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Dymista vs Astelin

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For patients with allergic rhinitis or other types of nasal allergies, certain drugs that inhibit the effects of histamine -- a compound in the body linked to immune responses -- can help in reducing allergy symptoms and improving quality of life. Dymista and Astelin are two such drugs commonly prescribed for these conditions. They both work by blocking H1 receptors in the body to reduce inflammation and allergy symptoms but differ slightly in their formulation. Dymista is a combination medication comprised of an antihistamine (Azelastine) similar to that found in Astelin, as well as a corticosteroid (Fluticasone propionate), which further helps reduce inflammation. On the other hand, Astelin contains only Azelastine, making it solely an antihistamine treatment option.

Dymista vs Astelin Side By Side

Brand NameDymistaAstelin
ContraindicationsShould not be used with MAO inhibitorsShould not be used with MAO inhibitors
CostAround $230 for 30 ml (137 mcg/50 mcg/spray)About $155 for 30 ml, 0.1%
Generic NameAzelastine hydrochloride and Fluticasone propionateAzelastine hydrochloride
Most Serious Side EffectSigns of an allergic reaction, severe dizziness or nervousness, unusual bleeding or bruising, slow heartbeat, eye pain or blurred vision, problems with balance and coordination, sleep problemsSigns of an allergic reaction, bronchospasm, unusual changes in mood and behavior, severe drowsiness leading to confusion and imbalance, fast heartbeats or pounding heartbeat sensation, eye redness or discomfort
Severe Drug InteractionsMAO inhibitorsMAO inhibitors
Typical Dose1 spray per nostril twice daily1 or 2 sprays in each nostril twice daily

What is Dymista?

Dymista (a combination of azelastine and fluticasone) is a newer class of nasal spray that marked a significant development over the traditional antihistamine nasal sprays such as azelastine (Astelin). Dymista was first approved by the FDA in 2012. It not only works to block histamines, but also has an anti-inflammatory effect, effectively "calming" the inflammation in your nose for longer than usual. It is prescribed for relief from seasonal allergies and perennial allergic rhinitis. Dymista combines an antihistamine with a corticosteroid which results in it having fewer side effects than other nasal sprays that only have an antihistamine like Astelin. This dual action provides more effective symptom relief.

What conditions is Dymista approved to treat?

Dymista is approved for the treatment of various allergic symptoms including:

  • Seasonal Allergic Rhinitis (SAR) in patients 12 years of age and older
  • Perennial Allergic Rhinitis (PAR), which occurs year-round, in patients 6 years of age and older.

It's worth mentioning that Dymista is a combination drug that includes azelastine hydrochloride, the same active ingredient found in Astelin.

How does Dymista help with these illnesses?

Dymista is used to manage the symptoms of allergies by combining two active ingredients: azelastine, an antihistamine, and fluticasone propionate, a corticosteroid. Azelastine works by blocking histamine's effect on H1 receptors in the body which are involved in allergic reactions such as sneezing or itching. Fluticasone propionate reduces inflammation by suppressing immune responses that trigger swelling and irritation. These actions work together to limit the effects of allergies and help individuals manage their condition more effectively.

Like Dymista, Astelin also contains azelastine as its active ingredient so it functions similarly in terms of blocking histamines. However, without the additional anti-inflammatory benefit provided by Dymista's fluticasone propionate component, Astelin may be slightly less effective at managing severe allergy symptoms but could still be beneficial for many patients with milder forms of seasonal or perennial allergies.

What is Astelin?

Astelin, a brand name for azelastine, is an antihistamine nasal spray that works by preventing the effects of histamines in your body. Histamines can produce symptoms like itching, sneezing, and runny nose. Azelastine was first approved by the FDA in 1996. As it is not a corticosteroid nasal spray, it does not have the anti-inflammatory properties associated with this class of drugs. Its unique mechanism of action implies that its side-effect profile varies from corticosteroids - notably Astelin doesn't cause dryness or irritation inside the nose and is less likely to result in nosebleeds (common side effects associated with some corticosteroids). Furthermore, Astelin's antihistaminic effect can be beneficial for treating certain allergy symptoms such as hay fever or other upper respiratory allergies particularly if patients do not respond well to "typical" OTC allergy medications.

What conditions is Astelin approved to treat?

Astelin has been approved by the FDA for use in treating nasal symptoms associated with:

  • Seasonal Allergic Rhinitis
  • Non-allergic Vasomotor Rhinitis (a form of chronic rhinitis not caused by allergies).

It works as an antihistamine to alleviate runny nose, sneezing, and postnasal drip.

