Azelastine (Nasal)

Azelastine nasal spray is an antihistamine recommended for the relief of seasonal and perennial rhinitis in children and adult populations.


Azelastine nasal spray is available under a number of brand names. The most commonly prescribed U.S. brands, however, are Astelin, Astelin Ready-Spray, and Astepro.

It is used to treat symptoms associated with rhinitis and other allergy-related disorders, including but not limited to:

  • Hay fever
  • Itching
  • Sneezing
  • Stuffy or runny nose

Rhinitis is listed as an inflammatory disease of the upper airways. Azelastine nasal spray can help to alleviate the symptoms of this condition. The disorder affects both children and adults. Today, it is estimated that rhinitis affects 58 million Americans.

Common Seasonal Rhinitis Triggers

Seasonal allergic rhinitis (SAR) is a short-term condition. The disorder may be triggered by the following allergens:

  • Grass
  • Pollen
  • Seasonal mold
  • Weeds

Common Perennial Rhinitis Triggers

Patients who suffer from perennial rhinitis (PR) often experience symptoms for prolonged periods of time. Some common triggers of perennial rhinitis include:

  • Dust
  • Insect droppings
  • Pet dander

Other irritants that could exacerbate rhinitis include smoke, odors, or even fluctuations in temperature. Fortunately, Azelastine nasal spray can help to alleviate bothersome symptoms of rhinitis in many patients who suffer from this condition.

How It Works

As an antihistamine, Azelastine nasal spray targets histamines that are naturally produced by the body due to perceived threats. When histamines are released by mast cells, the areas in which these are stored, some of the most common symptoms include:

  • An itchy or runny nose
  • Teary eyes
  • Unrelenting sneezing

Patients who exhibit these symptoms may have difficulty getting a full night's rest or completing normal functions throughout the day.

Azelastine nasal spray effectively treats both seasonal and year-round rhinitis. It cannot be purchased over the counter. You need a doctor's prescription to obtain this medication.

Condition(s) Treated?

  • Seasonal allergic rhinitis
  • Perennial allergic rhinitis
  • Rhinorrhea
  • Sneezing
  • Nasal pruritus
  • Vasomotor rhinitis
  • Nasal congestion
  • Postnasal drip

Type of Medicine?

  • Antihistamine
  • Histamine blocker
  • Histamine-H1-receptor antagonist

Side Effects

All medications come with certain risks of negative side effects. Azelastine nasal spray is no different. Doctors generally weigh benefits and risks before deciding to prescribe.

Common Side Effects

The most widely reported side effect of taking Azelastine nasal spray is drowsiness or lethargy. This adverse reaction could get worse when used in conjunction with other medicines. Therefore, it is important for patients to disclose all medicines to their healthcare provider, including prescription and over-the-counter medications before taking Azelastine nasal spray.

Less Common Side Effects

While taking Azelastine nasal spray, you may also experience:

  • Burning sensations in the nostrils
  • Headaches or muscle aches
  • Incessant sneezing
  • Lethargy
  • ightheadedness
  • Mucus tinged with blood
  • Nosebleeds
  • Sore throat
  • Weight gain

Rare Side Effects

Some of the rare side effects of taking Azelastine nasal spray include:

  • Bloody urine
  • Blurred vision
  • Chest tightness
  • Fast heartbeat
  • Hives and other skin rashes
  • Labored breathing
  • Mouth sores
  • Redness in the eyes


The following synopsis provides a general idea of the average doses of Azelastine nasal spray. It in no way replaces instructions given to you by your medical provider. Do not use this guide as a reference for personal use. Always consult a healthcare provider before modifying doses of Azelastine nasal spray or any other medication.

Perennial Allergic Rhinitis Doses:

  • Adults: 2 pumps for each nostril | 2 x daily (each spray is 137 or 205.5 micrograms of Azelastine)
  • Children 12 and older: 2 pumps for each nostril | 2 x daily (each spray is 137 or 205.5 micrograms of Azelastine)
  • Children 6-11 years old: 1 pump for each nostril | 2 x daily (each spray is 137 or 205.5 Micrograms of Azelastine)
  • Children 5 and under (Up to 6 Months): 1 pump for each nostril | 2 x daily (each spray is 137 Micrograms of Azelastine)
  • Infants under 6 months old: Varies by patient

