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" What is it used for?   Hay fever (seasonal allergic rhinitis) in adults and children aged 12 years and over.  Inflammation of the nasal lining due to allergies such as pet allergies or dust mite allergies that occur throughout the year (perennial allergic rhinitis) in adults and children aged 12 years and over.  Dymista nasal spray should be used as treatment for moderate to severe allergic rhinitis when treatment with an antihistamine or a corticosteroid nasal spray on its own has not been effective enough.    How does it work? Dymista nasal spray contains two active ingredients, azelastine hydrochloride (an antihistamine) and fluticasone propionate (a corticosteroid). Azelastine controls allergies by blocking the action of histamine. Histamine is a substance produced by the body as part of its defence mechanisms. It is stored in cells called mast cells, in almost all tissues of the body. When the body reacts to a foreign substance (known as an allergen, eg flower pollen), the mast cells stimulated by the allergen release their stores of histamine.  The released histamine then binds to its receptors (H1 receptors), causing a chain reaction that results in allergic symptoms. It causes an increase in blood flow to the area of the allergy, and the release of other chemicals that add to the allergic response. This results in the symptoms of an allergic reaction. In hayfever and nasal allergies, histamine causes inflammation of the nose, eyes or airways and results in itchy watery eyes, a runny nose, sneezing and nasal congestion. Azelastine in a nasal spray form acts directly on the membranes in the nose. It does not prevent the actual release of histamine from mast cells, but prevents it binding to its receptors. This in turn prevents the release of other allergy chemicals and increased blood supply to the area. Fluticasone is a synthetic corticosteroid that helps to decrease inflammation in the nasal passages. When administered into the nose, fluticasone is absorbed into the cells of the nasal passages. It works by preventing these cells from releasing the chemicals that trigger the allergic response. This stops the allergic reaction from happening, so the nasal inflammation is reduced and the symptoms relieved. It also reduces eye symptoms such as itchy, watery or red eyes. The azelastine in this nasal spray starts relieving nasal symptoms within 15 minutes of using the spray. However, it can take a few days of using a nasal steroid for it to build up to its full effect. It is therefore most effective to start using this nasal spray before you expect to get symptoms, for example before the start of the pollen season, or if you know you are going to be in contact with pets that give you the allergy. For maximum benefit, the spray should then be used regularly to keep the nasal inflammation under control.    How do I use it?    You should preferably start using this nasal spray before you expect to come into contact with the allergen and continue using it regularly all the time you are being exposed to the allergen. Follow the instructions given by your doctor.  Follow the instructions provided with the nasal spray. You should shake the bottle gently before use.  Before you use the spray for the first time the bottle needs to be primed by pressing down and releasing the pump six times. Hold the bottle upright and away from you while you are doing this. If the nasal spray hasn&amp;amp;#8217;t been used for more than seven days you should reprime it before use by pressing and releasing the pump once. Follow this link for general instructions on how to use a nasal spray.  Before using the spray you should blow your nose thoroughly.  Tilt your head forward, hold the bottle upright and insert the tip of the nozzle fully into one nostril. Close the other nostril with your finger then press the spray down once and sniff gently at the same time. Repeat for the other nostril. The usual dose is one spray into each nostril twice a day (morning and evening).   If you forget to use your nasal spray just leave out the forgotten dose. Don&amp;amp;#8217;t use a double dose to make up for a missed dose. If symptoms persist despite treatment with this medicine, seek medical advice from your doctor.   Warning!  This medicine is only intended for use in the nose and must not be taken by mouth.  Take care to avoid getting the spray in the eyes. Any remaining nasal spray should be discarded six months after the spray is first opened. This is because it could be contaminated with dirt or germs. Write the date you open your nasal spray on the bottle so you know when to throw it away. Dispose of carefully, preferably by returning to your pharmacy. When taken in high doses for long periods of time, corticosteroids have the potential to cause glaucoma, cataracts, slowed growth in children and adolescents, and to decrease the functioning of the adrenal glands (glands that produce natural steroid hormones). These side effects on other areas of the body are called systemic side effects and are extremely unlikely to occur with this nasal spray, because the amount of fluticasone absorbed into the bloodstream from the nose is very low. However, you should use the lowest effective dose needed to control your symptoms. Do not exceed the recommended dose of this medicine, which will be stated in the leaflet supplied with the medicine. If your child is using this nasal spray for long periods of time your doctor may want to monitor their height to make sure their growth is not being affected. For further information discuss this with your doctor.   