What Is The Difference Between Flonase and Flonase Sensimist?
The pharmacist details the difference between two steroid nasal sprays, Flonase and Flonase Sensimist.
Can you tell me the difference between Flonase and Flonase Sensimist? It looks like they have the same ingredient but they must be different since they are packaged differently and one costs more than the other.
May 04, 2021- Flonase and Flonase Sensimist contain different active ingredients with different chemical structures, not just different salt forms of the same drug.
- Flonase Sensimist uses a lower dose, may work slightly longer, and has a gentler spray mechanism that may cause less nasal dripping than regular Flonase.
- Flonase Sensimist is approved for children as young as age 2 and is specifically approved for treating itchy and watery eyes, while regular Flonase is approved only for children age 4 and older.
Previously available only by prescription, Flonase (fluticasone propionate) was approved by the FDA to go over the counter (OTC) in 2015. Flonase Sensimist (fluticasone furoate), a similar product, has been available since February 2017.
Both are certainly effective for treating seasonal allergy symptoms, but there is some confusion about how these products differ from each other.
Although they share the name Flonase, they are in fact two different drug products, with different active ingredients.
Fluticasone Propionate Vs. Fluticasone Furoate
Flonase contains fluticasone propionate, while Flonase Sensimist contains fluticasone furoate.
These two ingredients are often confused as simply different salt forms of the same drug, but that is not the case. They are two different drug molecules with distinct properties...they simply contain the same steroidal 'backbone'. One study on the matter states the following:
Their pharmacological activity is mediated by the entire molecule (backbone + ester) and they share no common metabolites – neither FF (fluticasone furoate) nor FP (fluticasone propionate) is metabolised to fluticasone. FF and FP are therefore structurally distinct drug substances with distinct properties.
Below is the chemical structure of each:
In terms of how these drugs work, and how we respond to them, numerous studies have shown that fluticasone furoate (Flonase Sensimist) binds more strongly to the site of action, the glucocorticoid receptor, than fluticasone propionate (Flonase).
Below is an excerpt from the prescribing information for Veramyst, a product that contains fluticasone furoate:
Fluticasone furoate has been shown in vitro to exhibit a binding affinity for the human glucocorticoid receptor that is approximately 29.9 times that of dexamethasone and 1.7 times that of fluticasone propionate. The clinical relevance of these findings is unknown.
Does One Work Better Than The Other?
How strongly these drugs bind to their receptor of action certainly is a distinct difference between the two drugs, but, as the excerpt says above, it is not known definitively whether this stronger binding affinity is clinically relevant.
Most studies have not shown that it works any better in controlling our allergy symptoms than fluticasone propionate. Nevertheless, some preliminary studies have shown that fluticasone furoate (Flonase Sensimist) may work slightly better at reducing certain symptoms, like red and watery eyes, and may have a slightly longer duration of action (i.e. it lasts longer between doses)
In fact, the marketing for Flonase Sensimist does state that it lasts the longest among steroid nasal sprays.
Additionally, since Flonase Sensimist binds to the glucocorticoid receptor stronger than Flonase, it requires a lower dose. If you look at the strength of each product, the dose for Flonase Sensimist is (27.5 mcg) compared with Flonase (50 mcg).
Other Differences
Other differences between the two drug products include:
- Flonase Sensimist (Fluticasone Furoate) may be gentler on the nasal passages and better tolerated (in terms of side effects) than Flonase (fluticasone propionate).
According to the manufacturer (GlaxoSmithKline) Flonase Sensimist (fluticasone furoate) has a patented spray mechanism that delivers the medication more gently than other products. This gentler spray may also result in less dripping from the nostrils.
- Flonase Sensimist (Fluticasone Furoate) is approved for use in children aged 2 years and older. Flonase (Fluticasone Propionate) is approved for children aged 4 years and older.
So, if you want to use a Flonase product for a child under 4, your only option (technically, based on FDA-approved indications) is Flonase Sensimist (Fluticasone Furoate).
- Flonase Sensimist (Fluticasone Furoate) may be more effective for red, itchy, and watery eyes.
Flonase Sensimist (Fluticasone Furoate) has an FDA-approved indication for the treatment of itchy & watery eyes due to allergies while Flonase (Fluticasone Propionate) does not. If you are having trouble with allergy symptoms in your eye (redness, itching, watering), Flonase Sensimist (Fluticasone Furoate) may be a better option.
Cost
You can expect to pay slightly more for Flonase Sensimist (Fluticasone Furoate). A 120 spray bottle costs around $20-25 while a 120 spray bottle of Flonase (Fluticasone Propionate) costs closer to $20 (generally around $18-$19).
References & sources
- Pharmacological properties of the enhanced-affinity glucocorticoid fluticasone furoate in vitro and in an in vivo model of respiratory inflammatory disease — Am J Physiol Lung Cell Mol Physiol 293
- Veramyst Prescribing Information — AccessFDA
- Fluticasone furoate/fluticasone propionate – different drugs with different properties — Pubmed
- Comparison of fluticasone furoate and fluticasone propionate for the treatment of Japanese cedar pollinosis — Pubmed
Glossary — Terms in This Answer
- FDA
- The Food and Drug Administration, the U.S. government agency responsible for approving medications for safety and effectiveness.
- Over the counter (OTC)
- Medications that can be purchased without a prescription from a doctor.
- Active ingredients
- The chemical substances in a medication that produce the intended therapeutic effect.
- Metabolites
- Chemical substances produced when the body breaks down a drug.
- Glucocorticoid receptor
- The target site on cells where steroid medications attach to produce their anti-inflammatory effects.
- Binding affinity
- The strength with which a drug attaches to its target site in the body.
- Duration of action
- The length of time a medication continues to work in the body after a single dose.
- FDA-approved indications
- The specific medical conditions that the FDA has determined a medication is safe and effective to treat.
Dr. Brian Staiger, PharmD
Doctor of Pharmacy, board certified clinical pharmacist (BCPS), American Herbalist Guild, Medication Therapy Management certified
Brian Staiger, PharmD, BCPS, is a licensed pharmacist with more than 13 years of experience across retail pharmacy, clinical pharmacy, medication safety, pharmacy program development, and healthcare administration. He is the founder of HelloPharmacist.com, where he helps patients...
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