Xhance vs. Flonase: 5 Differences Between These Nasal Fluticasone Formulations

Millions of people in the U.S. experience allergies every year. Allergy symptoms can vary from mild to severe, and some people have symptoms that only affect the nose. These nasal symptoms often include itchy or runny nose, sneezing, and congestion. Allergies might also raise your risk of developing nasal polyps, which are non-cancerous growths that can cause similar nasal symptoms.

Fortunately, there are medications available to address these symptoms. Two common and similar nasal sprays are Xhance (fluticasone propionate) and Flonase Allergy Relief (fluticasone propionate). They contain the same active ingredient, but they aren’t one and the same.

Here, we’ll compare Xhance to Flonase Allergy Relief — including their uses, effectiveness, and what side effects to expect.

1. Xhance and Flonase have slightly different uses, and Flonase is available OTC

Xhance is a prescription medication for adults that’s sprayed into each nostril. Each spray of Xhance contains 93 mcg of a steroid called fluticasone propionate. Xhance is only available as a brand-name medication.

Flonase Allergy Relief is another steroid medication that’s sprayed into each nostril. But unlike Xhance, it's available over-the-counter (OTC) as both name-brand and generic products. Each spray contains 50 mcg of fluticasone propionate. It can be used by both adults and children ages 4 and older.

Flonase is also available as Flonase Sensimist, which is another OTC nasal spray product. Flonase Sensimist contains 27.5 mcg per spray of fluticasone furoate. This nasal spray can be used by adults and younger children ages 2 and older.

What is Xhance approved to treat?

Xhance is FDA-approved to treat nasal polyps in adults, which are non-cancerous growths inside your nose. Depending on the size of your polyps, you may experience allergy-like symptoms of runny nose, stuffy nose, or sneezing. You may also experience no symptoms at all.

As of March 2024, it’s also approved to treat chronic rhinosinusitis (sinus infections) without nasal polyps. It’s the first medication to have this specific approved use.

What is Flonase approved to treat?

Flonase Allergy Relief can help relieve the following allergy symptoms:

• Itchy or runny nose

• Stuffy nose

• Sneezing

• Itchy or watery eyes

How do nasal steroids work for treating nasal symptoms? 

Nasal steroid sprays, such as Xhance and Flonase Allergy Relief, are thought to work by relieving inflammation (swelling) inside your nose. When the tissues inside of your nose are less inflamed, nasal symptoms from allergies and other conditions often become less severe. 

EXPERT PICKS: WHAT TO READ NEXT

• Assessing your options: Xhance and Flonase aren’t the only nasal steroids available. Here’s what to know about other nasal sprays for allergies.

• Identifying the problem: Are you sick, or do you just have allergies? Here are seven telltale allergy symptoms to watch out for.

• Want another choice? Rhinocort is another popular steroid nasal spray. It stands out from Flonase in several key ways.

2. Xhance and Flonase share an active ingredient, but they’re administered in their own ways

Xhance and Flonase Allergy Relief are both sprayed into the nose. But the logistics of how this is done slightly differs.

Keep in mind: Specific directions slightly differ for each nasal spray. So carefully read the labeling and information on the packaging or container. For more detailed directions, speak with your pharmacist or prescriber.

3. Flonase is more commonly used than Xhance, but they’re both effective treatments

Health experts recommend steroid nasal sprays as go-to options for nasal allergy symptoms. This is because they’re seen as effective options for symptoms that are only affecting your sinuses — not your entire body.

For instance, when compared to oral antihistamines such as loratadine (Claritin) in clinical studies, steroid nasal sprays were better at relieving nasal allergy symptoms. 

In one study, about half of people using Flonase Allergy Relief experienced significant improvement in nasal allergy symptoms. But only a little over 15% of people reported significant improvement with oral loratadine. 

In another study, about 65% of people using Xhance experienced “much” or “very much” improvement with nasal polyp symptoms, which include congestion and runny nose. Two phase 3 trials also found that Xhance can effectively lower the risk of symptoms and complications from chronic rhinosinusitis without nasal polyps — without the need for surgery.

