Inhaled nasal steroids (i.e. intranasal corticosteroids) are potent anti-inflammatory agents and moderate how the cells in our body respond to allergens. They can provide symptomatic relief of nasal/sinus congestion, a runny nose and ocular symptoms such as itching/redness.
Nasal steroids can be used on an 'as needed' basis for relief of these symptoms but most studies show that continuous use provides better relief. In fact, it can sometimes take up to 2 weeks to achieve maximum relief with these products.
As mentioned above, there are many nasal steroids available over the counter and it is often asked, what is the difference between the products? Below, we are going to look into Flonase (Fluticasone) and Rhinocort (Budesonide).
Flonase is available as both Flonase and Flonase Sensimist. We have written an article detailing the difference between the two here
Both Flonase products contain the active ingredient Fluticasone, although in different forms. Flonase contains Fluticasone Propionate and Flonase Sensimist contains Fluticasone Furoate.
Both Flonase products have been shown to be safe and effective for use in the treatment of nasal allergy symptoms. Flonase Sensimist does appear to be slightly stronger and better tolerated in terms of taste (if it happens to run down your throat) and gentleness of the spray than the regular Flonase is.
Nearly the entire effect of the product is from direct contact with the nasal passages and not through systemic absorption.
Studies have shown that less than 1% of the drug, if swallowed, is actually absorbed and has no effect. Once in contact with the nasal passages, it starts to work in 30-60 minutes and has a duration of action from 7 -24 hours. In general, continuous use provides a better effect than 'as needed' use.
Rhinocort contains the active ingredient budesonide. It known to possesses very high topical anti-inflammatory activity and is typically considered to be more potent than Flonase. Like Flonase, it works quickly, within 30-60 minutes after dosing and works best if used daily, on a consistent basis.
Studies have shown that budesonide is systemically absorbed slightly more than Flonase is. Approximately 34% of an intranasal dose reaches the systemic circulation and occurs primarily through the nasal tissues. It is not known if there are any negative effects from this.
There have been a few studies that have tested Rhinocort (Budesonide) and Flonase (Fluticasone) against one another. Based on the results of these studies, it does appear that Rhinocort is more effective and better tolerated than Flonase (fluticasone propionate). Unfortunately, there are no studies comparing Flonase Sensimist against other products, so the comparative efficacy of that product vs. others is unknown.
In a definitive study (J Allergy Clin Immunol 1998;102:902-8.), both Rhinocort and Flonase (fluticasone propionate) were better than placebo in treating allergy symptoms. However, Rhinocort, used once daily, was significantly better in controlling the symptoms of perrenial allergic rhinitis than once daily Flonase (fluticasone propionate). Rhinocort also may have a faster onset of action than Flonase (fluticasone propionate).
In conclusion, both Rhinocort and Flonase (fluticasone propionate) are effective products for nasal allergy sufferers. Based on the data available however, Rhinocort does appear to be slightly more potent and may work faster as well. We unfortunately can't make a definitive statement on Flonase Sensimist since it is so new.
There are a few drawbacks to Rhinocort to keep in mind. Firstly, a slighter higher amount of the steroid is absorbed systemically than Flonase (fluticasone propionate), although the effects of this aren't known. Secondly, Rhinocort is typically slightly more expensive than Flonase (fluticasone propionate), but only by a few dollars.