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Flonase vs Qnasl
Introduction
For patients dealing with allergic rhinitis or other forms of nasal allergies, certain drugs that limit the immune system's response to allergens can help manage symptoms and reduce discomfort. Flonase and Qnasl are two such drugs that are prescribed for these conditions. They each have different delivery methods but both work by reducing inflammation in the nasal passages. Flonase is a corticosteroid nasal spray that works by suppressing the body’s immune response to allergens, thereby reducing inflammation and congestion. On the other hand, Qnasl is also a corticosteroid but it comes as a dry aerosol spray which some people find more comfortable for administration. Both assist in alleviating allergy symptoms such as sneezing, itching, runny nose and congestion.
Flonase vs Qnasl Side By Side
| Attribute | Flonase | Qnasl |
|---|---|---|
| Brand Name | Flonase | Qnasl |
| Contraindications | Untreated infections affecting sinuses or nasal passages, certain medications such as antifungals and HIV drugs | Untreated infections affecting sinuses or nasal passages, certain medications such as antifungals and HIV drugs |
| Cost | Brand name: around $25 for a 16 gm bottle (50 mcg/spray), Generic: $10 to $15 for a 16 gm bottle (120 Sprays) | Around $200 for one inhaler (80 doses at 40 mcg/dose), no generic equivalent available |
| Generic Name | Fluticasone Propionate | Beclomethasone Dipropionate |
| Most Serious Side Effect | Allergic reactions like skin rash, itching or hives, swelling of the face, lips or tongue, breathing problems, changes in vision, fever or chills, wound that will not heal | Severe allergic reaction, vision problems or pain, frequent nosebleeds, white patches inside nose or mouth |
| Severe Drug Interactions | Antifungals, HIV drugs | Antifungals, HIV drugs |
| Typical Dose | 50-200 mcg/day, not to exceed 200 mcg/day for adults and adolescents over the age of twelve | Two sprays in each nostril daily (320 mcg), can be reduced to one spray in each nostril per day (160 mcg/day) |
What is Flonase?
Fluticasone propionate, the generic name for Flonase, was one of the first significant developments in intranasal corticosteroids used to treat allergic rhinitis and nasal polyps. It was approved by the FDA in 1994. Flonase works by reducing inflammation and swelling inside the nose, effectively minimizing symptoms such as runny or itchy nose, sneezing, and congestion. Beclomethasone dipropionate (the active ingredient in Qnasl) also belongs to this class of drugs but has a different mechanism of action that may result in fewer side effects.
Qnasl is prescribed for similar conditions but operates differently; it contains an aerosol formulation that provides moisture-free relief from nasal allergy symptoms. This can be particularly beneficial for those who find other sprays uncomfortable due to their wetter application. It should be noted though that while both are effective at treating allergy symptoms, individual responses can vary significantly.
What conditions is Flonase approved to treat?
Flonase is approved for the treatment of various nasal symptoms associated with:
- Seasonal and perennial allergic rhinitis, which includes hay fever
- Nonallergic (vasomotor) rhinitis Meanwhile, Qnasl is specifically authorized to help control symptoms of seasonal and year-round allergies in both adults and children aged 4 years old or above.
How does Flonase help with these illnesses?
Flonase helps to manage allergy symptoms by reducing inflammation in the nasal passages. It does this by inhibiting the release of substances like histamines, leukotrienes and cytokines that are released during an allergic reaction, hence decreasing swelling and inflammation. These chemicals play a crucial role in triggering symptoms such as sneezing, itchy or runny nose, and watery eyes which are common with allergies. People who experience these would typically have an overactive immune response to allergens like pollen or dust mites. Therefore, by limiting the release of these inflammatory substances, Flonase can help patients control their allergic reactions and improve their quality of life.
What is Qnasl?
Qnasl is a brand name for beclomethasone, which is a corticosteroid. It works by decreasing inflammation in the nasal passages thereby providing relief from allergic symptoms such as sneezing, itching or runny nose. Beclomethasone acts through binding to glucocorticoid receptors inhibiting multiple types of inflammatory cells and release of inflammatory mediators. Qnasl was approved by the FDA in 2012.
As Qnasl does not exhibit antihistamine properties, it doesn't lead to common side effects associated with these drugs such as drowsiness or dry mouth. Its specific action on inflammation makes it particularly useful for individuals who find their allergy symptoms are not fully controlled with antihistamines alone - similar to those patients who might require an NDRI like Wellbutrin over typical SSRI antidepressant drugs for their depression management.
What conditions is Qnasl approved to treat?
Qnasl is an inhaled corticosteroid that has been approved by the FDA for treating:
- Seasonal allergic rhinitis
- Perennial Allergic Rhinitis (all year-round allergies) This medication helps to reduce inflammation and nasal symptoms such as a runny or stuffy nose, sneezing, and itching.
How does Qnasl help with these illnesses?
