What is Azelastine Nasal Spray: Uses, Dosage, Side Effects and More

Azelastine nasal spray is an antihistamine medication that you spray directly into your nose to treat allergic symptoms. It works by blocking histamine, a chemical your body releases when it encounters allergens like pollen, dust mites, or pet dander.

This prescription nasal spray provides targeted relief right where you need it most. Unlike oral antihistamines that travel through your entire body, azelastine goes straight to work in your nasal passages to reduce sneezing, runny nose, and congestion.

What is Azelastine Used For?

Azelastine nasal spray treats seasonal allergic rhinitis (hay fever) and year-round allergic rhinitis. These conditions cause your nasal passages to become inflamed and irritated when exposed to allergens.

Your doctor might prescribe azelastine if you experience persistent sneezing, runny or stuffy nose, and itchy nose due to allergies. It's particularly helpful for people who need consistent relief from indoor allergens like dust mites, mold, or pet dander throughout the year.

Some doctors also prescribe azelastine for non-allergic rhinitis, a condition where your nose becomes irritated by triggers like strong smells, weather changes, or certain medications. The spray can help reduce these bothersome symptoms even when allergies aren't the root cause.

How Does Azelastine Work?

Azelastine is a second-generation antihistamine that blocks H1 histamine receptors in your nasal tissues. When you encounter an allergen, your immune system releases histamine, which causes inflammation, swelling, and increased mucus production in your nose.

By blocking these histamine receptors, azelastine prevents the cascade of allergic reactions before they start. This makes it more effective than simply treating symptoms after they've already developed.

The medication is considered moderately strong and typically begins working within 15-30 minutes of application. Because it's applied directly to your nasal passages, you get concentrated relief exactly where inflammation occurs, with minimal absorption into your bloodstream.

How Should I Take Azelastine?

Use azelastine nasal spray exactly as your doctor prescribes, typically one or two sprays in each nostril twice daily. Before your first use, you'll need to prime the pump by spraying it several times until a fine mist appears.

Here's how to use it properly for best results:

1. Blow your nose gently to clear your nasal passages
2. Remove the protective cap and shake the bottle gently
3. Tilt your head slightly forward and insert the spray tip into one nostril
4. Press down firmly while breathing in gently through your nose
5. Repeat for the other nostril, then wipe the spray tip clean

You can use azelastine with or without food, and there's no need to take it with milk or water since it's a nasal spray. Try to use it at the same times each day to maintain consistent levels of the medication in your system.

Avoid tilting your head back too far when spraying, as this can cause the medication to drip down your throat and create a bitter taste. If this happens, drink some water to help clear the taste.

How Long Should I Take Azelastine For?

The duration of azelastine treatment depends on your specific condition and how well you respond to the medication. For seasonal allergies, you might use it throughout allergy season, typically 2-6 months.

People with year-round allergies often use azelastine continuously as long as their symptoms persist. Your doctor will monitor your response and adjust the treatment plan based on how well the medication controls your symptoms.

Some people notice improvement within hours of their first dose, while others may need several days of consistent use to experience full benefits. Don't stop using azelastine suddenly without talking to your doctor, especially if you've been using it for an extended period.

What Are the Side Effects of Azelastine?

Most people tolerate azelastine nasal spray well, but like all medications, it can cause side effects. The most common side effects are generally mild and tend to improve as your body adjusts to the medication.

These common side effects affect about 5-15% of people using azelastine:

• Bitter taste in your mouth (this is the most frequent complaint)
• Drowsiness or fatigue
• Headache
• Nasal burning or stinging
• Sneezing fits right after using the spray
• Nosebleeds (usually minor)
• Dry mouth

The bitter taste often fades within a few minutes, and you can minimize it by avoiding tilting your head back during application. Drinking water after use can also help clear any lingering taste.

Less common but more concerning side effects require medical attention. Contact your doctor if you experience severe nasal irritation, persistent nosebleeds, changes in your sense of smell, or signs of an allergic reaction like rash, swelling, or difficulty breathing.

Rare but serious side effects include severe drowsiness that interferes with daily activities, irregular heartbeat, or mood changes. While these occur in less than 1% of users, they warrant immediate medical evaluation.

Who Should Not Take Azelastine?

Azelastine isn't suitable for everyone, and certain medical conditions or circumstances may make it unsafe for you to use. Your doctor will review your medical history before prescribing this medication.

You should not use azelastine if you're allergic to it or any of its ingredients. People with severe kidney disease may need dosage adjustments, as the medication can accumulate in your system when your kidneys aren't functioning properly.

Children under 5 years old should not use azelastine nasal spray, as safety and effectiveness haven't been established for this age group. Pregnant and breastfeeding women should discuss the risks and benefits with their doctor, though the medication is generally considered safe when used as directed.

If you have a history of heart rhythm problems, glaucoma, or enlarged prostate, tell your doctor before starting azelastine. While these conditions don't automatically prevent you from using the medication, they may require closer monitoring.

People who operate heavy machinery or drive professionally should use caution, as azelastine can cause drowsiness in some individuals. This effect is usually mild but can vary from person to person.

Azelastine Brand Names

Azelastine nasal spray is available under several brand names, with Astelin and Astepro being the most common in the United States. These branded versions contain the same active ingredient but may have slight differences in formulation or spray mechanism.

Generic azelastine is also widely available and works just as effectively as brand-name versions. Your insurance may prefer the generic version, which can significantly reduce your out-of-pocket costs.

Some combination products pair azelastine with other medications like fluticasone (sold as Dymista) to provide both antihistamine and anti-inflammatory effects. Your doctor will determine which formulation best suits your specific needs.

Azelastine Alternatives

If azelastine doesn't work well for you or causes bothersome side effects, several alternatives can provide similar relief. Your doctor can help you find the best option based on your symptoms and medical history.

Other nasal antihistamines include olopatadine (Patanase), which works similarly to azelastine but may cause less bitter taste. Some people find this alternative more tolerable for long-term use.

Nasal corticosteroids like fluticasone (Flonase), mometasone (Nasonex), or budesonide (Rhinocort) offer another approach. These medications reduce inflammation rather than blocking histamine and often provide more comprehensive symptom relief.

Oral antihistamines such as cetirizine (Zyrtec), loratadine (Claritin), or fexofenadine (Allegra) work throughout your body but may be less targeted than nasal sprays. They're often combined with nasal treatments for maximum effectiveness.

Natural saline rinses can complement any allergy treatment by physically washing allergens from your nasal passages. While not a replacement for medication, they can enhance the effectiveness of your prescribed treatment.

Is Azelastine Better Than Flonase?

Azelastine and Flonase (fluticasone) work differently and serve different purposes in allergy treatment. Azelastine is an antihistamine that blocks allergic reactions, while Flonase is a corticosteroid that reduces inflammation.

For quick relief of acute allergy symptoms like sneezing and runny nose, azelastine often works faster, typically within 15-30 minutes. Flonase may take several days to reach full effectiveness but often provides more comprehensive, long-lasting relief.

Many people find that Flonase works better for nasal congestion and overall inflammation, while azelastine excels at stopping the immediate histamine response. Your doctor might recommend using both medications together for optimal symptom control.

The choice between them depends on your specific symptoms, how quickly you need relief, and how your body responds to each medication. Some people do better with one over the other, while others benefit from combination therapy.