How should I correctly administer azelastine‑fluticasone nasal spray (137 µg azelastine + 50 µg fluticasone), one spray per nostril twice daily?

How to Properly Use Azelastine-Fluticasone (Dymista) Nasal Spray

Administer one spray per nostril twice daily using proper technique: prime the bottle before first use, shake before each use, blow your nose first, keep your head upright, use the opposite hand for each nostril (right hand for left nostril), aim the spray away from the nasal septum, breathe in gently during spraying, and do not close the opposite nostril. 1, 2, 3

Before First Use: Priming the Device

• Prime the bottle by pumping the spray mechanism until a fine mist appears before the very first use 1, 2
• If the spray has not been used for several days, re-prime with 1-2 pumps 1

Step-by-Step Administration Technique

Preparation (Before Each Dose)

• Shake the bottle vigorously immediately before spraying to ensure proper mixing of the medication 1, 2
• Blow your nose gently to clear nasal passages and improve medication delivery 1, 2
• Remove the protective cap from the spray nozzle 1

Proper Spray Technique (Critical for Safety and Efficacy)

• Keep your head in an upright position—do not tilt your head back or forward 1, 2
• Use the contralateral hand technique: Hold the bottle in your right hand to spray the left nostril, and your left hand to spray the right nostril 1
  • This technique reduces epistaxis (nosebleeds) risk by fourfold compared to using the same-side hand 1
• Aim the spray away from the nasal septum (the center wall dividing your nostrils) and toward the outer wall of the nostril 1
• Insert the nozzle just inside the nostril—do not insert deeply 1
• Do not close or pinch the opposite nostril during administration 1, 2
• Breathe in gently through your nose while pressing down on the pump to release the spray 1, 2
• Breathe out through your mouth after spraying 1

After Administration

• Keep your head upright for a few seconds after spraying to prevent the medication from draining out 1
• Wipe the nozzle with a clean tissue and replace the cap 1
• Avoid blowing your nose for at least 15 minutes after use to allow medication absorption 1

Dosing Schedule

• One spray per nostril twice daily (morning and evening) for patients ≥12 years old 3
• Each spray delivers 137 µg azelastine + 50 µg fluticasone 3
• Total daily dose: 274 µg azelastine + 100 µg fluticasone 3

Timing and Expectations

• Onset of action: Symptom relief begins within 12-24 hours after the first dose 3
• Maximum benefit: Requires several days to weeks of continuous daily use 1, 3
• This is maintenance therapy, not rescue therapy—continue using regularly even when symptoms improve 3
• Do not use "as needed"; consistent twice-daily dosing is required for optimal efficacy 3

Common Side Effects and How to Minimize Them

Bitter Taste (Most Common)

• Occurs in approximately 4.5% of patients and is directly related to improper technique 3, 4, 5
• To minimize: Ensure you are aiming away from the septum and not tilting your head back, which allows medication to drip into the throat 4, 5
• Keep your head upright and breathe out through your mouth after spraying 1

Epistaxis (Nosebleeds)

• Blood-tinged nasal secretions occur in 4-8% of patients 1, 3
• Prevention: Use the contralateral hand technique (opposite hand for opposite nostril) to direct spray away from the septum 1
• If persistent bleeding occurs, consult your physician 1

Other Side Effects

• Headache, nasal discomfort, and somnolence may occur 3, 6
• Somnolence is rare (0.4-1%) with the one-spray regimen 7

Important Contraindications

• Do not use if you have a known hypersensitivity to azelastine, fluticasone, or any component of the formulation 1, 2, 3

Special Considerations

If Using Nasal Saline Irrigation

• Perform saline irrigation BEFORE using the nasal spray, not after 1
• Wait a few minutes after irrigation before administering the medication 1

Long-Term Monitoring

• Periodic examination of the nasal septum (every 6-12 months) is recommended during long-term use to detect early mucosal erosion 1

Common Pitfalls to Avoid

• Do not tilt your head backward—this causes medication to drain into the throat, reducing efficacy and increasing bitter taste 1, 4
• Do not use the same hand for both nostrils—this directs spray toward the septum, increasing bleeding risk 1
• Do not stop when symptoms improve—this is maintenance therapy requiring continuous use 3
• Do not expect immediate relief—allow 12-24 hours for initial effect and days to weeks for maximum benefit 1, 3
• Do not blow your nose immediately after spraying—wait at least 15 minutes 1