How does Astelin help with these illnesses?

Histamine is a chemical compound that plays a role in local immune responses and also regulates physiological function in the gut. It acts as a neurotransmitter, communicating important messages from the body to the brain. Astelin, like Dymista, works by inhibiting histamine activity thus reducing inflammation and congestion often associated with allergies. This nasal spray has been known to alleviate symptoms such as itchy or runny nose, sneezing, and postnasal drip caused by seasonal allergens or environmental irritants. The key difference lies in its formulation: Astelin contains only azelastine hydrochloride while Dymista combines this ingredient with fluticasone propionate - an added steroid for more severe allergy cases. As such, Astelin may be preferred when there's no need for additional corticosteroid treatment or if patients respond poorly to combined therapy options.

How effective are both Dymista and Astelin?

Both Dymista and Astelin have established histories of success in treating symptoms associated with seasonal allergies, and they were initially approved by the FDA 15 years apart. As they contain different active ingredients, their use may be dictated by specific patient requirements. The efficacy of Dymista (a combination of azelastine hydrochloride and fluticasone propionate) and Astelin (azelastine alone) in alleviating nasal symptoms was directly studied in a randomized controlled trial; both drugs exhibited similar efficacy in managing allergic rhinitis symptoms.

In a study conducted on patients with moderate to severe allergic rhinitis, it was found that Dymista provided significantly greater relief from nasal symptoms than either of its components alone or placebo. This suggests that the combined action of an antihistamine (azelastine) and a corticosteroid (fluticasone propionate) can provide more effective relief for allergy sufferers.

Astelin has been widely prescribed since its approval in 1996 due to its effectiveness as an antihistamine spray. It specifically targets histamines - chemicals your body produces during an allergic reaction - providing rapid symptom relief without causing drowsiness common with some other antihistamines.

A review indicated that Azelastine seems to be more effective than placebo at reducing allergy symptoms but is typically considered alongside or after first-line treatments such as oral antihistamines or intranasal corticosteroids. Nonetheless, due to its unique pharmacology, Astelin may offer optimal treatment for patients who do not respond well to other medications or are unable to tolerate certain side effects.

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At what dose is Dymista typically prescribed?

Nasal sprays of Dymista are typically prescribed as 1 spray per nostril twice daily for adults and children over the age of 12. Studies have indicated that this dosage is sufficient for treating seasonal allergies in most people. For Astelin, the dosage can vary depending on the severity and type of allergy being treated; generally, it's recommended to use two sprays per nostril twice a day. In either population, dosage can be adjusted after a few weeks if there is no response or insufficient relief from symptoms. The maximum frequency should not exceed two applications (4 sprays) per nostril daily for both medications.

At what dose is Astelin typically prescribed?

Astelin treatment typically begins with a dose of 1 or 2 sprays in each nostril twice daily. The dosage can then be adjusted depending on the severity and response to initial doses. For some patients, relief can be achieved with as little as one spray per nostril twice a day. It's important to note that using more than the recommended dose will not increase effectiveness but may increase the chance of experiencing side effects. If there is no noticeable improvement after several days, it would be wise to consult with your healthcare provider for further evaluation and possible adjustment of medication.

What are the most common side effects for Dymista?

Potential side effects of Dymista and Astelin can include:

  • Unusual taste or smell
  • Headache
  • Nosebleeds
  • Fatigue (general weakness and tiredness)
  • Drowsiness/sleepiness
  • Nasal discomfort, burning, or stinging
  • Sneezing
  • Nausea
  • Dry mouth -Dizziness
    -Sore throat (pharyngitis)
    -Inflammation in the nasal passages.

It's important to note that while these medications share some common side effects, individuals may react differently. Always consult with a healthcare provider for personalized medical advice.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Dymista?

Dymista and Astelin are both nasal sprays prescribed for the treatment of allergy symptoms. They generally have a good safety profile, but like all medications, they can cause side effects in some people. The below symptoms are rare but if experienced, medical attention should be sought immediately:

  • Signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue or throat
  • Severe dizziness or nervousness
  • Unusual bleeding (nosebleeds) or bruising
  • Slow heartbeat
  • Eye pain or blurred vision
  • Problems with balance and coordination
  • Sleep problems (insomnia)

Additionally, Dymista has been reported to occasionally cause changes in taste and smell. It's important to note that while these side effects may seem alarming, the majority of patients using these medications do not experience severe adverse reactions. However, if you notice any unusual symptoms after starting treatment with either Dymista or Astelin it is essential to consult your healthcare provider promptly.

What are the most common side effects for Astelin?

