Dymista

Dymista is a combination nasal spray containing azelastine (a topical antihistamine) and fluticasone propionate (an intranasal corticosteroid), delivering dual mechanism treatment for allergic rhinitis in a single device.

Azelastine provides rapid onset antihistaminic and anti-inflammatory effects within 15 minutes, while fluticasone propionate delivers sustained anti-inflammatory activity targeting the underlying nasal mucosal inflammation.

Clinical trials (MP4004 and others) demonstrated that Dymista achieves significantly greater symptom relief than either component used alone, with a faster onset of action than fluticasone monotherapy.

It is licensed for the relief of symptoms of moderate-to-severe seasonal and perennial allergic rhinitis when monotherapy with either an intranasal antihistamine or corticosteroid is considered inadequate.

NICE and BSACI guidelines position intranasal corticosteroids as first-line therapy for persistent allergic rhinitis; Dymista is appropriate when monotherapy provides insufficient control.

One spray per nostril twice daily provides consistent 12-hourly coverage. The systemic bioavailability of both components via the nasal route is negligible.

Shake the bottle gently before each use. Prime the pump with 6 sprays if using for the first time or if not used for more than 7 days. Blow your nose gently before administration.

Tilt the head slightly forward, insert the nozzle into one nostril while closing the other, and spray once while inhaling gently through the nose. Repeat in the other nostril.

Wipe the nozzle clean after use. Administer one spray per nostril twice daily (morning and evening). Do not exceed the recommended dose. Avoid spraying directly onto the nasal septum.

Use consistently for optimal benefit; while some symptomatic relief occurs within 15 minutes, the full anti-inflammatory effect of the corticosteroid component builds over several days of regular use.

Adults and adolescents aged 12 years and older: one spray per nostril twice daily (total daily dose: azelastine 548 mcg and fluticasone propionate 200 mcg).

Not recommended for children under 12 years due to insufficient safety data. No dose adjustment for elderly patients or those with renal or hepatic impairment, as systemic absorption is minimal.

Treatment duration should be limited to the period of allergen exposure for seasonal rhinitis; for perennial rhinitis, regular clinical review is recommended.

Side effects per SmPC frequency categories.

Common (≥1/100 to <1/10): Dysgeusia (unpleasant bitter taste — the most commonly reported side effect, attributed to azelastine, occurring in approximately 4-8% of patients), epistaxis (nosebleeds, a class effect of intranasal corticosteroids), headache, nasal discomfort.

Uncommon (≥1/1,000 to <1/100): Nasal dryness, sneezing after application, nasal mucosal erosion, throat irritation, drowsiness (attributed to azelastine), nausea.

Rare (≥1/10,000 to <1/1,000): Nasal septal perforation (with prolonged corticosteroid use), hypersensitivity reactions, anaphylaxis, glaucoma, cataracts, adrenal suppression (theoretically possible with very high cumulative corticosteroid doses from multiple routes).

The bitter taste can be minimised by avoiding sniffing vigorously after spraying (which draws the solution into the throat) and tilting the head slightly forward rather than backward during administration.

Patients transferring from systemic corticosteroids to intranasal therapy should be monitored for adrenal insufficiency, though this is uncommon with Dymista at standard doses.

Nasal examination is recommended before starting and periodically during prolonged treatment to check for mucosal erosion or septal changes.

Azelastine may cause mild somnolence; caution is advised with activities requiring full alertness until individual response is established.

Avoid concurrent use with alcohol or CNS depressants if drowsiness occurs. Intranasal corticosteroids may cause growth retardation in children; Dymista is not licensed for use under 12 years.

Monitor intraocular pressure in patients with a history of glaucoma.

Dymista is contraindicated in patients with hypersensitivity to azelastine, fluticasone propionate, or any excipient. It is not recommended for children under 12 years.

Relative contraindications include untreated nasal infection, recent nasal surgery or trauma (until healing is complete), and active pulmonary tuberculosis.