1. Introduction
Azelastine nasal spray is a second-generation antihistamine used for treating allergic rhinitis and non-allergic rhinitis. It works by blocking histamine receptors (H1) in nasal tissues, reducing symptoms like sneezing, nasal congestion, runny nose, and itching.
2. Indications
- Seasonal Allergic Rhinitis (Hay Fever)
- Perennial Allergic Rhinitis (Year-Round Allergies)
- Non-Allergic Vasomotor Rhinitis (Irritant-induced rhinitis)
3. Dosage
Adults & Children (≥6 years):
- Allergic Rhinitis: 1–2 sprays per nostril twice daily.
- Non-Allergic Rhinitis: 2 sprays per nostril twice daily.
Children (2–5 years):
- 1 spray per nostril twice daily (under specialist supervision).
Elderly:
- No dose adjustment needed, but monitor for drowsiness.
Renal & Hepatic Impairment:
- No dose adjustments required.
4. Administration
- Shake the bottle well before use.
- Prime the spray by pressing a few times until mist appears before first use.
- Blow your nose gently before application.
- Spray while keeping head slightly tilted forward.
- Do not sniff hard after spraying to keep medicine inside the nasal cavity.
- Wipe the nozzle after each use.
5. Forms Available
- Azelastine Hydrochloride Nasal Spray 0.1% (137 mcg per spray, 23 mL bottle)
- Azelastine Hydrochloride Nasal Spray 0.15% (205.5 mcg per spray, 30 mL bottle)
6. Side Effects
6.1 Common Side Effects:
- Bitter taste (very common)
- Drowsiness
- Nasal irritation or burning sensation
- Sneezing
6.2 Less Common Side Effects:
- Dry mouth
- Headache
- Cough
6.3 Rare but Serious Side Effects:
- Nosebleeds (epistaxis)
- Severe allergic reactions (swelling, rash, difficulty breathing)
7. Warnings
- Drowsiness Risk:
- Less sedating than first-generation antihistamines, but can still cause drowsiness in some patients.
- Avoid alcohol and sedatives while using azelastine.
- Bitter Taste:
- Common but reduced if head is tilted forward and not sniffed deeply after spraying.
- Nasal Irritation:
- If persistent irritation occurs, discontinue use and consult a doctor.
8. Precautions
- Avoid driving or using heavy machinery until you know how the drug affects you.
- Use cautiously in asthma patients, as it may cause nasal irritation.
- Not for eye use—use azelastine eye drops for allergic conjunctivitis instead.
9. Interactions
- CNS Depressants (e.g., alcohol, benzodiazepines, opioids): Increased drowsiness and sedation risk.
- Other Nasal Sprays (e.g., corticosteroids, decongestants): Can be used together, but space doses apart to avoid nasal irritation.
- Anticholinergic Drugs (e.g., atropine, ipratropium): Increased risk of dry mouth and drowsiness.
10. Monitoring Parameters
- Relief of nasal allergy symptoms within 30–60 minutes.
- Check for drowsiness or dizziness if used with other medications.
- Monitor for nosebleeds or nasal dryness in long-term use.
11. Use in Children
- Approved for children ≥6 years for allergic rhinitis.
- Use under doctor supervision in children <6 years.
12. Use in Pregnancy
- Category C:
- Limited data in pregnancy—use only if benefits outweigh risks.
- Intranasal corticosteroids (e.g., budesonide, fluticasone) are preferred in pregnancy.
13. Use in Elderly
- Safe, but monitor for drowsiness as sensitivity to antihistamines increases with age.
14. Use in Kidney Disease
- No dose adjustment required—minimal systemic absorption.
15. Use in Liver Disease
- No dose adjustment needed—drug is primarily metabolised in nasal tissues.
16. Patient Counselling Points
- Use regularly for best results, especially for allergies.
- Avoid sniffing too hard after spraying—reduces bitter taste.
- Do not share the spray to prevent infections.
- Blow your nose gently before using the spray.
- Wait at least 10 minutes before using other nasal sprays.
- Avoid alcohol and sedatives if drowsiness occurs.
17. Table of Brand Names, Manufacturer, and Prices in USD
Brand Name | Manufacturer | Strength/Dosage Form | Price (USD) |
---|---|---|---|
Astelin | Meda Pharmaceuticals | 137 mcg/spray (23 mL) | $40 (one bottle) |
Astepro | Bayer | 205.5 mcg/spray (30 mL) | $50 (one bottle) |
Generic Azelastine | Various | 137 mcg/spray (23 mL) | $30 (one bottle) |
18. 15 FAQs (Frequently Asked Questions)
1. What is Azelastine Nasal Spray used for?
It treats allergic and non-allergic rhinitis, reducing sneezing, congestion, and runny nose.
2. How does Azelastine work?
It blocks histamine (H1 receptors) in nasal tissues, preventing allergy symptoms.
3. How long does Azelastine take to work?
Relief starts within 30–60 minutes and lasts up to 12 hours.
4. Can I use Azelastine daily?
Yes, it is safe for daily use during allergy season.
5. Does Azelastine cause drowsiness?
It is less sedating than older antihistamines but may still cause drowsiness in some people.
6. Can I use Azelastine with a decongestant nasal spray?
Yes, but space the doses apart to avoid nasal irritation.
7. Can I drink alcohol while using Azelastine?
Avoid alcohol—it may increase drowsiness.
8. Can children use Azelastine nasal spray?
Yes, for children ≥6 years. For 2–5 years, use only under medical supervision.
9. Can I use Azelastine if I am pregnant?
Not recommended unless prescribed—intranasal corticosteroids are safer in pregnancy.
10. Can I stop using Azelastine suddenly?
Yes, but symptoms may return if stopped abruptly.
11. Can I use Azelastine if I have asthma?
Yes, but monitor for worsening symptoms.
12. What should I do if I miss a dose?
Use it as soon as remembered, but do not double the next dose.
13. Can I use Azelastine long-term?
Yes, it is safe for long-term use for chronic allergic rhinitis.
14. Should I shake Azelastine nasal spray before use?
Yes, always shake before use.
15. Does Azelastine have a bitter taste?
Yes, a bitter aftertaste is common but can be reduced by not sniffing too hard after use.