Seasonal Allergic Rhinitis Doses:

  • Adults: 1-2 pumps for each nostril | 2 x daily (each spray is 137 or 205.5 Micrograms of Azelastine)
  • Children 12 and older: 1-2 pumps for each nostril | 2 x daily (each spray is 137 or 205.5 Micrograms of Azelastine)
  • Children 6-11 years old: 1 pump for each nostril | 2 x daily (each spray is 137 or 205.5 Micrograms of Azelastine)
  • Children 2-5 years old: 1 pump for each nostril | 2 x daily (each spray is 137 Micrograms of Azelastine)
  • Children Under 2 years old: Varies by patient

The average dosage for Azelastine nasal spray varies from one patient to another. The following conditions portray factors that doctors consider before prescribing Azelastine nasal spray to any patient:

  • Nasal spray strength
  • Number of doses per day
  • Number of times per day prescribed
  • The length of treatment
  • Pre-existing medical conditions

Other Considerations

In addition, healthcare workers generally weigh the severity of rhinitis under the following criteria:

  • Mild intermittent
  • Moderate/severe intermittent
  • Mild persistent rhinitis

In other words, some patients suffer from rhinitis year-round, while other patients' symptoms are triggered by seasonal allergies. In either case, the dosage will be customized based on these classifications as well as some of the above factors.

How to Use the Spray

Follow the steps below for help using the spray. An insert should also be included with your medication showing an illustration of best practices for use:

  1. Prime the Pump' Azelastine nasal spray must be primed at first in order to release the mist. To prime the pump, push the base of the tip downward six consecutive times or until you notice the mist released. This step should be repeated if there was a three-day lapse in usage.
  2. Prep for Administration' For best results, pharmacists recommend blowing the nose in a soft tissue or facial paper. Read the dosage amounts listed on the label before the final administration. To complete the process, lean your head backward. Place the top of the application (the tip) into one nostril while closing the other with a finger. Spray one dose at a time. After discharging the medicine, take a slow and gentle breath, then hold it for a few seconds before repeating slow and gentle breaths once more. Repeat this step for the opposite nostril. Try to avoid blowing your nose directly after use.
  3. Clean After Each Use' After each application of Azelastine nasal spray, use a clean disposable cloth or tissue to wipe off the tip before recapping. A paper towel works best.
  4. . Dispose After Use' Most healthcare professionals recommend discarding Azelastine nasal spray after roughly 200 pumps.

How to Handle a Clogged Pump

When the pump is primed but no mist is released, this could be a sign of blockage. Do not attempt to clear the blockage with a needle or pin as these instruments could compromise the sterility of the medicine or damage the tip. Instead, get a clean bowl of warm water and submerge only the pump area for a few minutes. After some time has lapsed, prime the pump under water by pressing several times. Let it air dry and replace the spray pump onto the rest of the bottle for use.

Missed Doses

If a dose is missed, take it as soon as you remember. However, if it's getting close to the time of the next scheduled dose, skip the missed dose and resume the regular schedule. Doses should never be doubled for Azelastine nasal spray.


Several studies have demonstrated that Azelastine nasal spray triggers adverse effects when used in conjunction with certain medications including Bupropion, Cimetidine, and Donepezil. In certain cases, though, it may be necessary to prescribe a combo of medicines even when it's been proven to trigger a negative reaction. In these events, a primary care physician generally adjusts the dosage of one or both medicines.

CNS Depressants

Using Azelastine nasal spray in conjunction with certain CNS depressants is proven to cause extreme drowsiness or dizziness. As such, do not drive or operate heavy machinery when taking this drug along with CNS depressants.

You should also tell your doctor if you are taking prescription or over-the-counter medicines for a cold, flu, allergy, or hay fever, for example. Other noteworthy interactions with Azelastine nasal spray include:

  • Anesthetics
  • Muscle relaxants
  • Narcotics
  • Prescription painkillers
  • Sedatives
  • Seizure drugs
  • Tranquilizers
  • Sleep medicines

Lifestyle Interactions

Tell your doctor if you drink alcohol or smoke tobacco products. These substances sometimes cause a negative reaction in patients using prescription medicines.


