Azelastine and Fluticasone

Azelastine & Fluticasone Nasal Spray is a combination medicine used to treat seasonal symptoms of allergic rhinitis and is available through a doctor’s prescription only.

Overview

Azelastine & fluticasone spray is taken to treat various nasal problems due to hay fever, also known as allergic rhinitis. It treats symptoms such as sneezing, itchy nose, and runny nose.

Azelastine is one of the antihistamine medications. It prevents the effects histamine when released by the body. The histamine effects include itchiness, sneezing, watery eyes and runny nose.

Fluticasone is a steroid medication. It is used to prevent the swelling that manifests during allergic reactions.

This medicine is not sold over-the-counter. It needs to be prescribed by a doctor. It is available only in spray form. The drug brand name for Azelastine and fluticasone combination nasal spray in the USA is Dymista.

Conditions Treated:

  • Sneezing
  • itchy nose
  • runny nose
  • Other symptoms of seasonal hay fever

Type of Medication:

  • Combination medicine of antihistamine and steroid

Side Effects

Azelastine & fluticasone combination nasal spray may produce undesirable side effects in some patients. The patient should call the doctor right away if he or she notices any of the following side effects:

Does not occur often:

  • Nosebleed
  • body pains
  • chills
  • dry or sore throat
  • Symptoms similar to cold or flu
  • Nasal congestion
  • coughing or a hoarse voice
  • Having trouble breathing
  • congestion in the ear
  • fever
  • runny nose
  • headache
  • loss of voice
  • congestion
  • sneezing
  • tender, swelling of glands in the neck
  • Difficulty in swallowing
  • Feeling unusually lethargic or weak
  • Changes in the voice

The following incident may also occur:

  • Blindness
  • Blood in the mucus or nosebleed
  • blurry vision
  • pain in chest
  • Skin darkens
  • Reduced vision
  • wound heals slowly
  • diarrhea
  • difficulty in breathing
  • Feeling dizzy
  • Pain in the eyes
  • fainting or loss of consciousness
  • Rapid beating of the heart
  • Itchiness or rashes on the skin
  • Slow growth in children
  • Huge swelling of the lips, face, tongue, feet, hands, legs, throat, or sex organs
  • appetite loss
  • mentally depressed
  • nauseous or vomiting
  • inflammation of the eyelids, in the face, eyes, tongue or lips
  • drowsiness
  • sore in mouth or tongue
  • sores inside the nose
  • tearing
  • chest tightness
  • white patches in the mouth or on the tongue

Some of these side effects may happen but they do not require immediate medical attention. This is because the body may just need time to get used to the medicine. The doctor can also advise the patient on how to minimize or prevent possible side effects. If these side effects continue after using the medicine or cause problems, talk to the doctor:

  • loss of taste
  • burning, tingling, or itching sensation
  • Dry eyes
  • change in sense of smell
  • vision changes
  • Tearing
  • welts
  • irritation in nose
  • loss of smell
  • Mood changes
  • Skin redness
  • redness, pain, or swelling of the eye, or eyelid

Not all side effects are listed here. If the patient notices something unusual, call the doctor right away. Side effects may also be reported to the FDA at 1-800-FDA-1088.

Dosage

Dosage will vary from patient to patient. The dosage usually depends on the strength of the medication. The frequency of the doses, the length of time in between doses, and for how long the patient takes the medicine will depend on the medical condition being treated.

Always follow the directions and recommendations of the doctor especially if the patient has other existing conditions or is taking other medicines. The dosage outlined below is the standard dosage. If the doctor prescribes another dosage, follow it. Do not change the dosage unless the doctor says so.

For nasal spray form the dosage is:

To treat seasonal allergic rhinitis:

  • Adults as well as children 6 years old and above — for each nostril 1 spray twice every day. Each one spray usually has 50 mcg of fluticasone and 137 micrograms (mcg) of azelastine.
  • Children 6 years old and younger —the doctor should determine the dose.

How to Use It

The patient should follow the directions as indicated by the doctor. Using it more often for a longer period of time may cause certain side effects to manifest especially if the patient has other medical conditions. Always use caution when using with other medications. Ask the doctor if it will cause adverse interactions.

Azelastine and fluticasone combination nasal spray comes with an information leaflet in the package. Read the instructions and follow them. If in doubt or have questions, ask the doctor to clarify them.

This medicine should only be used in the nose. Avoid getting it in the mouth or eyes, as this may cause irritation and undesirable side effects. If it gets to the mouth or eyes, rinse the area immediately for at least 10 minutes then call the doctor right away.

Do not use Azelastine and fluticasone combination nasal spray for other nose conditions without informing the doctor first.

