Recommended Dosing Frequency for Azelastine-Fluticasone Nasal Spray
You should use this nasal spray twice daily—one spray per nostril in the morning and one spray per nostril in the evening—for a total of 2 times per day. 1
FDA-Approved Dosing Regimen
The standard dose for patients 12 years and older is 1 spray per nostril twice daily, delivering 137 µg of azelastine hydrochloride and 50 µg of fluticasone propionate per spray. 1
This twice-daily regimen provides a total daily dose of 274 mcg azelastine hydrochloride and 100 mcg fluticasone propionate. 2
The medication is not approved for children under 12 years of age. 1
Critical Usage Instructions
This is maintenance therapy, not rescue therapy—you must use it regularly every day, even when your symptoms improve, to maintain effectiveness. 1
The onset of action occurs within 12-24 hours, but maximal efficacy requires days to weeks of regular continuous use. 1
Avoid the common pitfall of "as-needed" or intermittent use—continuous daily treatment is significantly more effective than episodic use because ongoing allergen exposure requires sustained medication effect. 2
You should continue using the spray throughout your entire allergy season (for seasonal allergies) or year-round (for perennial allergies). 2
Administration Technique to Minimize Side Effects
Bitter taste is the most common side effect, but can be minimized with proper administration technique. 1
Proper technique includes: priming the bottle before first use, shaking before spraying, blowing your nose prior to use, keeping your head upright during administration, and breathing in gently during spraying. 3
Other common side effects include epistaxis (nosebleeds), headache, and somnolence. 1
Clinical Context
The American Academy of Otolaryngology-Head and Neck Surgery notes that this combination provides more than 40% greater symptom reduction compared to fluticasone propionate alone, representing a clinically meaningful improvement over single-agent therapy. 1 However, they advise against using this combination as first-line therapy, instead recommending intranasal corticosteroids alone as initial treatment for allergic rhinitis. 1