• 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
  • 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