August 2025
| Class | Drug | Common brand name(s) and strength | Generic available | Available without a prescription (OTC) | Usual adult dose per nostril | Lower age limit based on FDA labeling | Usual pediatric dose per nostril | Type of preparation (alcohol content)* |
| Second generation glucocorticoid (systemic bioavailability <1% or undetectable) | Single-ingredient | |||||||
| Ciclesonide | Omnaris (50 mcg/spray) | No | No | 2 sprays once daily | 6 years¶ | 6 to 11 years: 1 or 2 sprays once daily ≥12 years: 2 sprays once daily | Aqueous suspension pump spray | |
| Fluticasone furoateΔ | Flonase Sensimist (OTC) (27.5 mcg/spray) | No | Yes | 2 sprays once daily | 2 years | 1 or 2 sprays once daily In children 2 to 11 years, start with 1 spray once daily | Aqueous suspension pump spray | |
| Fluticasone propionateΔ | Flonase Allergy Relief (OTC) (50 mcg/spray) | Yes | Yes | 2 sprays once daily or 1 spray twice daily | 4 years | 4 to 11 years: 1 spray once daily ≥12 years: 2 sprays once daily or 1 spray twice daily | Aqueous suspension pump spray (0.25% alcohol) | |
| MometasoneΔ | Nasonex 24HR Allergy (OTC) (50 mcg/spray) | Yes | Yes | 2 sprays once daily | 2 years | 2 to 11 years: 1 spray once daily ≥12 years: 2 sprays once daily | Aqueous suspension pump spray | |
| Combination with antihistamine (faster acting than glucocorticoid alone; may help patients who don't respond fully to single-ingredient glucocorticoid sprays) | ||||||||
| Azelastine-fluticasone propionateΔ | Dymista (azelastine 137 mcg/fluticasone propionate 50 mcg per spray) | Yes | No | 1 spray twice daily | 6 years¶ | ≥6 years: 1 spray twice daily | Aqueous suspension pump spray (0.25% alcohol) | |
| Olopatadine-mometasoneΔ | Ryaltris (olopatadine 665 mcg/mometasone 25 mcg per spray) | No | No | 2 sprays twice daily | 12 years¶ | ≥12 years: 2 sprays twice daily | Aqueous suspension pump spray | |
| First generation glucocorticoid (systemic bioavailability 10 to 50%) | Single-ingredient | |||||||
| Beclomethasone | Pediatric: Qnasl Children's (40 mcg/spray) Adolescent/adult: Qnasl (80 mcg/spray) | No | No | 2 sprays once daily using 80 mcg/spray product | 4 years | 4 to 11 years: 1 spray once daily using 40 mcg/spray product ≥12 years: 2 sprays once daily using 80 mcg/spray product | Pressurized aerosol spray (8% alcohol) | |
| Beconase AQ (50 mcg/spray) Available in some areas (not United States or Canada) | No | No | 1 to 2 sprays twice daily | 6 years | 1 to 2 sprays twice daily In children 6 to 11 years, start with 1 spray twice daily | Aqueous suspension pump spray (0.25% alcohol) | ||
| BudesonideΔ | Generic (formerly Rhinocort Allergy) (OTC) (32 mcg/spray) | Yes | Yes | 1 to 2 sprays once daily | 6 years | 1 to 2 sprays once daily In children 6 to 11 years, start with 1 spray once daily | Aqueous suspension pump spray | |
| Flunisolide | Generic (formerly Nasalide) (25 mcg/spray) | Yes | No | 2 sprays 2 or 3 times daily (maximum 2 sprays 4 times daily) | 6 years | 6 to 14 years: 1 spray 3 times daily or 2 sprays twice daily ≥15 years: 2 sprays 2 or 3 times daily (maximum 2 sprays 4 times daily) | Aqueous suspension pump spray (contains propylene glycol, a possible irritant) | |
| TriamcinoloneΔ | Nasacort Allergy 24HR (OTC) (55 mcg/spray) | Yes | Yes | 2 sprays once daily | 2 years | 2 to 5 years: 1 spray once daily ≥6 years: 1 to 2 sprays once daily In children 6 to 11 years, start with 1 spray once daily | Aqueous suspension pump spray | |
Nasal sprays work best when they are administered properly and the medication remains in the nose rather than draining down the back of the throat. Note that the recommended techniques for the aqueous and aerosol sprays are different. If the nose is crusted or contains mucus, it should first be cleaned with a saline nasal spray prior to use of intranasal sprays. Some people find that holding the other nostril closed with a finger improves their ability to draw the spray into the upper nose.
Once symptoms are controlled, the daily dose can be reduced to the lowest dose that maintains control.
Dosing and product descriptions are based upon products available in the United States and some other countries. Product descriptions in other countries may differ in some detail. Consult the drug monographs included within UpToDate and local product information for additional detail.
For agent selection, refer to UpToDate content on rhinitis.
CYP: cytochrome P450; FDA: US Food and Drug Administration; OTC: over the counter (available without a prescription in the United States and some other countries).
* Alcohol may contribute to dryness or irritation.
¶ Some available data suggest use may be safe in younger age groups. Refer to drug monographs for additional details.
Δ Subject to drug interactions with CYP3A4 inhibitors, requiring caution or avoidance. For example, fluticasone nasal sprays should be avoided in patients who are receiving strong CYP3A4 inhibitors. For specific interactions, refer to the drug interactions program included within UpToDate.
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