Fluticasone with azelastine

How it works

Fluticasone provides topical anti-inflammatory glucocorticoid action on the nasal mucosa while azelastine blocks local histamine H1 receptors, giving complementary control of allergic nasal symptoms.

Prescribing in practice

• It is intended for patients whose symptoms are not adequately controlled by an intranasal antihistamine or corticosteroid alone, and should be used regularly for full effect.
• Azelastine can cause an unpleasant or bitter taste and occasional drowsiness, particularly if the head is tipped back during administration.
• Local corticosteroid effects such as epistaxis and nasal irritation can occur, so good spray technique directed away from the septum should be advised.

Monitoring

Monitor symptom control and check for local nasal adverse effects and bothersome taste disturbance at review.

Counselling the patient

• Keep your head tipped slightly forward when spraying to reduce the bitter taste and drips down the throat.
• Use it regularly as prescribed for ongoing control rather than only when symptomatic.
• It may occasionally cause mild drowsiness, so take care until you know how it affects you.

Evidence & guidelines

Combined intranasal corticosteroid plus antihistamine sprays improve allergic rhinitis control beyond either component alone, supporting step-up use in line with ARIA guidance.