azelastine HCL & fluticasone propionate

Man using nasal spray
Man using nasal spray. ballyscanlon/Getty Images

Dymista (azelastine and fluticasone) is a combination nasal spray medication, containing azelastine hydrochloride (0.1%) and fluticasone propionate (0.037%). It comes in a dose of 50 micrograms (mcg) per spray and is used to treat symptoms related to seasonal allergies.

Because Dymista is a combination nasal spray, symptoms related to seasonal allergies are approached by interacting with two different pathways within the body.

The first component in Dymista, azelastine, is a H1 antagonist. This type of medication blocks the effects of histamine throughout the body and helps to reduce further release of histamine. Histamine and other mediators within the body assist in the allergic response, particularly inflammation. By blocking histamine Dymista may be able to relieve nasal passages of the “stuffy” feeling related to inflammation. Azelastine also helps improve movement of the cilia (the tiny hairs that line the respiratory tract) in your airways, which helps to improve the transportation of mucus.

The second way that Dymista helps relieve symptoms related to seasonal allergies is due to the second component of the combination nasal spray, fluticasone. Fluticasone is a corticosteroid, which is a synthetic version of the natural occurring adrenal hormone, cortisol. Corticosteroids help to constrict blood vessels and decrease inflammation in the nasal cavity when used in spray form.

Both actions help to relieve congestion associated with seasonal allergies. A condition called rebound congestion is related to nasal sprays containing cortisone, however, so you should discuss this risk with your doctor before using Dymista.

How to Use Dymista

Dymista is only for use as a nasal spray.

The first time use it you will need to prime the spray’s pump by pressing 6 times until you see a fine spray. You will probably need to repeat this process if you haven’t used your Dymista nasal spray for 2 weeks.

Tips for using Dymista:

  • Gently shake Dymista nasal spray bottle.
  • It is important to blow your nose in order to clear your nasal passages for best results.
  • Tilt your head downward while spraying into your nose.
  • Be sure to keep the tip of the nasal spray ¼ to 1/2 inches into your nose while spraying.
  • Bottle must be upright when spraying.
  • Close your other nostril and sniff immediately after you have pressed the pump.
  • Avoid spraying the side of your nasal passage between both your nostrils for best results.
  • Spray the other nostril in the same fashion.
  • After use, you will want to wipe the top of the applicator off and replace the cap.
  • Avoid eye contact – if eye contact occurs flush eyes for 10 minutes or longer. Seek medical attention if necessary.

Dymista Side-Effects

The most common side-effects related to use of Dymista include:

Dymista may cause drowsiness, so you should use caution when operating any machinery or driving until you know how your body reacts to the medication. You should also avoid other depressants such as alcohol when using Dymista as this can worsen the level of sedation or drowsiness. Because Dymista contains fluticasone, which is a corticosteroid, chronic use can lead to suppression of your adrenal system. Follow the instructions of your ordering physician if you want to stop this medication. Suppression is most likely to occur when using this medication in combination with Prednisone with a dose of 20 milligrams (mg) or more. The fluticasone component of Dymista also can cause a delay in healing wounds in your nasal passage and cause an increase in or prolong duration of infections.

If you have a history of increased intraocular pressure, open-angle glaucoma, or cataracts, you should see an ophthalmologist and discuss this with your physician prior to use. If you develop any vision changes during use of Dymista, you should stop using the nasal spray until you can discuss further with your doctor and ophthalmologist.

Can Dymista Interfere With Other Medications?

The majority of interactions with Dymista are related to medications that depress your central nervous system or brain function. These include antihistamines, antidepressants, sleeping medications and other medications that can cause drowsiness as a side-effect. Check with your physician when starting new medications.

Before Taking Dymista

Before you start Dymista, you should see your physician to review your medical history as well as to review your current medications. In particular, your physician will want to know if you have any sores in your nose, as delayed healing may occur with use of Dymista. If you are planning on pregnancy he should evaluate whether or not Dymista use should be avoided as it is a Pregnancy Category C medication.

Only use Dymista under physician approval and supervision if you are unvaccinated, or you have not had chickenpox or measles, because Dymista can increase the severity of these illnesses.


UpToDate.com. Azelastine and fluticasone: Drug information. Accessed: October 31, 2013 from http://www.uptodate.com

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