Flonase vs. Astelin

See how Flonase and Astelin compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Flonase is a corticosteroid spray that treats allergic and nonallergic rhinitis, while Astelin is an antihistamine spray mainly used for seasonal allergies and vasomotor rhinitis.

  • Flonase is available over the counter, while Astelin requires a prescription and carries a drowsiness warning.

  • Both sprays can cause headache and epistaxis, but only Astelin warns against driving until its sedating effects are known.

Flonase vs. Astelin Drug Summary

Flonase

Flonase is an intranasal corticosteroid that reduces inflammation to relieve seasonal and perennial allergic rhinitis, as well as nonallergic rhinitis, in people 4 and older. It typically starts at 200 mcg once daily and can be reduced to 100 mcg once daily once symptoms are controlled.

Astelin

Astelin is an intranasal antihistamine that blocks histamine to relieve seasonal allergic rhinitis in people 5 and older, and vasomotor rhinitis in adults and adolescents 12 and older. It is sprayed into each nostril twice daily, with a higher dose available for stronger symptoms.

Flonase vs. Astelin Side Effects

Flonase

Most common
Headache (up to 16.1%)
Epistaxis (up to 6.9%)
Pharyngitis (up to 7.8%)
Cough (up to 3.8%)

Astelin

Most common
Headache (up to 2%)
Epistaxis (up to 2%)
Bitter taste (up to 2%)
Somnolence (up to 2%)

Flonase vs. Astelin Dosage

Flonase

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 200 mcg once daily At the start
Maximum dose 100 mcg once daily If needed
Dose changes 1 increase As tolerated

Astelin

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 1 spray/nostril twice daily At the start
Maximum dose 2 sprays/nostril twice daily If needed
Dose changes 1 increase As tolerated

Flonase vs. Astelin Indications

Flonase

Flonase treats inflammation-driven nasal symptoms from both allergic and nonallergic causes. It covers seasonal and perennial allergic rhinitis, as well as year-round nonallergic rhinitis, in patients 4 and older.

  • Seasonal allergic rhinitis (ages 4+)

  • Perennial allergic rhinitis (ages 4+)

  • Nonallergic (perennial) rhinitis (ages 4+)

Astelin

Astelin treats nasal symptoms triggered by histamine release from seasonal allergies as well as nonallergic triggers. It is approved for seasonal allergic rhinitis in people 5 and up, and for vasomotor rhinitis in those 12 and older.

  • Seasonal allergic rhinitis in adults

  • Seasonal allergic rhinitis in children ages 5+

  • Vasomotor (nonallergic) rhinitis in adults and adolescents 12+

Flonase vs. Astelin Pros and Cons

Flonase

Flonase offers flexible over-the-counter access and covers a broad range of rhinitis types, but long-term steroid use carries some risk to nasal tissue. Growth monitoring is advised for children on extended treatment.

Pros

  • Available over the counter without a prescription

  • Approved for both allergic and nonallergic rhinitis

  • Approved for children as young as 4

Cons

  • Long-term use carries risk of nasal septal perforation

  • Possible growth suppression in children with prolonged use

  • Local nasal irritation can occur with improper technique

Astelin

Astelin works quickly for both allergic and vasomotor rhinitis, but its antihistamine effect can cause drowsiness. It also requires a prescription, unlike some over-the-counter nasal steroid options.

Pros

  • Approved for vasomotor (nonallergic) rhinitis without steroid-related tissue risks

  • Fast symptom relief, often within minutes

  • Flexible dosing with 1 or 2 sprays per nostril

Cons

  • Can cause drowsiness, so driving should be avoided until effects are known

  • Bitter taste after use is common

  • Not approved for children under 5 or vasomotor use under 12

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