Azelastine Nasal Spray: Uses, Dosage, and Side Effects Explained

Summary of Key Points

Azelastine is a prescription medication used to relieve allergy symptoms such as sneezing, runny nose, and itchy eyes. It is available in two forms: a nasal spray and eye drops. Azelastine works by blocking histamine, a chemical in the body that triggers allergic reactions. It is commonly prescribed for conditions like allergic rhinitis, conjunctivitis, and both seasonal and year-round allergies. Always consult your healthcare provider before starting or adjusting your dosage.

Names of Medication

US Brand Name: Astelin (Azelastine)

US Brand Name: Astepro (Azelastine)

US Brand Name: Optivar (Azelastine)

The generic name, Azelastine, is the active ingredient in all these brands.

Pharmacologic Category

Antihistamine (H1 receptor antagonist)

Azelastine Dosage

Azelastine is prescribed for various allergic conditions, with the dosage depending on the specific condition being treated. Always follow your healthcare provider’s instructions and consult them before making any changes to your dose. You can also schedule a telemedicine appointment with one of our providers for personalized guidance.

Azelastine for Allergic Rhinitis (Seasonal or Perennial)

Adults: 1 or 2 sprays in each nostril twice daily.

Azelastine for Conjunctivitis (Itchy Eyes)

Adults: 1 drop in each affected eye twice daily.

Hay Fever, Seasonal Allergies, Nasal Congestion, Sneezing, Runny Nose, Postnasal Drip

Adults: 1 or 2 sprays in each nostril twice daily.

Consult your doctor before adjusting your dose or if symptoms persist. You can also speak to one of our telemedicine providers for immediate advice.

Dosage Forms and Strengths of Azelastine

Nasal Spray: 137 mcg/spray

Nasal Spray: 205.5 mcg/spray

Ophthalmic Solution (Eye Drops): 0.05%

Administration Instructions for Azelastine Nasal Spray and Eye Drops

For the nasal spray, gently blow your nose before use. Insert the spray tip into your nostril and spray while breathing in gently. Avoid spraying directly onto the nasal septum (the wall between your nostrils). For the eye drops, tilt your head back and pull down your lower eyelid to create a small pocket. Squeeze one drop into the pocket and close your eyes for 1-2 minutes. Be careful not to touch the dropper tip to your eye or any surface to prevent contamination.

Azelastine Side Effects and Adverse Reactions

Like all medications, Azelastine may cause side effects. Most are mild, but some may require medical attention. If you experience any severe side effects, contact your healthcare provider or schedule a telemedicine appointment immediately.

Common Azelastine Side Effects: Bitter taste, drowsiness, headache, nasal irritation (for nasal spray), eye irritation (for eye drops).

Less Common Side Effects: Dry mouth, fatigue, sneezing after nasal spray use.

Rare but Serious Side Effects: Allergic reactions such as rash, itching, swelling, severe dizziness, or difficulty breathing.

Contraindications for Azelastine

A contraindication is a specific situation where a medication should not be used because it may be harmful. Before starting any new medication, it’s important to know if you have any conditions or are taking other medications that might make the drug unsafe for you. Below are the contraindications for taking Azelastine:

Allergy to Azelastine: If you have had an allergic reaction to Azelastine or any of its ingredients, you should not use this medication. An allergic reaction could cause symptoms like rash, itching, swelling, or difficulty breathing.

Severe liver disease: Azelastine is processed by the liver, and if you have severe liver disease, your body may not be able to break down the medication properly, leading to potential side effects or toxicity.

Use of alcohol or sedatives: Azelastine can cause drowsiness, and using it with alcohol or sedative medications can increase this effect, making it unsafe to perform activities like driving or operating machinery.

Drug to Drug Interactions with Azelastine

It’s important to be aware of medications that might interact with Azelastine, as these interactions can increase side effects or reduce the effectiveness of either drug. Below is a list of medications that may interact with Azelastine:

CNS depressants: These include medications like diazepam (Valium), lorazepam (Ativan), or alprazolam (Xanax). Combining these with Azelastine can increase drowsiness and sedation.

Alcohol: Drinking alcohol while using Azelastine can enhance the sedative effects of the medication, leading to increased drowsiness or dizziness.

