Dymista Nasal Spray

How do I use it?

• You should preferably start using this nasal spray before you expect to come into contact with the allergen and continue using it regularly all the time you are being exposed to the allergen. Follow the instructions given by your doctor.
• Follow the instructions provided with the nasal spray. You should shake the bottle gently before use.
• Before you use the spray for the first time the bottle needs to be primed by pressing down and releasing the pump six times. Hold the bottle upright and away from you while you are doing this. If the nasal spray hasn’t been used for more than seven days you should reprime it before use by pressing and releasing the pump once.
• Follow this link for general instructions on how to use a nasal spray.
• Before using the spray you should blow your nose thoroughly.
• Tilt your head forward, hold the bottle upright and insert the tip of the nozzle fully into one nostril. Close the other nostril with your finger then press the spray down once and sniff gently at the same time. Repeat for the other nostril. The usual dose is one spray into each nostril twice a day (morning and evening).
• If you forget to use your nasal spray just leave out the forgotten dose. Don’t use a double dose to make up for a missed dose.
• If symptoms persist despite treatment with this medicine, seek medical advice from your doctor.

Use with caution in

• People with severe liver disease.
• People with tuberculosis affecting the lungs.
• People with an infection in the nasal passages or sinuses (the infection should be treated).
• People who have had recent nasal surgery or injury (only use when the nose has healed).

Not to be used in

• This medicine is not recommended for children less than 12 years of age, as its safety and effectiveness have not been established in this age group.
• This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

• The safety of this medicine when used during pregnancy has not been established. However, only minimal amounts of the medicine pass into the bloodstream after using the nasal spray. As with all medicines it should be avoided during pregnancy, unless the expected benefit to the mother is greater than any possible risk to the developing baby. Seek medical advice from your doctor.
• It is unlikely that this medicine will pass into breast milk in significant amounts after application into the nose. However, it should be used with caution by mothers who are breastfeeding, and only if the benefits to the mother outweigh any risks to the nursing infant. Seek medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.

Very common

• Nosebleeds.

Common

• Headache.
• Unpleasant taste and smell.

Uncommon

• Nasal irritation, eg stinging or itching.
• Sneezing.
• Nasal dryness.
• Cough.
• Dry throat.
• Throat irritation.

Rare

• Dry mouth.

Very rare

• Dizziness.
• Sleepiness.
• Severe allergic reaction.
• Glaucoma.
• Cataract.
• Skin reactions such as rash, itching, hives.
• Feeling sick.
• Fatigue.
• Feeling weak.

Damage to the mucous membranes or the septum in the nose.

Side effects similar to those associated with corticosteroids taken by mouth may occur if this medicine is absorbed into the bloodstream. The risk of this when using a steroid nasal spray is very low, but may be more likely if the medicine is used at high doses for prolonged periods of time. See the warning section above or talk to your doctor or pharmacist for more details.

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

This medicine is only absorbed into the bloodstream in very small amounts after application into the nose. As such, it is unlikely to significantly affect other medicines that you are taking. However, if you are taking any other medicines, including those bought without a prescription and herbal medicines, you should tell your doctor or pharmacist before you start treatment with this medicine. This is particularly important if you are or have recently been using any other medicines that contain corticosteroids, for example tablets, injections, eye or nose drops, creams, asthma inhalers, or other similar nasal sprays. This is because there may be an increased chance of adverse effects if you are using more than one type of steroid medication and your doctor may want to monitor you more closely.

The following medicines may slow the breakdown of any fluticasone that is absorbed into your bloodstream from the nasal lining:

• protease inhibitors such as ritonavir for HIV infection
• telaprevir for hepatitis C
• the antifungals ketoconazole and itraconazole.
• These medicines can therefore increase your exposure to fluticasone and so increase the risk of side effects on the rest of the body. These are called systemic side effects, for example, decreased production of natural steroid hormones by the adrenal glands (adrenal suppression) and Cushing's syndrome.

Due to this risk, this nasal spray is not recommended for people who are taking ritonavir.

The antifungals ketoconazole and itraconazole should be used with caution in people using this nasal spray. Long courses of treatment with these antifungals should preferably be avoided.

Other medicines containing the same active ingredients

There are currently no other medicines in the UK that contain both azelastine and fluticasone as the active ingredients.

The following medicines contain fluticasone only:

• Avamys nasal spray.
• Boots allergy relief nasal spray.
• Flixonase aqueous nasal spray.
• Flixonase nasule drops.
• Nasofan nasal spray.
• Pirinase hayfever nasal spray.
• Optilast eye drops and Rhinolast nasal spray both contain azelastine only.

References:

http://safinatravel.com.ua/index.php/component/k2/itemlist/user/251702

http://www.netdoctor.co.uk/medicines/allergy-and-asthma/a8831/dymista-nasal-spray-azelastine-fluticasone/

https://www.drugs.com/dymista.html

http://www.medicines.ie/medicine/15709/SPC/Dymista+Nasal+Spray/

http://evfm.care/component/k2/itemlist/user/47202

http://lyceelimamoulaye.org/index.php?option=com_k2&view=itemlist&task=user&id=157353