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
Astelin
Flonase vs. Astelin Dosage
Flonase
Astelin
| 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 |
| 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
| 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
| 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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