Intranasal corticosteroid + antihistamine Pregnancy: There are no or limited data from use of azelastine hydrochloride and fluticasone propionate in pregnant women — use during pregnancy only if the potential benefit justifies the potential risk to the foetus. It is unknown whether the nasally administered substances or their metabolites are excreted in human breast milk — use during lactation only if the potential benefit justifies the potential risk to the newborn/infant. Only limited data with regard to fertility.

Fluticasone with azelastine

Brand names: Dymista

A combination nasal spray (e.g. Dymista) delivering the intranasal corticosteroid fluticasone propionate together with the antihistamine azelastine, used for moderate-to-severe allergic rhinitis.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Adults and adolescents (12 years and older): one actuation in each nostril twice daily (morning and evening). SPC product = azelastine hydrochloride 137 micrograms / fluticasone propionate 50 micrograms per actuation nasal spray, suspension

Route: Nasal use only — contact with the eyes should be avoided

Frequency: Twice daily (morning and evening)

Children below 12 years: not recommended, as safety and efficacy have not been established in this age group — no per-kg dose is stated. Elderly: no dose adjustment required. Renal and hepatic impairment: there are no data. Duration: suitable for long-term use; the duration of treatment should correspond to the period of allergenic exposure. For full therapeutic benefit regular usage is essential. Administration: shake gently for about 5 seconds before use; prime with 6 pump actuations prior to first use, and re-prime once if not used for more than 7 days; spray once into each nostril keeping the head tilted downward (tilting the head too far backwards is a common cause of the unpleasant taste). Doses higher than the recommended one have not been tested. Systemic exposure of intranasal fluticasone propionate is likely to be increased in severe liver disease — caution. Growth retardation has been reported in children receiving nasal corticosteroids at licensed doses; monitor growth in adolescents on prolonged treatment. NOT USED FOR THIS DOSE: the bundle's openFDA label is an OTC fluticasone propionate-only nasal spray (single component) and does not describe this fixed combination.

Dose adjustments

Renal

There are no data in patients with renal or hepatic impairment (§4.2). No adjustment is specified.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substances or to any of the excipients

Side effects

Dysgeusia (unpleasant taste), unpleasant smell and headache (common)
Epistaxis (very common)
Nasal discomfort including nasal irritation, stinging and itching; sneezing; nasal dryness; cough; dry throat; throat irritation (common)
Dizziness, somnolence; dry mouth; nausea; fatigue and weakness (uncommon)
Nasal septal perforation, mucosal erosion (rare); nasal ulcers (not known)
Hypersensitivity including anaphylactic reactions, angioedema (oedema of the face or tongue and skin rash), bronchospasm; glaucoma, increased intraocular pressure, cataract with prolonged intranasal fluticasone use; blurred vision

Interactions

Ritonavir — clinically significant interaction with fluticasone propionate reported post-marketing, resulting in systemic corticosteroid effects including Cushing's syndrome and adrenal suppression; concomitant use should be avoided unless the potential benefit outweighs the risk (§4.4)
Concurrent corticosteroid treatment by any route — the total systemic corticosteroid burden should be considered (§4.4)

Clinical monograph

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.

Reference: BSACI rhinitis guideline; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Mometasone with olopatadine · Intranasal corticosteroid + antihistamine

Pathways