Azelastine

Azelastine is a histamine agonist and is effective as a first-line therapy to combat intermittent and persistent rhinitis.

Overview

Azelastine Opthalmic helps vasomotor rhinitis sufferers to combat symptoms of seasonal and perennial allergies which affect the eye, as well as being an effective agent in the treatment of allergic conjunctivitis (often referred to as “pink eye”). Allergic conjunctivitis causes watery, itchy and red eyes, and can be caused by exposure to histamine-containing irritants such as pet fur, dust mites and plant pollens. Some patients may experience seasonal allergic conjunctivitis as a result of a high pollen count at certain times of the year.

Azelastine belongs to a class of medicines called antihistamines. These medicines function by blocking histamine, a substance in the body which is known to cause allergic symptoms.

Conditions treated:

  • Seasonal conjunctivitis
  •  Perennial conjunctivitis

Type of medicine:

  • Antihistamine

Side effects:

Along with the desired effects, some patients may experience unwanted side effects when taking this medicine. The most common side effects reported by those being treated with Azelastine in eyedrop form include a bitter taste in the mouth, temporary eye stinging or burning.

As the patient continues to take the medication as prescribed, the side effects mentioned above should begin to subside. If these side effects persist over a prolonged period or appear to worsen, the patient is advised to follow this up with his or her doctor immediately. However, some of these effects may only cause temporary discomfort, and in the case of a bitter taste in the mouth, patients are advised to drink a glass of cold water. The reason this side effect happens is because the channels of the eyes, ears, nose and throat are all connected and some of the solution may inadvertently make its way into the mouth when administered.

Other side effects, which occur very rarely but enough to warrant a mention, include chills, diarrhea, fever, hoarseness in the voice, itchy skin, loss of appetite, nausea, runny nose, shivering, sneezing, stuffy nose, sore throat, sweating, difficulty swallowing, difficulty sleeping, unusual weakness or tiredness, and/or vomiting. If the patient experiences any of these side effects to an uncomfortable or unbearable level, they are advised to seek medical assistance. Healthcare providers may be able to suggest ways to alleviate symptoms.

Patients who experience the following symptoms should discontinue use of Azelastine immediately and seek medical attention: shortness of breath, wheezing, noisy breathing.

Because Azelastine is administered in eye-drop form, the potential for temporary changes in vision is increased. Blurred vision, stinging eyes and irritation have all been reported, so patients undergoing treatment with this medicine are advised not to drive or operate heavy machinery immediately after administering a dose, as this could put the patient and other road users at risk.

Dosage:

As with all medicines, it is incredibly important to only take Azelastine as prescribed by a physician. This means that patients should refrain from administering more of this medicine than advised, either in frequency or size of dose. In addition to this, patients should be prepared to stop taking medication immediately when advised to do so by a physician – even if they still have a supply of the eye drops remaining.

Azelastine in ophthalmic form comes as a solution which is to be instilled into the eye. It is typically instilled in the affected eye (or both, if the allergy affects both the right and left eyes) twice a day. Patients are advised to use the solution at the same time every day in order to get into a routine. The instructions on the prescription label should be adhered to, and if the patient does not understand any of these instructions they are advised to contact their doctor or pharmacist for clarification. Azelastine should only be used as directed, and as prescribed.

To instill the eye drops, patients should:

  • Wash hands thoroughly with warm, soapy water.
  • Inspect the dropper tip to ensure it is not cracked, chipped or otherwise damaged.
  • Avoid making direct contact between the dropper tip and the eye. This decreases risk of contamination.
  • Pull down the lower lid of the with the index finger while tilting their head back.
  • Hold the dropper with the other hand, as close to the eye without physically touching it.
  • Brace the remaining unused fingers of the hand against the face.
  • Look up with the affected eye, before gently squeezing the dropper so that a single drop will fall into the pocket created by the lower eyelid.
  • Remove the index finger from the lower eyelid.
  • Close the eye for between 2-3 minutes and tip the head back down (towards the floor). At this point, patients should try to avoid blinking or squeezing the eyelids.
  • Place a finger upon the tear duct and apply slight pressure.
  • Wipe excess liquid (from the drops or tears) from the face.
  • Patients whose dose dictates more than one drop to be used should wait at least five minutes before instilling the following drop.
  • After use, the cap should be replaced and tightened on the bottle. The dropper should not be wiped or rinsed.
  • Patient should wash hands to remove any excess medication.

