Home Drug Guide Azelastine Hydrochloride and Fluticasone Propionate

Drug Guide

Generic Name

Azelastine Hydrochloride and Fluticasone Propionate

Brand Names Dymista

Classification

Therapeutic: Allergic Rhinitis, Nasal corticosteroid/antihistamine combination

Pharmacological: Antihistamine (Azelastine), Corticosteroid (Fluticasone)

FDA Approved Indications

  • Seasonal Allergic Rhinitis
  • Perennial Allergic Rhinitis

Mechanism of Action

Azelastine works as a selective antihistamine that blocks H1 receptors, reducing allergy symptoms. Fluticasone is a corticosteroid that reduces inflammation by suppressing multiple inflammatory genes.

Dosage and Administration

Adult: One spray in each nostril twice daily for adults.

Pediatric: Not established for children under 12; dosing should be determined by physician.

Geriatric: No specific dosage adjustment necessary but monitor for increased sensitivity.

Renal Impairment: No specific adjustments recommended.

Hepatic Impairment: Use with caution; no specific dose adjustment established.

Pharmacokinetics

Absorption: Rapid absorption after intranasal administration.

Distribution: Systemic distribution, primary localized effect in nasal tissues.

Metabolism: Azelastine is metabolized in the liver; Fluticasone extensively metabolized by CYP3A4.

Excretion: Metabolites are excreted primarily via urine and feces.

Half Life: Azelastine: approximately 22 hours; Fluticasone: approximately 7 hours.

Contraindications

  • Known hypersensitivity to azelastine, fluticasone, or any components of the formulation.

Precautions

  • Use with caution in patients with nasal infections, recent nasal surgery or injury, or ocular herpes.

Adverse Reactions - Common

  • Bad taste, nosebleed, headache (Common)
  • Drowsiness, fatigue (Less common)

Adverse Reactions - Serious

  • Allergic reactions including rash, swelling, difficulty breathing (Rare)
  • Nasal septum perforation (Rare)

Drug-Drug Interactions

  • CYP3A4 inhibitors (e.g., ketoconazole, ritonavir) may increase systemic corticosteroid effects.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor nasal symptoms and for adverse reactions like nasal irritation or bleeding.

Diagnoses:

  • Risk for nasal mucosal injury
  • Risk for systemic corticosteroid effects

Implementation: Administer intranasally as directed, instruct patient on proper spray technique.

Evaluation: Assess reduction in allergy symptoms and monitor for adverse effects.

Patient/Family Teaching

  • Use as directed, typically one spray per nostril twice daily.
  • Report any signs of allergic reactions or nasal irritation.
  • Avoid blowing nose immediately after administration.
  • Store at room temperature, away from moisture and heat.

Special Considerations

Black Box Warnings:

  • Systemic corticosteroid effects may occur, especially with long-term use.

Genetic Factors: No specific genetic considerations known.

Lab Test Interference: May affect adrenal function tests.

Overdose Management

Signs/Symptoms: Drowsiness, increased adrenergic effects, nasal mucosal irritation.

Treatment: Supportive care, symptomatic treatment, consult poison control.

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).

Stability: Stable for the duration of the shelf life indicated by the manufacturer.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.