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Azelastine with fluticasone nasal

Updated 2 Feb 2023 | Nasal allergy


Nasal spray containing azelastine with fluticasone.

Drugs List

  • azelastine 137microgram and fluticasone 50microgram nasal spray
  • DYMISTA nasal spray
  • Therapeutic Indications


    Rhinitis - perennial
    Seasonal allergic rhinitis - treatment



    One actuation in each nostril twice daily (morning and evening).


    Children aged 12 years and over
    One actuation in each nostril twice daily (morning and evening).


    Children under 12 years

    Precautions and Warnings

    Uncontrolled nasal infection
    Pulmonary tuberculosis
    Recent nasal surgery
    Recent nasal trauma
    Severe hepatic impairment

    Caution in transfer from oral steroids in adrenal insufficiency
    Systemic corticosteroids may be needed during elective surgery
    Systemic corticosteroids may be needed during periods of stress
    Advise ability to drive/operate machinery may be affected by side effects
    Contains benzalkonium chloride
    Advise patient to avoid spraying this preparation into or near the eyes
    If growth in children is slowed, consider referral to a paediatrician
    If visual disturbances occur, perform ophthalmic evaluation
    Monitor regularly the height of children receiving prolonged treatment
    Prolonged or high dose may lead to adrenal suppression
    Systemic side effects may occur
    Maintain treatment at the lowest effective dose

    Pregnancy and Lactation


    Use the combination of azelastine with fluticasone with caution in pregnancy.

    There is little data from the use of azelastine with fluticasone in pregnant women. The manufacturer notes that this medication should only be considered if the benefit exceeds any possible risk to the foetus.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Use the combination of azelastine with fluticasone with caution in breastfeeding.

    It is unknown whether nasally administered azelastine metabolites or fluticasone metabolites are excreted in human breast milk. The manufacturer notes that this medication should only be considered if the benefit to the mother exceeds any possible risk to the child.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Side Effects

    Adrenal suppression
    Aggression in children
    Anaphylactic reaction
    Behavioural disturbances
    Blurred vision
    Cushing's syndrome
    Cushingoid facies
    Dry mouth
    Dryness and irritation of throat
    Growth retardation (children)
    Hypersensitivity reactions
    Increased intra-ocular pressure
    Mucosal erosion
    Nasal discomfort
    Nasal dryness
    Nasal irritation
    Nasal itching
    Nasal stinging (transient)
    Perforation of nasal septum
    Psychological changes
    Psychomotor hyperactivity
    Sleep disturbances
    Visual disturbances


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: October 2017

    Reference Sources

    Summary of Product Characteristics: Dymista Nasal Spray. Meda Pharmaceuticals Ltd. Revised July 2017.

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    Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content

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