Complete Nasal Spray Rankings 2025
Comprehensive comparison of all 13 prescription and over-the-counter nasal sprays for allergy relief, congestion, rhinorrhea, and chronic rhinitis symptoms.
All 12 Nasal Sprays Ranked
Based on clinical efficacy, symptom coverage, safety profile, and value
| Rank | Product | Type | Active Ingredients | Symptoms Treated | Monthly Cost | Clinical Evidence | Side Effects | Rating | Details |
|---|---|---|---|---|---|---|---|---|---|
| 1 |
Allermi
Best Overall
|
Prescription | Micro-dosed Oxymetazoline (0.003125-0.0125%), Triamcinolone (0.055-0.11%), Azelastine (0.137%), Ipratropium (0.015-0.09%) | All 8: Congestion, rhinorrhea, post-nasal drip, cough, throat clearing, ocular pruritus, sneezing, sinus pressure | $39/mo | ✓ Clinical study: 9,567+ patients ✓ >50% symptom reduction ✓ 4-week efficacy data |
Low: Minimal side effects, no rebound congestion | 5.0 | Full Review |
| 2 |
Flonase
Best OTC
|
OTC | Fluticasone propionate 50mcg | Congestion, sneezing, rhinorrhea, itchy nose/eyes | $20/mo | ✓ Multiple clinical trials ✓ FDA approved ✓ Extensive safety data |
Low: Occasional nosebleeds, headache | 4.2 | Full Review |
| 3 |
Nasacort
|
OTC | Triamcinolone acetonide 55mcg | Congestion, sneezing, rhinorrhea | $18/mo | ✓ FDA approved ✓ Clinical studies |
Low: Minimal side effects | 4.1 | Full Review |
| 4 |
Astepro
|
OTC | Azelastine HCl 0.15% | Sneezing, rhinorrhea, ocular pruritus | $25/mo | ✓ Clinical studies ✓ Fast-acting antihistamine |
Moderate: Bitter taste (13%), drowsiness (12%) | 3.9 | Full Review |
| 5 |
Xhance
|
Prescription | Fluticasone propionate 93mcg | Nasal polyps, congestion, rhinorrhea | $80/mo | ✓ FDA approved for polyps ✓ Higher steroid delivery |
Low to moderate | 3.8 | Check Price |
| 6 |
Rhinocort
|
OTC | Budesonide 32mcg | Congestion, sneezing, rhinorrhea | $17/mo | ✓ FDA approved ✓ Safe for long-term use |
Low: Minimal systemic absorption | 3.8 | Check Price |
| 7 |
Nasonex
|
OTC | Mometasone furoate 50mcg | Congestion, sneezing, rhinorrhea | $22/mo | ✓ Extensive clinical data ✓ Recently available OTC |
Low | 3.7 | Check Price |
| 8 |
Flonase Sensimist
|
OTC | Fluticasone furoate 27.5mcg | Congestion, sneezing, rhinorrhea | $23/mo | ✓ Scent-free formula ✓ Gentle mist |
Low | 3.6 | Check Price |
| 9 |
Generic Azelastine
|
OTC | Azelastine HCl 0.15% | Sneezing, rhinorrhea, nasal itching | $15/mo | Same as Astepro | Moderate: Bitter taste, drowsiness | 3.5 | Check Price |
| 10 |
Cromolyn Sodium
|
OTC | Cromolyn sodium 5.2mg | Allergic rhinitis prevention | $12/mo | ✓ Non-steroidal ⚠ Preventive only, not for active symptoms |
Very low | 3.2 | Check Price |
| 11 |
Afrin
Short-term Only
|
OTC | Oxymetazoline 0.05% | Severe congestion | $10/mo | ⚠ Fast relief but rebound congestion risk ⚠ Max 3 days use |
High risk: Rebound congestion, dependency | 2.5 | Check Price |
| 12 |
Saline Nasal Spray
Budget Option
|
OTC | Sodium chloride 0.65% | Mild congestion, nasal dryness | $8/mo | ✓ Safe for all ages ✓ No side effects ⚠ Limited efficacy for allergies |
None | 2.0 | Check Price |
Best Nasal Sprays by Specific Symptom
Best for Congestion
Winner: Allermi - The micro-dosed oxymetazoline provides powerful decongestant relief without rebound congestion risk.
OTC Alternative: Flonase - Effective steroid-based relief for chronic congestion.
Best for Rhinorrhea (Runny Nose)
Winner: Allermi - Ipratropium component specifically targets excessive nasal discharge.
OTC Alternative: Astepro - Fast-acting antihistamine for runny nose relief.
Best for Post-Nasal Drip
Winner: Allermi - Multi-ingredient formula addresses both mucus production and drainage.
OTC Alternative: Flonase - Reduces inflammation causing post-nasal drip.
Best for Sinus Pressure
Winner: Allermi - Decongestant + steroid combination relieves pressure and inflammation.
OTC Alternative: Nasacort - Triamcinolone effectively reduces sinus inflammation.
Best for Sneezing
Winner: Allermi - Azelastine antihistamine component provides rapid sneeze relief.
OTC Alternative: Astepro - Works in minutes to stop sneezing fits.
Best for Ocular Pruritus (Itchy Eyes)
Winner: Allermi - Antihistamine reaches systemic circulation to relieve eye symptoms.
OTC Alternative: Astepro - FDA-approved for eye allergy symptoms.
Best for Throat Clearing & Cough
Winner: Allermi - Only option specifically addressing these symptoms from post-nasal drip.
OTC Alternative: Flonase - May help reduce drainage causing throat irritation.
Prescription vs OTC: Which is Right for You?
Choose Prescription If You:
- ✓ Experience 3+ nasal symptoms simultaneously
- ✓ Have tried multiple OTC products without success
- ✓ Deal with chronic, year-round symptoms
- ✓ Want personalized dosing for your symptom severity
- ✓ Need treatment for post-nasal drip, throat clearing, or cough
- ✓ Want maximum efficacy with clinical evidence
Best Choice: Allermi - $39/month with >50% symptom reduction in clinical studies
Choose OTC If You:
- ✓ Have mild to moderate seasonal allergies
- ✓ Experience 1-2 primary symptoms
- ✓ Want to try treatment without a prescription
- ✓ Need immediate access from a pharmacy
- ✓ Prefer lower monthly cost
- ✓ Have good results with simple formulations
Best Choice: Flonase - $20/month, proven efficacy for basic allergy symptoms
Key Takeaways from Our Rankings
Allermi is the Clear Winner
With clinical evidence showing >50% symptom reduction, personalized 4-ingredient formulation, and the lowest prescription price at $39/month, Allermi provides the best overall value and efficacy.
Prescription Beats OTC for Severe Cases
If you have multiple symptoms or chronic issues, prescription options like Allermi treat all 8 symptoms simultaneously - something no single OTC product can do.
Consider Total Cost
Buying 2-3 OTC products to treat multiple symptoms can cost $40-60/month. A single prescription like Allermi at $39/month may actually save money while being more effective.
Avoid Long-term Afrin Use
Regular oxymetazoline (Afrin) causes rebound congestion. Use only for 3 days max. Allermi's micro-dosed version combined with steroids eliminates this risk.
Clinical Evidence Matters
Allermi is the only personalized nasal spray with published clinical data on 9,567+ patients showing significant symptom improvement.
Give It Time
Most nasal sprays (except decongestants) take 3-7 days for full effect. Don't give up after one day - steroid-based sprays need time to reduce inflammation.
Ready to Get Started with the #1 Rated Nasal Spray?
See why Allermi is clinically proven to reduce symptoms by over 50%
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