Astepro and Flonase have different dosages
Knowing your chosen medication’s typical dosage is another essential part of getting the most out of it. You’ll follow the same steps for both Astepro and Flonase, but how often you administer them varies. The dosage also depends on your age.
For OTC Astepro, the typical dosages are as follows:
Adults and children ages 12 and older: Use 2 sprays in each nostril once a day or use 1 or 2 sprays in each nostril every 12 hours. Don’t use more than 4 sprays in each nostril in a 24-hour period.
Children ages 6 to 11: Use 1 spray in each nostril every 12 hours. Don’t use more than 2 sprays in each nostril in a 24-hour period.
For OTC Flonase, the recommended dosages are as follows:
Adults and children ages 12 and older: Use 2 sprays in each nostril once a day for 1 week. After that, use 1 or 2 sprays in each nostril once a day. After 6 months of use, talk with a healthcare professional about whether you should keep using Flonase.
Children ages 4 to 11 (Flonase Allergy Relief): Use 1 spray in each nostril once a day. Use for the shortest amount of time needed. Talk to your child’s pediatrician if they need to use Flonase for more than 2 months total per year.
Children ages 2 to 11 (Flonase Sensimist): Use 1 spray in each nostril once a day. Use for the shortest amount of time needed. Talk to your child’s pediatrician if they need to use Flonase for more than 2 months total per year.
6. Astepro and Flonase have different side effects
Both Astepro and Flonase are well tolerated, but their side effects vary. You should consider these differences when choosing between them.
Common or mild Astepro side effects include:
Bloody nose
Nasal discomfort
Sneezing
Bitter or bad taste
Headache
Drowsiness
Common or mild Flonase side effects include:
Headache
Sore throat
Bloody nose
Coughing or wheezing
Nausea
Beyond these milder side effects, Flonase has one serious side effect that Astepro does not. There is a potential risk of slowed growth when children use nasal steroids, such as Flonase, for long periods of time. One study suggests that this side effect becomes clinically significant about 2 months after starting treatment. That’s why there’s a warning on Flonase’s OTC label to speak with a child’s pediatrician regarding long-term use.
Can you combine Astepro and Flonase?
Yes, you can use both Astepro and Flonase if needed. Experts actually recommend the combination for people who have moderate to severe allergy symptoms. It’s also a good strategy if one nasal spray isn’t working well enough by itself.
You may find the combination starts working faster than Astepro can on its own. Some studies suggest it may provide noticeable relief in as little as 5 minutes.
Good to know: The nasal spray Dymista (azelastine / fluticasone) combines the active ingredients found in Astepro and Flonase. Dymista isn’t available OTC. But it could be a more convenient option if you regularly use both medications.
How to save on Astepro and Flonase
There are ways to save on Astepro and Flonase. Both are available as brand-name medications. But you can find OTC Flonase Allergy Relief as a lower-cost generic. The prescription versions of both azelastine and fluticasone propionate are available as generic medications.
By having a licensed healthcare professional write a prescription for OTC Flonase or Astepro, GoodRx can help you save.
Save on azelastine with GoodRx: GoodRx can help you save over 80% off the average retail price. The price of the prescription version of azelastine at certain pharmacies is as low as $15.00 with a free GoodRx discount.
Save on Flonase with GoodRx: GoodRx can help you save over 50% off the average retail price. The price of generic Flonase Allergy Relief at certain pharmacies is as low as $19.85 with a free GoodRx discount. Flonase Sensimist’s price at certain pharmacies may be as low as $28.85. And the prescription version of fluticasone propionate may cost as little as $14.66.
Save on Flonase with a coupon from the manufacturer: If you’re purchasing brand-name Flonase without a prescription, the manufacturer has a $4 coupon available, which you can have emailed to you.
Frequently asked questions
You shouldn’t use Astepro if you’ve ever had an allergic reaction to azelastine (its active ingredient) or any of the product’s inactive ingredients. You can find the inactive ingredient list on Astepro’s OTC label. Ask a pharmacist if you’re having trouble finding this information.
You should ask a healthcare professional before using Astepro if you’ve had recent nose ulcers (sores) or nose surgery. You should also check with them if you have a nose injury that hasn’t healed. And if you’re pregnant or nursing, it’s also a good idea to ask a healthcare professional if it’s safe for you to use Astepro.
Astepro and Flonase are both very effective nasal allergy sprays. Other OTC steroid sprays, such as Nasonex (mometasone), work similarly well, too. Studies haven’t found any of these nasal allergy sprays to definitively work better than others. But if you need quick relief, Astepro typically starts working faster than Flonase or other steroid sprays.
Overall, azelastine (Astepro) isn’t better or worse than fluticasone (Flonase). But there’s evidence that azelastine may be a better option for seasonal allergies or allergies that only happen every now and then. Studies suggest fluticasone may work better than azelastine if you have persistent allergies or your symptoms aren’t caused by allergies.
You shouldn’t use Astepro if you’ve ever had an allergic reaction to azelastine (its active ingredient) or any of the product’s inactive ingredients. You can find the inactive ingredient list on Astepro’s OTC label. Ask a pharmacist if you’re having trouble finding this information.
You should ask a healthcare professional before using Astepro if you’ve had recent nose ulcers (sores) or nose surgery. You should also check with them if you have a nose injury that hasn’t healed. And if you’re pregnant or nursing, it’s also a good idea to ask a healthcare professional if it’s safe for you to use Astepro.
Astepro and Flonase are both very effective nasal allergy sprays. Other OTC steroid sprays, such as Nasonex (mometasone), work similarly well, too. Studies haven’t found any of these nasal allergy sprays to definitively work better than others. But if you need quick relief, Astepro typically starts working faster than Flonase or other steroid sprays.
Overall, azelastine (Astepro) isn’t better or worse than fluticasone (Flonase). But there’s evidence that azelastine may be a better option for seasonal allergies or allergies that only happen every now and then. Studies suggest fluticasone may work better than azelastine if you have persistent allergies or your symptoms aren’t caused by allergies.
The bottom line
Astepro (azelastine) and Flonase (fluticasone propionate) are two popular over-the-counter allergy nasal sprays. They’re different in how they work, how fast they work, and what age ranges they’re FDA approved for. Their dosages and side effects also vary. If needed, you can combine Astepro and Flonase for added allergy relief.
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