Pay attention to the following precautions when taking Azelastine nasal spray:

  1. Meet All Follow-Up Appointments' When follow-up visits are scheduled with your primary healthcare provider, it is important that you make every effort to keep them' or reschedule as soon as possible. Your doctor will check to see if your symptoms have cleared or if the condition worsens. If you are experiencing worse symptoms or rhinitis isn't alleviated after three days of use, schedule a new appointment with your health provider.
  2. Do Not Operate Heavy Machinery' One of the side effects of taking Azelastine nasal spray is drowsiness. As a result, avoid operating heavy or dangerous machinery or driving, especially when this medicine is used in conjunction with cold, flu, allergy, or sleep medicines.
  3. Follow the Instructions on the Label' Azelastine nasal spray should be used exactly as directed by your primary care physician. As with all other prescription medicines, Azelastine nasal spray carries side effects. As a result, patients should not overuse the nasal spray or take it more times than prescribed. Follow the custom label on the medication. The dosage is generally prescribed after weighing factors like age, condition, and patient's medical history. Azelastine nasal spray is therefore tailored for individual use only and should never be shared with other members of your household.
  4. Do Not Use for Other Nasal Issues' Azelastine nasal spray should not be used for any other nasal conditions, unless prescribed by a doctor. When in doubt about how to take this medicine, check with your doctor or pharmacist before use.
  5. Do Not Swallow' Azelastine nasal spray should never be taken by mouth. If accidental drops of the medicine get into the mouth, rinse with water and contact your medical provider. In the event this medicine is swallowed by minors, contact the Poison Control Center immediately at (800) 222-1222 and seek medical help.
  6. Avoid Eye Contact' Azelastine nasal spray may cause eye irritation or blurred vision. If it gets into the eyes while spraying, rinse with water and contact your healthcare provider.

Pediatric Patients

Though Azelastine is considered safe in pediatric patients, the following exceptions apply:

  • Seasonal Allergic Rhinitis' Children under 2 years old should not be treated with Azelastine nasal spray
  • Perennial Allergic Rhinitis' Infants 6 months old and younger should not be treated with Azelastine nasal spray

Geriatric Patients

In senior patients with certain underlying conditions, the dosage is occasionally modified for the patients' safety. Specifically, individuals with liver, kidney, or heart issues should be closely monitored after taking adjusted doses of Azelastine nasal spray.

Expecting and Nursing Mothers

A medical provider will gauge the benefits and risks before prescribing Azelastine nasal spray to expecting or nursing mothers. Patients should consult their primary physician or pharmacist when in doubt about taking any medication while pregnant or breastfeeding, including prescription and non-prescription medications.

Past Allergic Reactions

Tell your doctor about any recent or past allergic events you've experienced. In particular, disclose any adverse reactions to dyes, food, preservatives, or animal by-products.

Underlying Conditions

Patients who are diagnosed with kidney disease should be closely monitored when taking Azelastine nasal spray. The disease delays the normal waste removal process in the body, and as a result, the prescription could possibly exacerbate kidney disease.


Azelastine nasal spray should be stored upright at all times. Place in a cool and dry location and avoid areas with heat, humidity, or direct sunlight to protect the integrity of the medication. After recapping the applicator, double-check that the screwed-on portion is tightly closed.

Azelastine nasal spray should be properly discarded of after about 200 sprays. To dispose of Azelastine nasal spray, ask your pharmacist for help. Take it to the pharmacy and a pharmacologist will discard any unused portions in a safe manner.

As always, keep all medications, including Azelastine nasal spray, out of the reach of pets and children.


Azelastine nasal spray works by regulating histamine, which is the body's natural response to certain triggers and allergies. As a result, this drug is classified as an antihistamine or histamine blocker.

It is primarily used to treat seasonal and perennial rhinitis in both adults and children' generally over the age of five. Younger patients may also be treated, but only under the directives and supervision of a medical provider. This particular antihistamine blocker is usually well tolerated by geriatric and pediatric populations.

Azelastine nasal spray generally provides quick relief of the symptoms of rhinitis, including, itching, sneezing or a runny nose. It is available by prescription only and dosage is customized by patient's age, diagnosis, medical history, and other factors. Use only as prescribed.

The application sprayer delivers a metered dose of 137 or 205.5 Micrograms. It is intended for intranasal applications only. Avoid contact with the eyes or mouth as it could lead to burning and other adverse effects.

Last Reviewed:
December 23, 2017
Last Updated:
April 03, 2018
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