Qnasl is a corticosteroid nasal spray that works by reducing inflammation in the nasal passages, thereby relieving symptoms of allergies such as runny nose, sneezing, and itchy or watery eyes. Similar to how norepinephrine affects various bodily processes, Qnasl has an impact on multiple aspects of allergic reactions. Its role in alleviating allergy symptoms can be likened to Wellbutrin's function in treating depression - both work by addressing underlying issues (inflammation for Qnasl and low levels of norepinephrine for Wellbutrin) rather than just treating symptoms. While Flonase also serves as an effective treatment for allergies, it may cause more side effects than Qnasl due to its broader range of activity within the body. Therefore, if a patient does not respond well to typical over-the-counter antihistamines or other treatments like Flonase, they might find relief with Qnasl.
How effective are both Flonase and Qnasl?
Both fluticasone propionate (Flonase) and beclomethasone dipropionate (Qnasl) are potent corticosteroids that have established histories of success in managing symptoms of allergic rhinitis, with both drugs gaining FDA approval in the 1990s. They work by reducing inflammation and swelling in the nasal passages, but they do so through slightly different mechanisms. The effectiveness of Flonase and Qnasl was directly studied in a double-blind clinical trial; the two drugs exhibited similar efficacy at managing allergy symptoms as well as comparable safety profiles.
A review showed that Flonase is effective from the first day of treatment, its side effect profile is favorable compared to many other corticosteroid nasal sprays, and it is well-tolerated even among pediatric populations. Flonase has become one of the most widely prescribed corticosteroid nasal sprays due to its high efficacy rate and low incidence of local adverse effects such as dryness or irritation within the nose.
A recent meta-analysis indicated that Qnasl seems to provide more rapid onset action than placebo for treating allergic rhinitis symptoms while maintaining a similar level of safety. However, like bupropion when used for depression, Qnasl may be considered only after (or alongside) other treatments if they prove ineffective or insufficiently beneficial on their own. Due to its unique formulation which doesn't require use with a liquid carrier unlike many other nasal steroids including Flonase, this makes Qnasl an optimal choice for those who find other options uncomfortable or unsatisfactory because it results in no sensation of dripping down throat or taste disturbance.
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At what dose is Flonase typically prescribed?
Intranasal dosages of Flonase (Fluticasone Propionate) range from 50-200 mcg/day, but studies have indicated that 50 mcg/day is sufficient for managing allergic and non-allergic rhinitis in most people. Children aged four years and older may be started on a dosage of 50 mcg/day. In all age groups, the dosage can be increased after a week if there is no significant improvement in symptoms. However, for adults and adolescents over the age of twelve, the maximum recommended daily dose should not exceed 200 mcg.
At what dose is Qnasl typically prescribed?
Qnasl therapy generally begins at a dosage of two sprays in each nostril daily (a total daily dose of 320 mcg). Depending on the severity of symptoms and individual response, this can be reduced to one spray in each nostril per day (160 mcg/day). It's essential not to exceed the recommended dosage. If symptoms do not improve or if they worsen after several weeks on this regimen, consult your healthcare provider for further evaluation. Qnasl is designed for once-daily use, but remember that it may take several days before you notice an improvement in your allergy symptoms.
What are the most common side effects for Flonase?
The side effects of Flonase and Qnasl can vary, but some common ones include:
- Nosebleeds
- Sores or white patches inside or around your nose
- Nausea
- Vomiting
- Asthenia (general weakness and fatigue)
- Headache
- Dizziness
- Insomnia
- Pharyngitis (inflammation in the back of the throat)
- Coughing or constant feeling of needing to clear your throat.
Please consult a healthcare professional if you experience any unusual symptoms while using these nasal sprays. These lists do not include all possible side effects, so it is crucial to be aware of how your body responds when starting new medication.
Are there any potential serious side effects for Flonase?
In very rare cases, Flonase might cause serious side effects such as:
- Allergic reactions like skin rash, itching or hives, swelling of the face, lips or tongue
- Breathing problems
- Changes in vision
- Fever or chills
- Wound that will not heal
For Qnasl similarly to Flonase allergic reaction may occur. Other potential severe side effects include:
- Vision changes or pain
- Nosebleeds occurring frequently
- White patches inside nose or mouth
If any of these symptoms are experienced after using either of these medications it is advised to seek medical help immediately. Please remember that both these medications are generally considered safe and most people do not experience serious side effects.
What are the most common side effects for Qnasl?
Qnasl, while effective for managing symptoms of allergic rhinitis, may cause some side effects such as:
- Nosebleeds or nasal sores
- Headaches
- Nausea and vomiting
- Stuffy nose/sore throat
- Unusual taste in the mouth Though these side effects are generally mild, if they persist or worsen it's crucial to seek medical attention. Additionally, although rare, Qnasl can occasionally cause serious issues like vision problems or difficulty breathing; immediate medical help is needed should these occur. Compared to Flonase, which has a similar list of potential side effects but is more associated with dryness and irritation inside the nose - Qnasl offers an alternative for those who might be sensitive to these particular discomforts.