4. Xhance and Flonase are linked to slightly different side effects

Xhance and Flonase Allergy Relief have several side effects. Some are common to both nasal sprays, and some are more unique to just one. Side effects can also vary by total daily dose and particular product (e.g., Flonase Sensimist, etc).

What are the serious side effects of Xhance and Flonase?

Some rare but serious side effects are possible with both Xhance and Flonase Allergy Relief. Contact your HCP if you experience any of the side effects mentioned below. But know that in some cases, immediate medical attention may be warranted.

Nose-related effects

Certain nose-related effects — such as nosebleeds — are common. But they can be excessive and severe for some people. In some cases, you may need to seek emergency treatment for a nosebleed.

Plus, some people may also experience the following serious nose-related effects:

• A hole in the wall that separates the nostrils

• A fungal infection due to a germ called Candida albicans  

• Difficulties healing nasal wounds

Eye-related effects

Long-term use of Xhance or Flonase Allergy Relief is rarely linked to glaucoma (high eye pressure). These nasal sprays may also lead to a cloudy eye-sight condition called cataracts.

Higher risk of infections

Xhance and Flonase can suppress your immune system and prevent it from working as well. So, you may be more likely to get an infection or have a harder time fighting one off. Talk with your HCP right away if you suspect that you have an infection or you came into contact with someone who has an illness such as chicken pox, measles, or tuberculosis.

Adrenal insufficiency

High and consistent doses of steroid nasal sprays may contribute to adrenal insufficiency. In adrenal insufficiency, the adrenal glands — the small organs that sit on top of the kidneys — don’t make enough naturally-occurring hormones called cortisol and aldosterone.

Symptoms of adrenal insufficiency include:

• Low blood pressure

• Muscle weakness

• Patchy or dark skin

• More sleepiness than usual

• Weight loss

If you start experiencing these symptoms, let your HCP know. They’ll work with you to slowly lower your dose.

Severe allergic reactions

It’s possible to have a severe allergic reaction to these nasal sprays. If you start experiencing the following symptoms, seek emergency medical attention right away:

• Trouble breathing 

• Itchiness

• Swelling of your face, tongue, or throat

• Skin rashes

5. Xhance and Flonase each interact with certain medications

In general, avoid combining Xhance or Flonase Allergy Relief with strong CYP3A4-inhibiting medications. CYP3A4 is an enzyme (protein) in your liver that’s responsible for breaking down many medications, including Xhance and Flonase.

If you take one or more CYP3A4 inhibitors, they can prevent Xhance and Flonase from breaking down properly. With higher amounts of these steroid medications in your body, you’ll have a higher risk of experiencing fluticasone side effects, such as a sore throat.

One example of a CYP3A4 inhibitor is ritonavir (Norvir), an antiviral medication that’s often used with other HIV medications. Another one is itraconazole, an antifungal medication. For more details about medication interactions, speak with your pharmacist or prescriber. 

How to save on Xhance and Flonase

There are ways to save on Xhance and Flonase Allergy Relief. Both are available as brand-name medications. But you can also find Flonase as a lower-cost generic. GoodRx can help you navigate ways to save on your prescription.

• Save with GoodRx. GoodRx can help you save over 70% off the average retail price of the generic version of Flonase. Generic Flonase’s price at certain pharmacies is less than $14.67 with a free GoodRx discount.

• Save with a copay savings card. If you have commercial insurance and meet eligibility requirements, Xhance’s price is as little as $0 using a savings card from the manufacturer. 

Can you take Xhance and Flonase together?

No. You shouldn’t combine Xhance and Flonase Allergy Relief. Xhance and Flonase are used for similar symptoms, but they treat different medical conditions. Plus, both nasal sprays contain the same medication. Combining them wouldn’t offer any additional benefits, and you’d have a higher risk of side effects.

Why trust our experts?

Written by:

Ross Phan, PharmD, BCACP, BCGP, BCPS

Ross Phan is a board-certified clinical pharmacist. She has roughly two decades of healthcare experience — with most of her experience being pharmacy related.

Written by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

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