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Generic Dymista ( Fluticasone/Azelastine )
Dymista (fluticasone propionate and azelastine hydrochloride) is a fixed‑dose combination nasal spray containing an intranasal corticosteroid and a second‑generation antihistamine. It is indicated for the symptomatic treatment of moderate to severe seasonal and perennial allergic rhinitis in adults and adolescents 12 years of age and older when monotherapy with either an intranasal antihistamine or an intranasal corticosteroid is considered insufficient. Fluticasone propionate reduces nasal inflammation by inhibiting multiple inflammatory mediators, while azelastine hydrochloride blocks H1 receptors, providing rapid relief of itching, sneezing, rhinorrhea, and nasal congestion. Dymista is intended for regular twice‑daily use and may provide both rapid symptom improvement and sustained anti‑inflammatory control.
Usual adult dose: The recommended dose is one spray in each nostril twice daily (morning and evening). The bottle should be gently shaken before each use, and the device must be primed before first use or if not used for 3 days. Patients should be instructed to blow their nose gently, tilt the head slightly forward, and avoid inhaling deeply while spraying. After use, the nozzle should be wiped with a clean tissue. The maximum daily dose is two sprays per nostril. If a dose is missed, the patient should take the next dose at the usual time; two doses must not be taken at the same time. Use should be continued regularly for full benefit, even when symptoms improve. In Canada, Dymista is available only by prescription.
Dosage form: Nasal spray suspension: each metered actuation delivers 50 mcg of fluticasone propionate and 137 mcg of azelastine hydrochloride (equivalent to 140 mcg azelastine hydrochloride as commonly rounded; the user‑specified strength 50/140 mcg is consistent with this formulation). The product is supplied in a glass bottle fitted with a metered‑dose manual spray pump, delivering 120 metered sprays after priming.
Onset of action: The antihistamine component (azelastine) begins to relieve nasal symptoms within 15 to 30 minutes after the first dose. The corticosteroid component (fluticasone) has a slower onset; clinically meaningful improvement in nasal congestion and overall symptom control typically develops after 2 to 4 days of continuous twice‑daily use, with maximum benefit achieved after 1 to 2 weeks.
Duration of action: The combination provides symptom control over a 12‑hour dosing interval, supporting twice‑daily administration. Regular use maintains sustained anti‑inflammatory and antihistaminic activity; the elimination half‑life of azelastine is approximately 22 hours and fluticasone propionate is approximately 7.8 hours after intranasal administration, but the clinical effect is governed by local receptor occupancy and anti‑inflammatory action.
Alcohol recommendation: Alcohol should be used with caution during treatment with Dymista. Azelastine may cause somnolence, and alcohol can potentiate this central nervous system depressant effect, leading to increased drowsiness, dizziness, and impaired judgment. Patients should avoid or limit alcohol intake, especially when first starting therapy or if they experience significant sedation.
Most common side effects: Dysgeusia (bitter or altered taste, reported in up to 10% of patients), epistaxis (nosebleeds), headache, nasal irritation or dryness, sneezing, and somnolence. Bitter taste can be minimized by instructing the patient to avoid tilting the head back during administration and to sniff gently after spraying. Epistaxis is generally mild; persistent or severe bleeding should be reported. Dymista is contraindicated in patients with known hypersensitivity to fluticasone propionate, azelastine, or any component of the formulation. Caution is advised in patients with tuberculosis, untreated fungal, bacterial, or viral infections, or ocular herpes simplex. Intranasal corticosteroids may cause an increased risk of localized Candida albicans infection, especially with long‑term use. Systemic corticosteroid effects including growth retardation, adrenal suppression, and increased intraocular pressure are rare at recommended doses but may occur with high‑dose or prolonged therapy. Patients who are pregnant or breastfeeding should consult a healthcare professional before use. Dymista is not indicated for the relief of acute asthma or for use in children under 12 years of age.
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