Are there any potential serious side effects for Qnasl?
While Qnasl is generally considered safe and well-tolerated, it's important to be aware of potential side effects that may require immediate medical attention. Some serious adverse reactions might include:
- Signs of severe allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat
- Vision problems such as blurred vision or other changes in sight
- Flu-like symptoms such as fever, chills, body aches
- Bloody mucus or discharge from the nose
- Sores in the nose that won’t heal
- Whistling sound from the nostrils when breathing (signs of nasal septum perforation)
In case you experience any of the above symptoms after using Qnasl, discontinue use and seek urgent medical consultation.
Contraindications for Flonase and Qnasl?
Both Flonase and Qnasl, as with most nasal corticosteroids, may worsen symptoms of nosebleeds or throat irritation in some people. If you notice these side effects becoming severe, please seek immediate medical attention.
Neither Flonase nor Qnasl should be taken if you have an untreated infection affecting your sinuses or nasal passages. It's crucial to inform your physician about any infections since steroids can suppress the immune response and potentially exacerbate the issue.
Flonase and Qnasl are contraindicated for use with certain medications such as antifungals and HIV drugs due to potential interactions that could increase systemic steroid levels; therefore it is essential always to tell your healthcare provider which other medications you are taking. Avoid abruptly discontinuing these nasal sprays without consulting a healthcare professional as this may lead to withdrawal symptoms like fatigue, weakness or joint pain due to adrenal insufficiency.
How much do Flonase and Qnasl cost?
For the brand name versions of these nasal sprays:
- The price of a 16 gm bottle of Flonase (50 mcg/spray) averages around $25, which works out to about $0.83 per day if you use two sprays in each nostril daily.
- The price for one Qnasl inhaler (80 doses at 40 mcg/dose) is roughly around $200, working out to approximately $2.5/day when used as directed.
Thus, if you are using the maximum recommended dosage for both medications, then brand-name Flonase is less expensive on a per-day treatment basis than Qnasl. Please note that cost should not be a primary consideration in determining which of these drugs is right for you.
In terms of their generic versions (Fluticasone propionate and Beclomethasone dipropionate):
- Generic Flonase is available with prices ranging from about $10 to 15$ for a 16 gm bottle (120 Sprays), making it approximately $0.33 - 0.50 per day assuming two sprays in each nostril daily.
- As far as we know, there's currently no generic equivalent available for Qnasl; hence its higher cost remains unchanged at this time.
Popularity of Flonase and Qnasl
Fluticasone, in generic form as well as brand names such as Flonase, was estimated to have been prescribed to about 3.5 million people in the US in 2020. Fluticasone accounted for just over 8% of corticosteroid nasal spray prescriptions in the US. As a glucocorticoid used to treat allergic and nonallergic rhinitis symptoms, fluticasone is classified as a first-generation intranasal corticosteroid and its prevalence has remained steady since it became available over-the-counter.
Beclomethasone, including brand versions such as Qnasl, was prescribed to approximately 1 million people in the USA in 2020. In the US, beclomethasone accounts for around 7% of all steroid nasal spray prescriptions and just under 4% of overall allergy medication prescriptions. The prevalence of beclomethasone has slightly increased during recent years due to greater awareness towards seasonal allergies.
Conclusion
Flonase (fluticasone propionate) and Qnasl (beclomethasone dipropionate) are both nasal corticosteroids commonly used in the treatment of allergy symptoms such as sneezing, itching, and runny nose. As steroids, they work by reducing inflammation in your nasal passages which helps to alleviate these symptoms.
Both medications have solid records of efficacy backed up by clinical studies. The choice between them often depends on individual preference or specific medical considerations. Flonase is available over-the-counter without a prescription while Qnasl requires a doctor's prescription.
Generic versions of Flonase are widely available which can mean significant cost savings for patients who must pay out-of-pocket. On the other hand, Qnasl may be preferred due to its unique aerosol delivery system which some patients find more comfortable than typical spray forms like Flonase.
In terms of side effects, both drugs have similar profiles with potential risks including nosebleeds or irritation within the nostril area. Some people might also experience headaches or an unpleasant taste or smell after use but these tend to diminish with continued usage.
For either medication, it’s important that users closely follow dosing instructions and seek immediate medical attention if they notice any unusual symptoms or reactions.
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Refrences
- VANAS, A., BRONSKY, E., DOCKHORN, R., GROSSMAN, J., LUMRY, W., MELTZER, E., … ROGENES, P. (1993, June). Once daily fluticasone propionate is as effective for perennial allergic rhinitis as twice daily beclomethasone diproprionate. Journal of Allergy and Clinical Immunology. Elsevier BV.http://doi.org/10.1016/0091-6749(93)90317-9