Flonase and Azelastine for Allergies

Some may benefit from using these nasal sprays in combination

Relief of allergic rhinitis often requires a scheduled medication regimen to prevent allergy symptoms like a runny, itchy nose, and congestion. Your healthcare provider may prescribe Flonase (fluticasone propionate) nasal spray or azelastine nasal spray for this purpose. Although effective on their own, some may find that they need the added benefit of using these medications together.

Woman using nasal spray
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It is generally considered safe to use both Flonase and azelastine for the treatment of your allergic rhinitis. Your healthcare provider may recommend this or prescribe you Dymista (azelastine hydrochloride and fluticasone propionate), a nasal spray composed of generic forms of both medications.

How the Medications Compare

  • Nasal steroid

  • Prescription and OTC; generic available

  • One to two sprays per nostril once a day

  • Antihistamine

  • Prescription and OTC

  • One or two sprays per nostril twice a day

Flonase is a nasal steroid that works by reducing inflammation, a major component of allergic reactions.

Fluticasone propionate, the generic of Flonase, is also sold in another formulation, called Xhance, by prescription only for patients with chronic rhinosinusitis.

Flonase can cause side effects, including:

  • Nosebleeds or nose tenderness
  • Headaches
  • Sore throat
  • Nausea
  • Cough

Azelastine is an antihistamine, which works by suppressing histamine—a protein that triggers the symptoms of an allergic reaction.

Only generic azelastine is available by prescription, as the brand Astelin has been discontinued in the U.S. However, Astepro (azelastine 0.15%) nasal spray has been approved for nonprescription use in those 6 years and older. Azelastine 0.1% remains a prescription medication for younger children.

This type of nasal spray can cause:

  • Bitter taste
  • Headaches
  • Drowsiness
  • Tingling
  • Nasal burning
  • Sore throat
  • Sinusitis
  • Bloody nose
  • Sneezing episodes
  • Nausea
  • Dizziness
  • Weight gain

Combining Flonase and Azelastine

Using Flonase with azelastine is considered a second-line option, which means that the combined treatment approach is only used when you don't experience adequate improvement of your symptoms with use of just one of these sprays.

Using Flonase plus azelastine gives you the benefit of two different mechanisms of action that reduce inflammation. The body's inflammatory reaction is lower when a combination, rather than one, of these therapies is used.

Whether or not that level of treatment is necessary to tame your symptoms depends, in part, on the severity of your allergies. Symptoms are generally so bothersome and noticeable that you should be able to judge your response to treatment well.

Combining Flonase and azelastine is considered safe and does not add to side effects outlined for each medication.


Combination medications like Dymista include more than one medication. The advantage of this type of treatment is that it is faster and more convenient to get more than one ingredient at once than to take them separately.

The disadvantage is that you get a fixed dose of each component, so you and your healthcare provider can't make adjustments to one drug without affecting the other. Also, this medication is sometimes not covered by insurance.

If your healthcare provider prescribes Dymista, you would also take it on a schedule to prevent your symptoms from happening.

Dymista nasal spray suspension delivers 137 mcg of azelastine hydrochloride and 50 mcg of fluticasone propionate (137 mcg/50 mcg) in each 0.137 mL spray. The recommended dose is one spray per nostril twice daily.

The most common side effects of Dymista, as reported by the manufacturer, are:

This medication can also cause sleepiness or drowsiness, so you need to be careful about driving or using heavy machinery.

A Word From Verywell

There are a number of treatments for allergic rhinitis, including nasal steroids, oral or nasal antihistamines, leukotriene inhibitors, and allergy shots. It's not uncommon to combine different medications when trying to reduce symptoms of allergic rhinitis, but combining treatments has to be done safely to avoid drug interactions and harmful side effects.

If you feel that your current regimen is not providing you adequate relief, speak with your healthcare provider.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Stjarne P, Strand V, Theman K, Ehnhage A. Control of allergic rhinitis with MP-AzeFlu: a noninterventional study of a Swedish cohort. Rhinology. 2019;57(4):279–86. doi:10.4193/Rhin18.028

  2. MedlinePlus. Fluticasone nasal spray.

  3. U.S. Food and Drug Administration. FDA approves a nasal antihistamine for nonprescription use.

  4. Cleveland Clinic. Azelastine nasal spray.

  5. Debbaneh PM, Bareiss AK, Wise SK, McCoul ED. Intranasal Azelastine and Fluticasone as combination therapy for allergic rhinitis: Systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2019;161(3):412–8.doi:10.1177/0194599819841883

  6. Roca-Ferrer J, Pujols L, Pérez-González M, et al. Superior effect of MP-AzeFlu than azelastine or fluticasone propionate alone on reducing inflammatory markers. Allergy Asthma Clin Immunol. 2018;14:86.doi:10.1186/s13223-018-0311-4

  7. U.S. Food and Drug Administration. Dymista label.

By Daniel More, MD
Daniel More, MD, is a board-certified allergist and clinical immunologist. He is an assistant clinical professor at the University of California, San Francisco School of Medicine and currently practices at Central Coast Allergy and Asthma in Salinas, California.