What is the recommended dosing for Dymista (azelastine/fluticasone) for allergic rhinitis?

Dymista Dosing for Allergic Rhinitis

For patients with allergic rhinitis, Dymista (azelastine/fluticasone) should be dosed as 1 spray per nostril twice daily for patients 12 years and older. 1

Age-Specific Dosing

Dymista dosing is based on patient age:

• Ages ≥12 years: 1 spray per nostril twice daily
• Ages <12 years: Not approved for use in children under 12 years

Medication Details

Dymista is a combination nasal spray containing:

• 137 μg of azelastine (intranasal antihistamine)
• 50 μg of fluticasone propionate (intranasal corticosteroid) per spray

This combination provides dual-action treatment targeting multiple inflammatory pathways involved in allergic rhinitis.

Clinical Efficacy

Dymista has demonstrated superior efficacy compared to its individual components:

• MP-AzeFlu (Dymista) provides significantly greater and more rapid symptom relief than fluticasone propionate alone 2
• Patients using Dymista achieve symptom-free status up to 16 days faster than those using fluticasone propionate alone 2
• Long-term studies show sustained efficacy over 52 weeks of continuous use 3

Safety Considerations

Common side effects include:

• Bitter taste
• Epistaxis (nosebleeds)
• Somnolence
• Headache 1

Long-term safety data is reassuring, with a 1-year randomized study showing:

• Low incidence of treatment-related adverse events (9.4%)
• No evidence of nasal mucosal ulcerations or septal perforations
• No clinically important changes in laboratory values or serum cortisol levels 4

Practical Administration Tips

1. Proper technique: Shake bottle gently before use
2. Positioning: Tilt head slightly forward
3. Administration: Direct spray away from septum
4. Consistency: Use regularly as prescribed for optimal effect

Clinical Pearls

• Dymista offers a rapid onset of action (15 minutes), making it particularly useful for patients needing quick symptom relief 5
• The combination of azelastine and fluticasone in a single device may improve patient adherence compared to using separate products
• Unlike oral antihistamines, the intranasal delivery provides targeted relief with potentially fewer systemic side effects

Potential Pitfalls

• Patients may discontinue use due to bitter taste - advise them this is a common side effect that often diminishes with continued use
• Somnolence can occur, though recent studies show rates of only 0.4-3%, similar to placebo 1
• Ensure patients understand the importance of consistent twice-daily dosing for optimal effect

For patients who cannot tolerate Dymista due to side effects, consider alternative options such as intranasal corticosteroids alone or oral antihistamines based on symptom profile and patient preferences.