Sinusitis and allergic rhinitis are among the common upper respiratory conditions. They show similar symptoms such as sneezing, nasal congestion, runny nose, throat irritation, and nasal inflammation.
There are many treatment options for sinusitis and rhinitis, one of the most known ones are nasal sprays. Nasal sprays are widely used for their faster action, ease of use, fewer side effects and patient compliance.
Nasal sprays have an advantage due to their delivery method. They are to be sprayed directly into the nose, unlike the syrups and tablets which show slower action than nasal sprays. Older individuals may even find it difficult to take tablets every time they have sinusitis or rhinitis.
Fluticasone propionate
- Fluticasone propionate is a corticosteroid. It helps to reduce inflammatory conditions such as allergic and non-allergic rhinitis, sinusitis, asthma, bronchitis and COPD.
- A nasal spray containing Fluticasone propionate is safe for long-term use. It provides long-term benefits to people without causing major side effects. It is ideal for people suffering from chronic respiratory conditions such as sinusitis and chronic rhinitis.
- It relieves the symptoms of seasonal, allergic and non-allergic symptoms such as stuffy or blocked nose, sneezing, itching in the nose and sinus discomfort.
Azelastine hydrochloride
- Azelastine hydrochloride is a nasal antihistamine. It manages allergic and non-allergic rhinitis by blocking the actions of a chemical substance called histamine that is released during an allergic reaction.
- It provides fast relief from the symptoms of rhinitis such as sneezing, nasal and sinus congestion, runny nose, nasal irritation and itching.
- Studies have shown that a nasal spray of Azelastine shows rapid action against rhinitis and is considered safe and well tolerated. It improves the symptoms of rhinitis in patients who did not respond to oral antihistamines. The effectiveness of Azelastine will be noticeable with a lower dose of one or two sprays per nostril twice daily. Unlike most antihistamines, Azelastine nasal spray helps to ease nasal congestion.
Benefits of the combination therapy
- Synergistic effect: a combination of Fluticasone propionate and Azelastine shows greater efficacy than individual drugs.
- It helps to manage chronic conditions like sinusitis and rhinitis more effectively.
- Safe for long-term use: unlike many nasal sprays that provide acute relief from sinusitis and rhinitis, a combination of Fluticasone propionate and Azelastine can be used for long-term relief from these conditions.
- No rebound congestion: a nasal spray containing Fluticasone propionate and Azelastine does not cause rebound congestion even if used for the long term.
Fluticasone- for reversing rebound congestion
Oxymetazoline nasal spray is one of the most effective medicines for the acute management of nasal congestion. But chronic use of nasal decongestants such as oxymetazoline may reduce its effectiveness. A person may not get relief from the standard dose and hence would require a larger dose to get relief from blocked nose and nasal congestion. Using nasal decongestants for more than a few days in a row (for less than 10 days) can cause rebound congestion (i.e., worsening of nasal congestion).
A study has shown that a nasal spray containing corticosteroids such as Fluticasone helps reverse the rebound congestion and tachyphylaxis (decrease in the drug response due to sequential doses) caused due to excess use of oxymetazoline nasal spray.
Can this combination cause any side effects?
Every medicine has some side effects, but it is not necessary that you get them. However, some people may experience one or more of the following side effects. These effects are generally mild and would resolve on their own when you discontinue the medicine or once the body adjusts to the medicine.
The common side effects include:
- Dry nose
- Altered smell or taste
- Nausea
- Headache
- Nosebleeds
- Excess sleep
If any of the below-mentioned symptoms occur, it is better to stop using this medicine and consult a doctor immediately. These effects could be severe.
- Dizziness
- Drowsiness
- Nosebleeds (severe)
- Slow wound healing
- Fungal infections (such as thrush) in the nose and throat
- Glaucoma and cataracts (eye problems)
- Immune suppression
- Slowed or delayed growth in children (rare)
Who should not use this combination?
Some people may experience dizziness after taking this combination. It is always better to know if you feel dizzy after taking this combination. If so, take a rest and avoid doing things that require mental alertness, such as driving or operating heavy machinery.
There are some health conditions like chickenpox, measles, tuberculosis, respiratory tract infection, recent nasal or sinus surgery, cataracts, infection of the eyes, glaucoma, wounds or ulcers in the nose that can be worsened by using a combination of Fluticasone and Azelastine Nasal Spray. Hence it is always better to avoid self-medication and inform your doctor about all the health conditions you have before taking this combination.
Reference:
- Horak F. Effectiveness of twice daily azelastine nasal spray in patients with seasonal allergic rhinitis. Ther Clin Risk Manag. 2008 Oct;4(5):1009-22. doi: 10.2147/tcrm.s3229. PMID: 19209282; PMCID: PMC2621402.
- Vaidyanathan S, Williamson P, Clearie K, Khan F, Lipworth B. Fluticasone reverses oxymetazoline-induced tachyphylaxis of response and rebound congestion. Am J Respir Crit Care Med. 2010 Jul 1;182(1):19-24. doi: 10.1164/rccm.200911-1701OC. Epub 2010 Mar 4. PMID: 20203244.
- Ratner PH, Hampel F, Van Bavel J, Amar NJ, Daftary P, Wheeler W, Sacks H. Combination therapy with azelastine hydrochloride nasal spray and fluticasone propionate nasal spray in the treatment of patients with seasonal allergic rhinitis. Ann Allergy Asthma Immunol. 2008 Jan;100(1):74-81.
