Azelastine

About Azelastine

Azelastine blocks histamine H1 receptors. The prescription 0.1 percent nasal spray (137 mcg per spray) is approved for seasonal allergic rhinitis from age 5 and vasomotor rhinitis (a runny or stuffy nose not caused by allergy) from age 12. From age 12 the dose is one or two sprays in each nostril twice a day for allergies and two sprays twice a day for vasomotor rhinitis; children 5 to 11 use one spray in each nostril twice a day. The 0.05 percent eye drops treat eye itching from allergic conjunctivitis, one drop in each affected eye twice a day; they are not established below age 3.

There is no boxed warning, and the nasal spray label lists no contraindications. The main warning is drowsiness: the label advises caution with driving or operating machinery and avoiding alcohol and other central nervous system depressants. A bitter taste is the most common side effect; others include headache, nasal burning, sore throat, nosebleeds and tiredness. The eye drops must not be used by anyone allergic to an ingredient and often cause brief stinging, headache and a bitter taste.

What is distinctive is the split between prescription and over the counter forms. In June 2021 the FDA approved the 0.15 percent spray (205.5 mcg per spray) for nonprescription use from age 6 and said the 0.1 percent strength would stay prescription only. The Optivar eye drop brand and the prescription Astepro brand are no longer marketed. Limited pregnancy data have not identified a drug related risk; while breastfeeding, the label advises watching for the infant refusing milk because of the bitter taste. Azelastine with fluticasone is a separate combination product.

Taking Azelastine

How to take it

Prime the pump before first use with 4 sprays or until a fine mist appears, and reprime with 2 sprays after 3 or more days without use. Tilt your head slightly forward, close one nostril and spray into the other; keep it out of your eyes and discard the bottle after 200 sprays. With the eye drops, do not wear contact lenses while the eye is red, and wait at least 10 minutes before inserting soft lenses.

If you miss a dose

Use it when you remember unless the next dose is nearly due; then skip it. Never double a dose.

Storage

Store the spray upright at 68 to 77 degrees F (20 to 25 degrees C), protected from freezing, and the eye drops upright as labeled, out of reach of children. Use a take-back program for unused medicine.

Interactions to know about

Alcohol, sedatives and tranquilizers can add to the drowsiness. In a study with azelastine taken by mouth, cimetidine raised azelastine levels. Tell the prescriber about other allergy products, recent nose surgery or injury, and pregnancy or breastfeeding.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Azelastine differs from pharmacy to pharmacy

All prescription azelastine is generic from several makers, so quotes differ with the maker a pharmacy buys from, whether it stocks the product or orders it in, and its own cash pricing. On a single bottle the dispensing fee is a noticeable part of the quote.

The over the counter 0.15 percent spray is a different strength, so a pharmacist cannot swap it for the 0.1 percent spray on a prescription without the prescriber’s approval. Compare quotes for the same strength and number of bottles.

Ways to pay less for Azelastine without insurance

• Ask for the generic name, azelastine 0.1 percent nasal spray, so any maker’s version can be dispensed.
• Once the dose is settled, ask about a ninety-day supply.
• Compare quotes from more than one pharmacy for the same strength and bottle size.
• For allergies in someone 6 or older, ask the prescriber whether the over the counter 0.15 percent spray would suit; its label lists hay fever and other upper respiratory allergies, not vasomotor rhinitis.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Azelastine

1. 1.Is my spray the prescription 0.1 percent strength, and does that matter for my condition?
2. 2.How do I prime my spray, and how long will one bottle last at my dose?
3. 3.Could my other medicines add to the drowsiness?
4. 4.When can I put my contact lenses in after the eye drops?

Related medications