To use the Azelastine and fluticasone combination nasal spray:

  • Gently shake the bottle before every use.
  • When you use the the nasal spray for the first time, make sure to prime it first. To prime it, the patient has to press the pump 6 times or until it produces a fine. Spray it to the air, making sure it is away from the eyes. If the patient has used the spray for 2 weeks or 14 days, he or she should prime it again.
  • Blow the nose before using the Azelastine and fluticasone combination nasal spray. The patient then tilts his or her head. Insert the tip of the nose piece into the nostril.
  • Close the other nostril using a finger. Spray once and breathe through the nostril.
  • Hold the breath for several seconds then slowly exhale through the mouth.
  • Use the spray the same way in the other nostril.
  • Do not blow the nose after spraying.
  • Wipe the tip of the nose piece with a clean, dry cloth after using it and put the cap back on.
  • Dispose the basal spray safely after using it for 120 sprays.

Missed Dose

If a patient misses a dose, take it immediately. But, if it is time for the next dose, just skip it and continue regular dosing after. Do not double the dose to prevent unwanted side effects.

Drug Interactions

Certain medications when used together may cause adverse side effects. This is why it is important for the patient to let the doctor know what medications he or she is taking. Some medications should not be used together with Azelastine and fluticasone combination nasal spray. However, the doctor may prescribe these medications together despite the interaction to treat symptoms. The doctor may change the dosage, change the frequency or modify the medicine. It is important to take necessary precautions when taking different medicines.

The patient should tell the doctor if he or she is taking other medicines that cause drowsiness such as opioids or cough medicines. HIV protease inhibitors may also interact with Azelastine and fluticasone combination nasal spray adversely. The patient should tell the doctor if he or she is taking this drug.

Using the medicines listed below together with Azelastine and fluticasone combination nasal spray is not advisable but may be necessary in some medical conditions, especially life-threatening ones. The patient should let the doctor know if he or she takes the following:

  • Atazanavir
  • Bemiparin
  • Boceprevir
  • Bupropion
  • Ceritinib
  • Clarithromycin
  • Cobicistat
  • Conivaptan
  • Darunavir
  • Dasabuvir
  • Donepezil
  • Idelalisib
  • Indinavir
  • Itraconazole
  • Ketoconazole
  • Lumacaftor
  • Nadroparin
  • Nefazodone
  • Nelfinavir
  • Pixantrone
  • Posaconazole
  • Ritonavir
  • Saquinavir
  • Telaprevir
  • Telithromycin
  • Tipranavir
  • Voriconazole

The medicine Cimetidine if taken together with Azelastine and fluticasone combination nasal spray may cause undesirable side effects. If the patient takes Cimetidine, the doctor may modify the required dosage, length of time the medicine is taken, and the frequency of one or both medicines.

Other Interactions

Azelastine and fluticasone combination nasal spray also interact adversely with grapefruit juice. Do not consume grapefruit juice when taking Azelastine and fluticasone combination nasal spray to prevent any unwanted side effect. Alcohol and tobacco products may also affect the effectiveness of the medication. The doctor may need to change the dosage or frequency of taking Azelastine and fluticasone combination nasal spray.

Other Medical Problems

Other medical conditions may also affect the use of Azelastine and fluticasone combination nasal spray for treatment. Some of these medical conditions may worsen if a patient takes the medication. If a patient has any of the following medical problems, he or she should inform the doctor before taking the medicine:

  • Adrenal illnesses
  • Asthma
  • Cataracts, or if the patient has undergone cataract operation in the past
  • Glaucoma, or if the patient has glaucoma in the past. The patient should be cautious in using Azelastine and fluticasone combination nasal spray as this may make his or her illness worse.
  • Chickenpox or a recent exposure to the virus
  • Herpes simplex infection of the eye
  • All kinds of active or untreated Infections whether fungal, bacterial, parasitic or viral,
  • Measles or a recent exposure to it
  • Tuberculosis, whether at present or in the past. Azelastine and fluticasone combination nasal spray can lower the patient’s capacity to fight the infection
  • Nose injury
  • Surgery of the nose, or recent surgery
  • Sores and ulcers in the nose, including recent. Azelastine and fluticasone combination nasal spray may cause the condition to heal improperly.

Warnings

Before Using the Medicine

Always take necessary caution when using a medicine. Make sure that the benefits outweigh the risks especially if the patient is using other medications or has other medical conditions. When using Azelastine and fluticasone combination nasal spray, the doctor should help the patient find ways to minimize risks and maximize benefits.

Allergies

The patient should inform the doctor of any allergic reactions to drugs, preservatives, animals, or food. If the patient is allergic to Azelastine or fluticasone or both, he or she should tell the doctor.

Children

The use of Azelastine and fluticasone nasal spray does not seem to cause problems in children aged years old and above. However, the effects and safety of Azelastine and fluticasone nasal spray in children below 6 years old has not been established. It would be best to use other medications if the child is below 6 years old.