The manufacturers of Azelastine provide general dosage instructions within the literature provided with the medicine, however, it should be reiterated that these guidelines can be altered at the discretion of the patient’s doctor. There are many varied factors, including the physiology of the patient and the severity of the allergy, that will inform a doctor’s decision to describe Azelastine at a particular level.

In addition to prescribing a course of Azelastine, a doctor may also advise patients suffering from perennial conjunctivitis on a variety of ways to reduce or avoid exposure to substances that can cause conjunctivitis symptoms to worsen.

If a patient misses a dose of Azelastine, they are advised to use the medicine as soon as they remember. If this is impractical or the time for the next scheduled dose is approaching, the patient is advised to skip the dose and continue as normal with the next scheduled dose. The patient should not double the dose in an attempt to catch up, as this can lead to overdosing. In the event of overdosing on any medicine, patients are advised to contact the emergency services on 911, or their local poison control center on 1800-222-1222 immediately.

Interactions:

Drugs have the potential to interact with other medications or chemicals within the human body, and these interactions can potentially affect the efficacy of a treatment, leading to it becoming ineffective. In some instances, interactions can cause unwanted effects which can be potentially harmful to the patient. For these reasons, it is important for patients to keep a full, detailed list of medications they are currently taking. This includes over the counter remedies, vitamins and herbal supplements as well as any prescribed medicine.

Below is a list of medications known to have negatively interacted with Azelastine. Patients who are currently undergoing treatment with any of these drugs should notify their doctor before taking the first dose of Azelastine:

  • Tagamet
  • Equaline acid reducer
  • Cimetidine
  • Leader heartburn relief
  • Acid reducer

Warnings:

Before taking Azelastine, patients are advised to tell their doctor or pharmacist if they are allergic to Azelastine or any other anti-allergy medications. This medicine may contain inactive ingredients that could potentially cause allergic reactions or other issues.

Patients who are currently undergoing treatment with Azelastine are advised against wearing contact lenses until the treatment has run its course – particularly if their eyes are pink or red in color. Azelastine contains a chemical which can cause discoloration to soft contact lenses. This medication should only be used as prescribed, and should not be used to treat irritation caused by wearing contact lenses or forgetting to take out contact lenses.

During pregnancy, this medicine should only be used if clearly required. Although there is no evidence to suggest it is harmful to the human fetus, this is standard FDA recommendation on most medicines. Patients who are pregnant or considering getting pregnant are advised to consult their doctor prior to using this medicine.

It is currently unknown whether Azelastine is passed into breastmilk. However, breastfeeding mothers are advised to exercise caution and to consult their doctor, who may advise that the risks of using a medicine outweighs the risks when no studies have been undertaken with regard to the effects on infants.

Storage:

Azelastine should be kept in the container it was shipped in, tightly closed, and out of the reach of pets or children. It should be stored at room temperature and away from excess moisture; it is therefore not suitable for storage in the bathroom.

After treatment, any excess or unwanted Azelastine should be disposed of in a safe and hygenic manner, to ensure that pets, children and other people do not inadvertently consume it. It is not suitable for flushing down the toilet or drain. The best way to dispose of any unwanted medicine is to make use of a take back program. Many pharmacies and community waste disposal departments can offer advice on how to take advantage of such a scheme.

Summary:

Azelastine, which is often marketed in the US as Optivar, is an effective treatment for both ongoing (perennial) and seasonal conjunctivitis. There are relatively low risks when this medicine is used as prescribed by a doctor, and it is an affordable means of combating eye allergies. It is used regularly throughout the entire western world.

Although the same base ingredient can be used to treat nasal allergies, in eye-drop form Azelastine is only recommended for the treatment of macular allergies, and the medication should only be used in this manner. Care should be taken when administering this medicine to children, with an adult or healthcare professional present to oversee the instillation to ensure optimum effectiveness.

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Last Reviewed:
December 25, 2017
Last Updated:
December 22, 2017