azelastine hydrochloride + fluticasone propionate: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
azelastine hydrochloride + fluticasone propionate: clinical details
Prescribing considerations
- Confirm moderate to severe seasonal or perennial allergic rhinitis inadequately controlled by either intranasal component alone.
- Review total corticosteroid exposure, especially with other inhaled, topical or systemic corticosteroids.
- Use caution in severe hepatic disease because systemic fluticasone exposure may increase.
- Assess risks after recent nasal or oral surgery or trauma, and in tuberculosis or untreated infection. Treat nasal infection appropriately.
- Review new visual disturbance and consider ophthalmic assessment.
Contraindications and cautions
- Hypersensitivity to azelastine, fluticasone or any excipient.
Monitoring
- Monitor adolescent growth during prolonged intranasal corticosteroid treatment.
- Monitor for systemic corticosteroid effects with excessive exposure or unavoidable strong CYP3A4 inhibition.
- Monitor visual changes and patients with a history of raised intraocular pressure, glaucoma or cataract.
- Review persistent irritation, mucosal swelling, ulceration or recurrent nosebleeds.
Clinical pharmacology
Azelastine is a selective H1-receptor antagonist with mast-cell-stabilising and anti-inflammatory effects. Fluticasone is a high-affinity glucocorticoid-receptor agonist with potent local anti-inflammatory activity. Intranasal fluticasone normally has low systemic exposure because of extensive first-pass metabolism and high clearance.
Formulation and product differences
- The white, homogeneous nasal spray suspension contains benzalkonium chloride, which may cause nasal irritation or mucosal swelling with long-term use.
- The bottle requires shaking and pump priming; it should not be refrigerated or frozen.
azelastine hydrochloride + fluticasone propionate preparations and strengths
Nasal preparation
Route: Nasal
Strengths: 137 micrograms + 50 micrograms/actuation
azelastine hydrochloride + fluticasone propionate interactions
Tell the prescriber or pharmacist about all medicines, particularly other corticosteroids and the following:
Ritonavir
Can greatly increase fluticasone exposure and cause systemic corticosteroid effects; concurrent use should generally be avoided unless benefits outweigh risks.
Cobicistat-containing medicines
May increase systemic fluticasone effects; avoid unless clinically justified and monitor carefully if used.
Potent CYP3A4 inhibitors, including ketoconazole
May increase fluticasone exposure, requiring additional caution and clinical review.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.