Allergies Nose & Eye Allergies Astepro vs. Flonase for Allergies Some may benefit from using these nasal sprays in combination By Daniel More, MD Updated on December 05, 2023 Medically reviewed by Jurairat J. Molina, MD Print Table of Contents View All Table of Contents What Is Flonase? What Is Astepro? Flonase vs. Astepro Combination Medication Dymista Astepro and Flonase are two different nasal spray medications used to treat symptoms like runny nose, itchy nose, and congestion. Astepro contains an antihistamine, while Flonase is a steroid medication. The effects of the two medications are similar, but they work differently. Astepro blocks histamines, while Flonase decreases inflammation in the nasal passages. Although these medications are effective on their own, it is generally considered safe to use both if you aren't experiencing complete relief with just one. Your healthcare provider may recommend this or prescribe Dymista (azelastine hydrochloride and fluticasone propionate), a nasal spray composed of generic forms of both medications. This article goes over the differences between Astepro and Flonase, and when you might need to use these nasal spray medications together. dmphoto / Getty Images What Is Flonase? Flonase (fluticasone propionate) is a nasal spray that contains a corticosteroid. Corticosteroids help reduce inflammation in the nasal passages. This helps relieve symptoms like nasal congestion and runny nose. Non-prescription Flonase is used to treat the symptoms of nasal allergies. Fluticasone propionate, the generic of Flonase, is also sold in another formulation, called Xhance, by prescription only for people with chronic nasal symptoms that are not caused by an allergic reaction. Flonase can cause side effects, including: Nosebleeds or nose tendernessHeadachesSore throatNauseaCough Children under the age of 4 should not use Flonase. If you've recently had nasal surgery or have any injuries to your nose, ask your healthcare provider before using this medication. You should also inform your healthcare provider if you are pregnant or if you have any of the following conditions: GlaucomaAsthmaA herpes infection in the eyeA viral infection such as chicken pox or measles Make sure your healthcare provider knows about any other medication you are taking, including supplements. What Is Astepro? Astepro (azelastine nasal) is a nasal spray that contains an antihistamine. Astepro is available OTC and is used to treat the symptoms of nasal allergies. The antihistamine in Astepro blocks a protein called histamine, which is responsible for allergy symptoms like sneezing and runny nose. Only generic azelastine is available by prescription, as the brand Astelin has been discontinued in the U.S. Prescription azelastine is used to treat congestion and other nasal symptoms caused by non-allergic conditions. Astepro (azelastine 0.15%) nasal spray has been approved for nonprescription use in those 6 years and older. Azelastine 0.1% is a prescription version approved for use in younger children. This type of nasal spray can cause: Bitter tasteHeadachesDrowsinessTinglingNasal burningSore throatSinusitisBloody noseSneezing episodesNauseaDizzinessWeight gain Children under the age of 6 should not use Astepro. Because this medication can make you drowsy, you should avoid operating machinery until you know how you respond to it. Check with your healthcare provider if you have any injuries to your nose, if you have sores in your nose, or if you have recently had nasal surgery. Make sure your healthcare provider knows about any other medications you're taking, including supplements. Flonase vs. Astepro Flonase Nasal steroid Prescription and OTC; generic available One to two sprays per nostril once a day Azelastine Antihistamine Prescription and OTC One or two sprays per nostril twice a day Combining Flonase and Astepro Using Flonase with azelastine is considered a second-line option, which means that the combined treatment approach is only used when you don't experience adequate improvement of your symptoms with use of just one of these sprays. Using Flonase plus azelastine gives you the benefit of two different mechanisms of action that reduce inflammation. The body's inflammatory reaction is lower when a combination, rather than one, of these therapies is used. Whether or not that level of treatment is necessary to tame your symptoms depends, in part, on the severity of your allergies. Symptoms are generally so bothersome and noticeable that you should be able to judge your response to treatment well. Combining Flonase and Astepro is considered safe and does not add to side effects outlined for each medication. Dymista Combination drugs like Dymista include more than one medication. The advantage of this type of treatment is that it is faster and more convenient to use a single medication than to use them separately. The disadvantage is that you get a fixed dose of each component, so you and your healthcare provider can't make adjustments to one drug without affecting the other. Also, this medication is sometimes not covered by insurance. If your healthcare provider prescribes Dymista, you would also take it on a schedule to prevent your symptoms from occurring. Dymista nasal spray suspension delivers 137 mcg of azelastine hydrochloride and 50 mcg of fluticasone propionate (137 mcg/50 mcg) in each 0.137 mL spray. The recommended dose is one spray per nostril twice daily. The most common side effects of Dymista, as reported by the manufacturer, include: Distorted sense of taste (dysgeusia) Headaches Bloody nose (epistaxis) This medication can also cause sleepiness or drowsiness, so you need to be careful about driving or using heavy machinery. How to Stop a Bloody Nose Summary Flonase and Astepro are two different types of nasal spray medication used to treat allergy symptoms such as nasal congestion, runny nose, and sneezing. Prescription versions of both medications are available to treat congestion and other symptoms caused by non-allergic conditions. Flonase contains a corticosteroid, and Astepro contains and antihistamine. Because these two medications work differently, it is generally considered safe to use them together. However, you should only try this if using either medication alone does not help your symptoms. 9 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Stjarne P, Strand V, Theman K, Ehnhage A. Control of allergic rhinitis with MP-AzeFlu: a noninterventional study of a Swedish cohort. Rhinology. 2019;57(4):279–86. doi:10.4193/Rhin18.028 National Library of Medicine. Fluticasone nasal spray. Flonase. Flonase dosage directions for allergy relief. National Library of Medicine. Azelastine nasal spray. U.S. Food and Drug Administration. FDA approves a nasal antihistamine for nonprescription use. Astepro Allergy. Frequently asked questions for healthcare providers. Debbaneh PM, Bareiss AK, Wise SK, McCoul ED. Intranasal Azelastine and Fluticasone as combination therapy for allergic rhinitis: Systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2019;161(3):412–8.doi:10.1177/0194599819841883 Roca-Ferrer J, Pujols L, Pérez-González M, et al. Superior effect of MP-AzeFlu than azelastine or fluticasone propionate alone on reducing inflammatory markers. Allergy Asthma Clin Immunol. 2018;14:86.doi:10.1186/s13223-018-0311-4 U.S. Food and Drug Administration. Dymista label. By Daniel More, MD Daniel More, MD, is a board-certified allergist and clinical immunologist. He is an assistant clinical professor at the University of California, San Francisco School of Medicine and formerly practiced at Central Coast Allergy and Asthma in Salinas, California. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit