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Drug Details

Azelastine

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Apr 21, 2023

Drug Details

Generic Name:

Azelastine hydrochloride

Common Brands:

Astepro Allergy Nasal Spray and Children’s Astepro Allergy (intranasal azelastine), Optivar (ophthalmic solution)

Availability:

Prescription and over-the-counter

Therapeutic Class:

Antihistamine

Forms:

Nasal spray, ophthalmic solution

Administration:

By application to the nose (azelastine nasal spray) or eyes (azelastine ophthalmic solution)

Therapeutic Uses:

To relieve nasal symptoms of seasonal allergic rhinitis (hay fever) and perennial allergic rhinitis such as sneezing, itchy nose, runny nose, and nasal congestion
For treatment of allergic conjunctivitis symptoms such as watery eyes, itchy eyes
To relieve symptoms of nonallergic rhinitis (prescription nasal spray only)

Controlled Status:

Not a controlled substance

Azelastine Drug Class

Azelastine (ah-zel-ahs-teen) belongs to a group of medications called antihistamines.

Azelastine Age Range

Azelastine (Astepro Allergy Nasal Spray) is approved for use in adults and children 12 years of age and older. Children’s Astepro Allergy is approved for children 6 years of age and older. The safety and efficacy of this medication in children younger than 6 years have not been established. The ophthalmic solution is for children 3 years of age and older.

Uses

Azelastine Uses

Azelastine nasal spray is used to relieve nasal symptoms of year-round or perennial allergic rhinitis and seasonal allergic rhinitis such as runny nose, stuffy nose, sneezing, and nasal itching. The prescription nasal spray can be used to relieve nonallergic rhinitis. The ophthalmic solution is used to relieve itchy and watery eyes from allergic conjunctivitis (pink eye).

There may be other uses of azelastine—your pharmacist or doctor can give you further drug information.

Azelastine Mechanism of Action

Azelastine is an antihistamine. It works by blocking the action of a natural chemical called histamine, which causes allergy symptoms and other effects.

Azelastine Doses

Azelastine is available as a 0.15% over-the-counter nasal spray and a 0.1% and 0.15% prescription nasal spray. The pump dispenses 137 mcg/spray or 205.5 mcg/spray. It is also available as 0.05% prescription eye drops.

The usual dose of azelastine nasal spray is 1-2 sprays in each nostril 1-2 times daily. Do not use more than 2 sprays in each nostril for children 6-11 years of age and 4 sprays in each nostril for adults and children 12 years of age and above in a 24-hour period. The ophthalmic solution should be instilled 1 drop in each eye twice a day.

Directions

How To Use Azelastine

Azelastine nasal spray should be sprayed into the nostrils 1-2 times a day. The eye drops are instilled in the affected eye(s) twice a day.

Read the package instructions or prescription label carefully and use azelastine as exactly directed. Do not use a higher or lower dose of this medicine or use it more frequently than your doctor tells you.

Be careful not to spray the nasal spray into your eyes or mouth. Do not share your bottle of azelastine nasal spray or eye drops with anyone else, as this can lead to the spread of germs.

Each bottle of azelastine nasal spray contains a fixed number of pumps. After you have used them up, throw the bottle away even if there is some remaining liquid because this liquid may not contain enough medicine.

Azelastine will control symptoms of seasonal allergic rhinitis but will not cure your condition.

Here are some tips on intranasal administration of azelastine:

Remove the pump’s cap and safety clip.
Prime the pump if you are using it for the first time. Hold it away from your face and pump it 4 times until you see a fine mist. Pump it 2 times if you are using it after more than 3 days.
To use the medicine, keep your head tilted forward, close one nostril with a finger, and insert the spray tip into the other nostril, making sure you keep the bottle upright.
Spray the medicine and breathe through your nose to prevent the medicine from going to your throat.
Repeat on the other side.
Keep the pump tightly closed between doses.

Here are some tips on the proper use of azelastine eye drops:

Wash your hands with soap and water.
Avoid touching the dropper tip against your eye, finger, or anything else.
Tilt your head back and form a pocket in your lower eyelid using a finger.
Hold the dropper tip close to the pocket without touching it and squeeze so that one drop falls into the pocket.
Close your eyes for 2-3 minutes and apply gentle pressure with a finger to allow the medicine to be absorbed.
Wipe excess liquid on your face using a tissue.
Wait 5 minutes before applying any other eye drops.

Missed dose: If you forget to use azelastine, do it as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and go back to your regular dosing schedule. Do not use extra azelastine to make up for a missed dose.

Storage: Store azelastine at room temperature (between 15-30° C or 59-86° F) away from moisture, heat, and direct light in its original container, tightly closed. Do not store medications in the bathroom where they can be exposed to moisture and heat. Keep all medications safely out of reach of children and pets.

Unused medicine: Unused azelastine should be disposed of in a way that children, other people, and pets cannot get to them. Do not throw azelastine in the trash or flush it down the toilet. The best way to dispose of expired or unneeded azelastine is through a drug take-back program. Learn more about proper medication disposal.

NOTE: This medication guide is a summary and may not contain all possible drug information on azelastine. The information contained here may not be up-to-date. This sheet is for information purposes only. If you have questions about azelastine, talk to your doctor or health system pharmacists for medical advice.

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Side Effects

Azelastine Side Effects

Some of the possible side effects of azelastine are listed below. Tell your doctor if these unwanted effects are severe or do not go away in a few days.

Bitter taste
Headache
Tiredness
Sleepiness
Nasal discomfort
Nosebleed
Sore throat
Dry mouth
Runny nose
Sneezing
Dizziness
Nausea
Increase in weight
Abnormal sensations (burning, pricking, tingling, aching)
Temporary burning or stinging in the eyes, eye pain, blurred vision (with eye drops)

Other side effects and adverse events related to azelastine are more serious. Call your doctor right away or seek emergency medical attention if you develop signs and symptoms of allergic reactions such as difficulty breathing or any other unusual or allergic reaction.

The above list may not include all the potential side effects of azelastine. Contact your healthcare provider if your side effects are unusual or severe or if they do not get better over time. You can also report unusual side effects to the Food and Drug Administration at 1-800-FDA-1088.

Azelastine Overdose: In case of an overdose, call your doctor immediately. You can also call the national poison control center at 1-800-222-1222. If someone has lost consciousness, collapsed, is not breathing, or has had a seizure, call 911.

Source: FDA

Warnings

Azelastine Risks, Warnings, and Complications

Using azelastine may cause or worsen certain health problems. Talk to your doctor or pharmacist about other treatments for allergic rhinitis if you are at increased risk of complications from azelastine use.

DIZZINESS AND DIFFICULTY CONCENTRATING: Using azelastine can lead to dizziness and difficulty concentrating, focusing, thinking, and reacting quickly. These side effects can be made worse by drinking alcohol. Do not drive or do anything that requires your full concentration until you know how this medicine affects you.
BACTERIAL INFECTIONS: Using azelastine eye drops can lead to a bacterial infection in the eye if the dropper tip becomes contaminated. Be careful not to touch the dropper tip with your finger, eye, or anything else.
NO SOFT CONTACT LENSES: If you wear soft contact lenses, take them out before applying azelastine eye drops. The eye drops contain a substance called benzalkonium chloride which can be absorbed by the soft contact lenses and cause damage. Wait 10 minutes before putting your contact lenses back on. Do not use azelastine to treat eye redness caused by contact lens use.

Precautions Before Starting Azelastine

Tell your doctor if you have ever had an allergic reaction to azelastine, any of the active or inactive ingredients in azelastine formulations, or any other medications. Your pharmacy can give you a list of ingredients.

Give your doctor and pharmacist a complete list of your medications, including prescription drugs, over-the-counter medicines, other cold and allergy products or antihistamines, vitamins, supplements, and herbal products. This can help avoid interactions between azelastine and your other medications.

Give your doctor a complete medical history. Azelastine may not be right for people with certain medical conditions such as sores in the nose, nose injury, or nose surgery.

Tell your doctor if you are pregnant, could be pregnant, plan to get pregnant, or are breastfeeding.

Precautions During Use of Azelastine

Keep all your medical appointments while using azelastine. Your doctor may want to change your dose and monitor you for side effects.

Azelastine nasal spray can make you drowsy. Avoid driving or doing other hazardous activities until you know how this medicine affects you.

If you wear soft contact lenses, take them out before applying the azelastine eye drops and wait 10 minutes before putting them back on.

Tell your doctor if you become pregnant while on azelastine.

Azelastine Drug Interactions

Certain other drugs can affect how azelastine works. Possible interactions between azelastine and other medicines can increase the risk of severe adverse reactions.

Give your doctor or pharmacist a complete list of your medications, including prescription drugs, OTC medications, herbal remedies, and other cold and allergy products, including antihistamines and dietary supplements. Also, tell your healthcare professional if you smoke, drink alcohol, or use recreational drugs as some of these substances can cause serious health complications when used with prescription and over-the-counter medications.

Pros & Cons

Azelastine Pros and Cons

pros header.svg

Azelastine nasal spray can quickly and effectively relieve nasal symptoms of seasonal allergic rhinitis.
It works faster than an oral dose of antihistamines.
You can use it as needed.
The 0.15% nasal spray is available over the counter.

cons header.svg

Azelastine can cause a temporary bitter taste in the mouth.
The nasal spray does not have a counter number to tell you when the medicine has finished.
You cannot wear contacts for 10 minutes after using the eye drops.
The ophthalmic solution is not available without a prescription.

Pharmacist Tips

Azelastine Tips from Pharmacists

You need to prime the nasal spray before using it for the first time or using it after a gap of 3 days. Do this by holding it away from your face and pressing on the pump 2-4 times until you see a fine mist.
Do not blow your nose for a few minutes after using azelastine nasal spray. This will ensure the medicine stays in your nose.
You will need to keep track of how many sprays you’ve used. Throw the bottle after you’ve used the number of sprays indicated on the package. Any remaining liquid may not contain enough medicine.
Avoid drinking alcohol while using azelastine as it can make side effects like drowsiness and dizziness worse.
If you’re using the eye drops, be careful not to touch the dropper tip to anything, including your eye or finger, to avoid contamination and a risk of eye infection.

Rx Savings Tips

Azelastine Rx Savings Tips

Azelastine is a generic medication available at significantly lower prices than the brand name. Brand names Astepro and Optivar and generic azelastine contain the same medicine and are equally effective and safe. Like with most medications, the generic version offers better value. A BuzzRx azelastine coupon can result in big savings on the brand name and generic forms of the drug. With a BuzzRx discount card, savings card, or discount coupons, the medication could cost you a fraction of retail prices. Azelastine may be under $17.00 for 30 spray/pumps of the 137 mcg strength at Walmart, Walgreens, Rite Aid, CVS Pharmacy, and other participating pharmacies with a BuzzRx discount card or free coupon. For the biggest discounts on azelastine, give the checkout clerk your BuzzRx azelastine discount coupon when you drop off your prescriptions or purchase it over the counter.

Lowest Price for Azelastine

Brand
$28.87

Generic
$16.82

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Pricing based on most commonly-filled versions. Select the strength and quantity of your medication for the most accurate pricing.

Common Questions

Common Questions about Azelastine

Does azelastine have a steroid in it?

No, azelastine does not have a steroid in it. It is a steroid-free antihistamine medication. However, combination products of azelastine and steroids such as fluticasone are available (Dymista Nasal Spray) to treat nasal symptoms of seasonal allergic rhinitis.

Is azelastine over-the-counter?

Azelastine nasal spray 0.15% percent is available over the counter. It is also available by prescription for the 0.15% and 0.1% strength nasal spray. Azelastine ophthalmic solution 0.05% is by prescription only.

How quickly does azelastine start working?

Azelastine usually starts working within 30 minutes and can provide 12-24 hours of relief from runny nose, stuffy nose, nasal congestion, itchy nose, and sneezing.

Can you use azelastine every day?

Yes, you can use azelastine every day. Make sure you follow the instructions on the package and read the prescription label carefully. Adults and children 12 years of age and older should not use more than 4 sprays in each nostril in a 24-hour period. Children 6-11 years of age should not use more than 2 sprays in each nostril in a 24-hour period.

Can azelastine be used long-term?

Azelastine can be used long-term for up to 8 weeks to relieve allergy symptoms. If you need to use it for a long duration (more than a couple of months), check with your provider.

What is the price of azelastine without insurance?

Without insurance, azelastine can be as high as $53.41, but with a free BuzzRx prescription discount coupon, you could pay as low as $16.82 for the most common version of this medication. Use the BuzzRx drug price look-up tool to find the lowest discounted price, and be sure to enter the correct dosage, form, and quantity for the most accurate pricing. While generics tend to have the best savings, you can also use your BuzzRx card and coupons to purchase brand-name versions. It never hurts to ask your pharmacist to try BuzzRx when filling or refilling any of your prescription drugs—whether you have insurance or not.

What is the price of azelastine with insurance?

Ask your pharmacist or insurance provider for your copay price on azelastine—Copay amounts vary depending on the type of insurance plan you have and if there is a deductible to reach before prescription drug coverage begins.

You could save up to 80% on your prescription medication with a free BuzzRx discount coupon for azelastine. When using the BuzzRx lookup tool to find the price of your medicine, be sure to enter the correct dosage, form, and quantity to receive the most accurate discounted pricing. It never hurts to ask your pharmacist to try BuzzRx when filling or refilling any of your prescriptions—whether you have insurance or not.