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Even though the medication wasn't FDA-approved until 2014, it almost immediately became the best selling product nasal decongestant. It is more popular than Benadryl, more popular than Mucinex (despite the ads with the green blob of mucus that is always trying go out with people), and far outsells both Dayquil and Nyquil. The only product that comes close to it in terms of sales is Nasacort. Both Flonase and Nasacort are inhalable steroids, and they have some overlapping side effects, although Flonase has fewer side effects than Nasacort.

Flonase is actually a medication called fluticasone propionate. Long before it became popular for treating stuffy nose, it was used to treat Crohn's disease (a condition causing irritation that "skips" along the digestive tract), ulcerative colitis (a similar condition that doesn't "skip" but causes continuous areas of inflammation), another digestive tract problem called esinophilic esophagitis, nasal polyps, and asthma. Like Nasacort, Flonase is a potent steroid drug that can rapidly reduce swelling and inflammation of mucosal linings of the nose and throat. Unlike Nasacort, Flonase is relatively specific and doesn't have the same potential for systemic side effects, such as:

  • Immunosuppression. Ironically, Nasacort reduces the activity of the immune system (which generates inflammation as a protection against infection) that people who have active infections in the upper respiratory tract shouldn't take it. Flonase is safer but not totally safe for people getting over a cold or a bacterial infection. Flonase is not as likely to interfere with the immune system's ability to keep herpes or a cold sore in check as Nasacort is.
  • Barrier dysfunction. Part of what the mucosal linings of the nose and throat do is to serve as a barrier against viral infection and irritant chemicals, like those in cigarette smoke. There are really potent steroids like budesonide (Symbicort) that strengthen the linings of the upper respiratory tract to withstand potential infections, including strep throat (although Symbicort causes other problems). Flonase won't do anything to protect you from strep.
  • Weight gain. Any kind of steroid you take by mouth or by injection can cause weight gain. This is a slight problem with Nasacort, but not with Flonase.
  • Hormone imbalances. Steroids can also interfere with the production of stress hormones. This doesn't happen with Flonase nasal spray.
  • A variety of side effects your doctor will probably tell you just to put up with, including diarrhea, nausea, vomiting, and minor nosebleed. Flonase can cause all of these, and occasionally also leukoplakia (development of white patches in the mouth), bruising of the nasal passages or throat, swelling of the neck and tongue (which can be serious and are something you should report to your doctor right away), and elevated eye pressure (which is a serious problem if you have glaucoma). 

What about anxiety caused by Flonase?

This is usually an issue in people who have a serious, underlying problem like COPD (chronic obstructive pulmonary disease) along with anxiety and/or depression. In terms of hospitalizations for anxiety and/or depression, researchers have actually looked at this problem. They found that Flonase wasn't as problematic as anticholinergic medications, which act not by reducing inflammation but by reducing mucus production. You'll get fewer problems from Flonase than from Atrovent. 

That's not a lot of comfort if you are the parent comforting an anxious child. Usually it's a better idea to stick with the treatment unless other, intolerable side effects show up. Anxiety eases as breathing becomes easier and post-nasal drip clears up. If you switch to Nasacort just to ease anxiety symptoms, you'll likely be disappointed. If the anxiety is tolerable, work through it to get to a happier state quickly.

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