Use with caution in  People with severe liver disease.  People with tuberculosis affecting the lungs. People with an infection in the nasal passages or sinuses (the infection should be treated). People who have had recent nasal surgery or injury (only use when the nose has healed).   Not to be used in   This medicine is not recommended for children less than 12 years of age, as its safety and effectiveness have not been established in this age group.   This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.   Pregnancy and breastfeeding Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.  The safety of this medicine when used during pregnancy has not been established. However, only minimal amounts of the medicine pass into the bloodstream after using the nasal spray. As with all medicines it should be avoided during pregnancy, unless the expected benefit to the mother is greater than any possible risk to the developing baby. Seek medical advice from your doctor. It is unlikely that this medicine will pass into breast milk in significant amounts after application into the nose. However, it should be used with caution by mothers who are breastfeeding, and only if the benefits to the mother outweigh any risks to the nursing infant. Seek medical advice from your doctor.   Side effects Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.  Very common (affect more than 1 in 10 people)  Nosebleeds.    Common (affect between 1 in 10 and 1 in 100 people)  Headache.  Unpleasant taste and smell.   Uncommon (affect between 1 in 100 and 1 in 1000 people)   Nasal irritation, eg stinging or itching. Sneezing. Nasal dryness.  Cough.  Dry throat. Throat irritation.    Rare (affect between 1 in 1000 and 1 in 10,000 people)  Dry mouth.    Very rare (affect fewer than 1 in 10,000 people)  Dizziness. Sleepiness. Severe allergic reaction. Glaucoma. Cataract. Skin reactions such as rash, itching, hives. Feeling sick.  Fatigue. Feeling weak.  Damage to the mucous membranes or the septum in the nose.  Side effects similar to those associated with corticosteroids taken by mouth may occur if this medicine is absorbed into the bloodstream. The risk of this when using a steroid nasal spray is very low, but may be more likely if the medicine is used at high doses for prolonged periods of time. See the warning section above or talk to your doctor or pharmacist for more details.  The side effects listed above may not include all of the side effects reported by the medicine&amp;#039;s manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.   How can this medicine affect other medicines? This medicine is only absorbed into the bloodstream in very small amounts after application into the nose. As such, it is unlikely to significantly affect other medicines that you are taking. However, if you are taking any other medicines, including those bought without a prescription and herbal medicines, you should tell your doctor or pharmacist before you start treatment with this medicine. This is particularly important if you are or have recently been using any other medicines that contain corticosteroids, for example tablets, injections, eye or nose drops, creams, asthma inhalers, or other similar nasal sprays. This is because there may be an increased chance of adverse effects if you are using more than one type of steroid medication and your doctor may want to monitor you more closely. The following medicines may slow the breakdown of any fluticasone that is absorbed into your bloodstream from the nasal lining:  protease inhibitors such as ritonavir for HIV infection  telaprevir for hepatitis C the antifungals ketoconazole and itraconazole.  These medicines can therefore increase your exposure to fluticasone and so increase the risk of side effects on the rest of the body. These are called systemic side effects, for example, decreased production of natural steroid hormones by the adrenal glands (adrenal suppression) and Cushing&amp;#039;s syndrome.  Due to this risk, this nasal spray is not recommended for people who are taking ritonavir.  The antifungals ketoconazole and itraconazole should be used with caution in people using this nasal spray. Long courses of treatment with these antifungals should preferably be avoided.   Other medicines containing the same active ingredients There are currently no other medicines in the UK that contain both azelastine and fluticasone as the active ingredients. The following medicines contain fluticasone only:  Avamys nasal spray. Boots allergy relief nasal spray. Flixonase aqueous nasal spray. Flixonase nasule drops. Nasofan nasal spray. Pirinase hayfever nasal spray.   Optilast eye drops and Rhinolast nasal spray both contain azelastine only.   Last updated 18.06.2013 "^^<http://www.w3.org/2001/XMLSchema#string>
<http://www.netdoctor.co.uk/medicines/allergy-and-asthma/a8831/dymista-nasal-spray-azelastine-fluticasone/>