Nasonex is a prescription intranasal corticosteroid spray containing mometasone furoate monohydrate designed to treat allergic rhinitis, nasal polyps, and seasonal allergies. It works by reducing inflammation in the nasal passages, easing congestion, sneezing, and itchy eyes. FDA‑approved in 1999, Nasonex delivers 50µg per spray and is typically used once daily.
The active ingredient, mometasone furoate, binds to glucocorticoid receptors in nasal mucosa, suppressing cytokine release and limiting the swelling that blocks airflow. Because the drug stays localized, systemic absorption is minimal-less than 0.5% of the dose reaches the bloodstream. Studies from the American Academy of Otolaryngology show a 30‑40% reduction in nasal symptom scores after two weeks of consistent use.
When doctors talk about “intranasal steroids,” they usually compare a handful of brands. Below are the most frequently prescribed alternatives, each defined with its own microdata block.
Fluticasone propionate is the active ingredient in the widely‑available Flonase nasal spray. It carries a slightly lower potency per microgram than mometasone but is approved for both adults and children aged 4‑+. The standard dose is 2 sprays per nostril once daily (50µg per spray).
Budesonide powers the Rhinocort Aqua spray. Budesonide is known for a faster onset-often noticeable within 6‑12hours-but its overall potency is modest compared with mometasone. Recommended dosing is 1-2 sprays per nostril once daily (32µg per spray).
Azelastine hydrochloride is the antihistamine component of the Astepro nasal spray. Though not a corticosteroid, azelastine offers rapid relief (within minutes) for itchy, watery eyes and sneezing, making it a favorite for acute flare‑ups. Typical dosing is 1 spray per nostril twice daily (137µg per spray).
Beclomethasone dipropionate appears as the Beconase AQ spray. It falls in the middle of the potency spectrum and is available OTC in many countries. The usual regimen is 1 spray per nostril once daily (50µg per spray).
All intranasal steroids share a handful of common adverse events: nasal dryness, mild epistaxis, and occasional headache. Rarely, high‑dose or prolonged use can affect the HPA axis, leading to cortisol suppression. Antihistamine sprays like azelastine tend to cause a bitter taste and drowsiness in about 5% of users, but they avoid steroid‑related systemic risks. A 2022 meta‑analysis in the Journal of Allergy & Clinical Immunology concluded that the overall incidence of serious side effects is below 1% for all approved corticosteroid sprays.
| Attribute | Nasonex (Mometasone) | Flonase (Fluticasone) | Rhinocort (Budesonide) | Astepro (Azelastine) | Beconase (Beclomethasone) |
|---|---|---|---|---|---|
| Active ingredient | Mometasone furoate | Fluticasone propionate | Budesonide | Azelastine HCl | Beclomethasone dipropionate |
| Potency (relative per µg) | High | Medium‑high | Medium | Not a steroid (antihistamine) | Medium |
| Typical daily dose | 1 spray/nostril | 2 sprays/nostril | 1‑2 sprays/nostril | 1 spray/nostril (twice‑daily) | 1 spray/nostril |
| Onset of symptom relief | 12‑24h (steady state) | 12‑24h | 6‑12h | 5‑15min | 12‑24h |
| OTC availability (U.S.) | Prescription | OTC (12‑yr+) | OTC (12‑yr+) | Prescription | OTC (12‑yr+) |
| Common side effects | Dryness, mild bleeding | Dryness, mild bleeding | Dryness, mild bleeding | Bitter taste, drowsiness | Dryness, mild bleeding |
Choosing the right spray isn’t a one‑size‑fits‑all exercise. Below is a quick checklist that maps patient priorities to the most suitable option.
Allergic rhinitis is an inflammation of the nasal mucosa triggered by allergens such as pollen, dust mites, or pet dander. For patients with persistent symptoms that interfere with sleep or work, a high‑potency steroid like Nasonex is often recommended because the anti‑inflammatory effect accumulates over days, providing lasting control.
When the main complaint is sudden sneezing and itchy eyes during a seasonal peak, an antihistamine spray such as Azelastine can be added on top of a low‑dose steroid, creating a “dual‑therapy” regimen that attacks both histamine release (quick) and inflammation (slow).
Children under 12 typically receive Budesonide or Fluticasone at reduced doses, as the FDA has approved those ages for OTC use. Nasonex can be prescribed for kids as young as 2, but providers often start with a lower‑dose fluticasone to assess tolerance.
Improper technique is the #1 reason users see bleeding or reduced efficacy. Aim the spray toward the outer wall of the nostril-not the septum-to avoid irritation. Allow the spray to dry before blowing the nose; otherwise, the medication can be expelled.
Never exceed the recommended dose. A 2021 safety alert from the FDA warned that prolonged use of >2 sprays per nostril per day can increase the risk of systemic cortisol suppression, especially in children.
By following this roadmap, you’ll land on the option that balances effectiveness, convenience, and safety for your unique allergy profile.
Yes. Clinical trials spanning up to 12months show no significant increase in systemic cortisol levels when the recommended dose (1 spray per nostril daily) is followed. Routine monitoring is advised for children and patients on chronic high‑dose regimens.
Combining two intranasal corticosteroids offers no added benefit and raises the risk of local irritation and systemic exposure. If relief is insufficient, discuss switching to a different steroid or adding an antihistamine spray instead.
Azelastine (Astepro) delivers symptom relief within minutes because it blocks histamine receptors directly. For a steroid‑only approach, Budesonide tends to have the quickest onset among the corticosteroids, usually noticeable within 6‑12hours.
As of 2025, mometasone furoate is still under patent in the United States, so only the brand‑name Nasonex is available. However, several international markets sell generic mometasone nasal sprays at lower cost.
Gently blow your nose, tilt your head slightly forward, insert the nozzle, and aim the spray toward the outer wall of the nostril. Press the pump once, inhale gently through the nose, then repeat for the other side. Avoid sniffing hard, which can draw the medication down the throat.
All intranasal corticosteroids are classified as pregnancy category C, meaning risk cannot be ruled out. Doctors often recommend the lowest effective dose, and many opt for fluticasone because of its extensive safety data. Always discuss with your obstetrician before starting any new medication.
Marie Green
September 25, 2025 AT 00:00Got a lot of people mixing up the spray technique, so here’s a quick rundown. After you blow your nose, tilt your head slightly forward and aim the nozzle toward the outer wall of the nostril, not the septum. That way you avoid the dreaded nosebleeds and get the medication where it belongs. Give it a gentle inhale and let the spray dry before you sniff again. Consistency is key – use it once daily at the same time.