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Azelastine

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Azelastine, Azelastine Hydrochloride, Azelastine Ophthalmic, Azelastine Nasal, Astelin, Astepro, Optivar

  • See Also
  1. Antihistamine
  2. Allergic Rhinitis
  3. Allergic Conjunctivitis
  • Indications
  1. Allergic Rhinitis or Vasomotor Rhinitis (intranasal Azelastine)
    1. Second-line agent
    2. FDA Approved for age >5 years (seasonal allergies) and >6 years (perennial allergies)
  2. Allergic Conjunctivitis
    1. FDA Approved for age >=3 years
  • Mechanism
  1. See Antihistamine
  2. Second-generation Antihistamine (phthalazinone)
  • Medications
  1. Azelastine Nasal (Astelin, Astepro): 0.1% and 0.15% (with 200 sprays/bottle)
  2. Azelastine Ophthalmic (Optivar): 0.05% solution (6 ml bottle)
  3. Combination: Fluticasone with Azelastine (Dymista)
    1. Expensive (up to $200/month) and add little to benefit of generic nasal Corticosteroids alone
    2. Alternatively, use OTC Azelastine (Astepro) and a generic generic nasal Corticosteroid
    3. (2022) Presc Lett 29(5): 25-6
  • Dosing
  1. Nasal (age >5-6 years old)
    1. One spray per nostril twice daily
    2. Adults and children age >12 years may increase to 2 sprays per nostril if needed
    3. Shake well before each use
  2. Ocular (age >= 3 years old)
    1. Use 1 drop in each each eye twice daily
  • Adverse Effects
  • Nasal
  1. Somnolence (11%)
    1. May affect safety in driving and hazardous activities
  2. Bitter Taste (20%)
  3. Headache (15%)
  4. Nasal burning (4%)
  5. Pharyngitis (4%)
  • Adverse Effects
  • Ophthalmic
  1. Eye burning or stinging (30%, transient)
  2. Headaches (15%)
  3. Bitter taste (10%)
  • Safety
  1. Pregnancy Category C
  2. Unknown safety in Lactation
  • Efficacy
  1. Azelastine in Covid19 Prevention
    1. Single study in Germany reported lower Incidence of Covid19 with longterm use of Azelastine
    2. Required high dose use during cold symptoms in mostly vaccinated, young adults with an NNT 23
    3. Not recommended for routine use (get the Vaccine instead for single shot, lower cost with better efficacy)
    4. (2025) Presc Insights 32(11): 64-5
    5. Lehr (2025) JAMA Intern Med +PMID: 40892398 [PubMed]
  • Resources
  1. Azelastine Hydrochloride Nasal Spray (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7902605c-944a-4d7e-a7d4-eb4a71bcacdb
  2. Azelastine Hydrochloride Ophthalmic Solution (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=6945fb86-27fb-4bab-8908-98772c6269c5