Elderly Patients

Studies conducted recently showed that Azelastine and fluticasone nasal spray does not cause problems when used by the elderly population. However, elderly patients are prone to have problems in the kidney, liver or heart due to their age. It is best to use the medication with caution when prescribed to the elderly due to other existing medical conditions.

Pregnant Women

Azelastine and fluticasone nasal spray is deemed to be a Category C medication in the FDA categories. This means that the medicine may have side effects on the unborn fetus. There are not enough studies to prove its effects on the unborn baby but pregnant women should take necessary caution when using this medication.

Lactating Women

It cannot be ascertained if Azelastine and fluticasone nasal spray can cause side effects in lactating women or lactating babies. Women should be cautious in using this medication when breastfeeding.

Other Warnings

If the patient is a child, it is important to monitor his or her progress. Always ask the doctor for the child’s medical updates in every visit. Also, ask the doctor if the medicine needs to be continued once the symptoms are gone. It If the child or patient’s condition does not improve after several days or worsens, consult the doctor immediately.

Azelastine and fluticasone combination nasal spray may cause some side effects, particularly in the nose. If the patient has blood in the mucus, develops sores in the nose, or produces whistling sound while breathing, see your doctor right away.

The patient may develop infections easily while taking Azelastine and fluticasone combination nasal spray. Stay away from people with infections such as measles or chickenpox. Children are particularly prone to these illnesses. Make sure that the child is not exposed to people with these conditions. The patient should inform the doctor if he or she was exposed to measles or chickenpox.

This medicine may make the patient prone to getting thrush (a fungal infection) located in the nose or throat. If the patient sees white patches in their throat or has difficulty swallowing, he or she should call the doctor immediately.

Eye problems while using Azelastine and fluticasone combination nasal spray should be referred to the doctor right away. Blurred vision, vision problems, having difficulty reading should be checked by a doctor to rule out possible side effects from the medicine.

Azelastine and fluticasone combination nasal spray may cause the patient to get dizzy or sleepy. Do not drive or operate a machine soon after you take the medication.

The medication may reduce adrenal gland activity. Adrenal glands are responsible for producing steroids in the body. If the patient notices symptoms of less active adrenal glands such as skin darkening, diarrhea, fainting spells, appetite loss, nausea, vomiting, lethargy, skin rashes, mental depression, and sleepiness, consult a doctor immediately.

The medicine may cause a child to grow slower than usual. The child may have difficulty gaining weight or getting taller. Talk to the doctor if the child is not growing or if there are concerns about his or her weight gain.

This medicine will worsen the effects of alcohol and CNS depressants making the patient drowsy. CNS depressants include antihistamines or medicine used to treat hay fever, allergies, or colds, pain prescriptions, sedatives, sleeping medicine, tranquilizers, narcotics, medicine to treat seizures such as barbiturates muscle relaxants, or anesthetics, and several dental anesthetics. Talk to the doctor or dentist before taking any of these CNS depressants while using Azelastine and fluticasone combination nasal spray.

Talk to the doctor about taking other medicines including prescribed medicines, over-the-counter medicines, vitamins, and herbals as these may cause adverse drug interactions.

Storage

Store in a place that is out of children’s reach.

Dispose of medicines that already expire or are no longer needed. Inquire with a healthcare professional in disposing of expired or excess medicines properly.

Put nasal spray bottle in an upright position, at room temperature.

Do not expose to heat or directly expose to direct sunlight. Do not freeze or refrigerate.

Summary

Azelastine and fluticasone combination nasal spray is an effective medicine to treat seasonal allergic rhinitis symptoms such as runny nose, sneezing and watery eyes. However, this medicine may interact with other drugs. The patient should inform the doctor if he or she is taking some vitamins, herbal supplements, prescription medicines or over-the-counter medicines. The patient should also talk to the doctor pertaining her or his existing medical conditions, as this medicine may make it worse.

Azelastine and fluticasone combination nasal spray should be used in the nose only. It should not be sprayed in the eyes or mouth. The patient should inform the doctor right away if it is accidentally sprayed in eyes or mouth.

The antihistamine component of this medication may make the patient drowsy or less alert. It would be a good idea to refrain from using this medication when driving or operating a machinery. Follow the doctor's instruction and the directions in the leaflet to ensure that there will be no undesirable side effects. Do not use more than the prescribed dosage or more frequently than required by the doctor.

Do not consume alcohol and grapefruit juice when using Azelastine and fluticasone combination nasal spray as this may cause undesirable side effects. If unsure of the effects of the medicine on other products ingested, ask the doctor or pharmacist.

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Last Reviewed:
December 24, 2017
Last Updated:
December 22, 2017
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