Common side effects associated with Astelin include:

  • Bitter taste in the mouth
  • Headache
  • A burning or stinging sensation inside the nose
  • Sleepiness or drowsiness
  • Nosebleeds
  • Sneezing fits immediately after use
  • Nausea and dry mouth
  • Weight gain is also possible but less common.

Significant muscle or joint pain, vision changes, confusion, agitation, fast heartbeat are not typically linked to Astelin; however, if these symptoms occur they should be reported to your healthcare provider. As always, it's crucial to consult a medical professional before initiating any new medication regimen.

Are there any potential serious side effects for Astelin?

While Astelin is generally safe for use, it's essential to be aware of potential severe side effects. Some adverse reactions that need immediate medical attention include:

  • Signs of an allergic reaction such as hives; difficulty breathing; swelling of your face, lips, tongue or throat
  • Bronchospasm (wheezing, chest tightness, trouble breathing)
  • Unusual changes in mood and behavior
  • Severe drowsiness leading to confusion and imbalance
  • Fast heartbeats or pounding heartbeat sensation
  • Eye redness or discomfort

If any of these symptoms occur after using Astelin, seek immediate medical assistance.

Contraindications for Dymista and Astelin?

Both Dymista and Astelin, like most other nasal sprays, may exacerbate symptoms of allergies in some individuals. If you notice your allergy symptoms worsening or experience increased discomfort, please seek immediate medical attention.

Neither Dymista nor Astelin should be used if you are taking or have recently taken monoamine oxidase (MAO) inhibitors. It's crucial to share with your physician all the medications that you are currently on; MAOIs will necessitate a clearance period of about 5 weeks to prevent hazardous interactions with Dymista and Astelin.

How much do Dymista and Astelin cost?

For the brand name versions of these drugs:

  • The price of 30 ml (137 mcg/50 mcg/spray) Dymista nasal spray averages around $230, which works out to around $7.60 per day if using four sprays per day as commonly prescribed.
  • The price of Astelin nasal spray (30 ml, 0.1%) is about $155, working out to approximately $5/day with a typical dosing of two sprays in each nostril twice daily.

Thus, if you are in the higher dosage range for Dymista (i.e., up to six sprays per day), then brand-name Astelin is less expensive on a per-day treatment basis. Please note that cost should not be a primary consideration in determining which of these drugs is right for you.

For the generic versions Azelastine hydrochloride and Fluticasone propionate/Dymista costs are significantly lower:

  • Generic Azelastine hydrochloride (Astelin) ranges from approximately $35-$70 for a bottle depending on insurance coverage and pharmacy rates.
  • The generic equivalent to Dymista has not been made available yet due to patent laws protecting its proprietary blend until 2026; thus making it more costly compared to its alternatives at this time.

Popularity of Dymista and Astelin

Dymista, a combination of fluticasone and azelastine, was estimated to have been prescribed to about 1 million people in the US in 2020. Dymista accounted for just over 2% of nasal spray prescriptions in the US. However, it appears to be one of the most common dual-mechanism nasal sprays (containing both a corticosteroid and an antihistamine). The use of Dymista has been generally increasing since its introduction on the market.

On the other hand, Astelin, which includes only azelastine as its active ingredient, was prescribed to around 800 thousand people in USA during 2020. In the US, Astelin accounts for just under 5% of antihistamine nasal spray prescriptions and less than 2% overall when considering all types of nasal sprays. Despite being available longer than Dymista's combined formulation; Astelin's prevalence has remained steady over recent years.


Both Dymista (a combination of azelastine and fluticasone) and Astelin (azelastine) have a solid track record in managing the symptoms of seasonal allergic rhinitis, as demonstrated by various clinical trials proving their efficacy over placebo treatments. In some instances, they may be used together but this requires careful evaluation by a medical professional due to potential interactions.

The difference lies in their mechanisms of action; while both contain azelastine, an antihistamine that blocks the effects of histamine thereby reducing allergy symptoms, Dymista also contains fluticasone - a corticosteroid that reduces inflammation.

Dymista tends to be prescribed when symptoms are more severe or persistent and do not respond well to antihistamines alone such as Astelin. Both drugs come in generic forms which can provide cost savings especially for patients who pay out-of-pocket.

It is important to note there may be an adjustment period with these medications where the maximum relief from allergy symptoms might not be noticeable right away.

As for side effects, both drugs are generally well-tolerated although bitter taste has been reported more frequently with Astelin compared to Dymista. When starting treatment with either drug, patients should monitor any adverse reactions closely and seek immediate medical help if experiencing difficulty breathing or swelling around the face area.