Azelastine hydrochloride displayed no sensitising potential in the guinea pig. Azelastine demonstrated no genotoxic potential in a battery of in vitro and in vivo tests, nor any carcinogenic potential in rats or mice. In male and female rats, azelastine at oral doses greater than 3 mg/kg/day caused a dose-related decrease in the fertility index; no substance-related alterations were found in the reproductive organs of males or females during chronic toxicity studies, however, embryotoxic and teratogenic effects in rats, mice and rabbits occurred only at maternal toxic doses (for example, skeletal malformations were observed in rats and mice at doses of mg/kg/day).
Whilst the use of inhaled steroids and long acting beta-adrenoceptor agonists (LABA) are recommended in asthma guidelines for the resulting improved symptom control,  concerns have been raised that salmeterol may increase the small risks of asthma deaths and this additional risk is not reduced with the additional use of inhaled steroids.  Other side effects from this drug combination may include increased blood pressure, change in heart rate, an irregular heartbeat, increased risk of osteoporosis, cataracts, and glaucoma.  With available studies, the safety of inhaled fluticasone propionate cannot be questioned for its effect on growth of asthmatic children. A systematic review published in year 2013,  could not derive any significant adverse effect on HPA function, growth and bone mineral density in asthmatic children when inhaled fluticasone is used for long duration and followed for up to three months.
Elimination: The elimination rate of intravenous administered fluticasone propionate is linear over the 250-1000mcg dose range and are characterized by a high plasma clearance (CL=/min). Peak plasma concentrations are reduced by approximately 98% within 3-4 hours and only low plasma concentrations were associated with the terminal half-life. The renal clearance of fluticasone propionate is negligible (<%) and less than 5% as the carboxylic acid metabolite. The major route of elimination is the excretion of fluticasone propionate and its metabolites in the bile.