Other antihistamines: Medications like diphenhydramine (Benadryl) or cetirizine (Zyrtec) may increase the risk of side effects like drowsiness when taken with Azelastine.

Opioid pain medications: Drugs such as hydrocodone (Norco) or oxycodone (OxyContin) can also increase the risk of sedation and respiratory depression when used with Azelastine.

Azelastine in Pregnancy

Is it safe to take Azelastine when pregnant?

Azelastine is classified as a Category C medication by the FDA for use during pregnancy. This means there are not enough well-controlled studies in humans to confirm its safety. While animal studies have shown some risk to the fetus, the potential benefits of using Azelastine nasal spray may outweigh the risks in certain situations. If you are pregnant or planning to become pregnant, it’s crucial to discuss the risks and benefits of using Azelastine with your healthcare provider. Our telemedicine providers are available to help you make the best decision for both your health and your baby’s well-being.

Azelastine While Breastfeeding

Is it safe to take Azelastine while breastfeeding?

There is limited information on the safety of Azelastine during breastfeeding. It is not known whether Azelastine passes into breast milk or what effects it might have on a nursing infant. If you are breastfeeding, it’s important to consult your healthcare provider before using Azelastine nasal spray. They can help you weigh the potential risks and benefits and determine if this antihistamine nasal spray is the best option for you.

Estimated Cost of Azelastine Nasal Spray

The cost of a 30-day supply of generic Azelastine nasal spray without insurance can vary. With a GoodRx coupon, the price typically ranges from $20 to $40. The brand-name version, Astelin, may be more expensive, often costing between $50 and $100 for a 30-day supply. Prices can fluctuate depending on the pharmacy and location, so it’s a good idea to check for discounts or coupons before purchasing.

Possible Alternatives to Azelastine

If Azelastine is not the right medication for you, several alternative treatments and lifestyle changes may help manage your symptoms. Always consult your healthcare provider before making any changes to your treatment plan. Our telemedicine providers are available to discuss these options with you.

Allergic Rhinitis, Hay Fever, and Seasonal Allergies

Alternatives include oral antihistamines like loratadine (Claritin) or fexofenadine (Allegra), nasal corticosteroids such as fluticasone (Flonase), or leukotriene receptor antagonists like montelukast (Singulair). Lifestyle changes, such as avoiding allergens, using air purifiers, and keeping windows closed during high pollen seasons, may also help alleviate symptoms.

Conjunctivitis (Allergic)

Eye drops containing antihistamines, such as ketotifen (Zaditor), or mast cell stabilizers like olopatadine (Patanol), can be effective alternatives. Avoiding allergens and using cold compresses may also help reduce symptoms.

Perennial Allergic Rhinitis

For year-round symptoms, nasal corticosteroids like mometasone (Nasonex) or oral antihistamines may be effective. Reducing exposure to indoor allergens, such as dust mites and pet dander, can also provide relief.

Nasal Congestion, Sneezing, and Runny Nose

Decongestants like pseudoephedrine (Sudafed) or combination antihistamine-decongestant medications may offer relief. Nasal saline irrigation (using a neti pot) can also help clear nasal passages and ease congestion.

Itchy Eyes

Antihistamine eye drops like ketotifen (Alaway) or olopatadine (Pataday) can help relieve itching. Wearing sunglasses outdoors and avoiding rubbing your eyes may also reduce irritation.

Postnasal Drip

Nasal corticosteroids or antihistamines can help manage postnasal drip. Staying hydrated, using a humidifier, and avoiding irritants like smoke can also help reduce symptoms.

Recent Updates on Azelastine Research

Recent studies have focused on the effectiveness of Azelastine in combination with other medications, such as fluticasone, for treating allergic rhinitis. A 2021 study found that a combination nasal spray containing both Azelastine and fluticasone provided greater symptom relief than either medication alone. This combination therapy may be particularly beneficial for patients with moderate to severe allergic rhinitis symptoms.

Additionally, ongoing research is exploring the use of Azelastine in treating other allergic conditions, such as chronic urticaria (hives) and asthma. While more studies are needed, early results suggest that Azelastine may have broader applications in managing allergic diseases.

As always, it’s important to stay informed about the latest research and discuss any new treatment options with your healthcare provider. If you have questions about Azelastine or other medications, our telemedicine providers are here to help you navigate your treatment options.

James Kingsley

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