Loading...
Loading...
Medical Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice.
Brand Name
Azelastine Hcl
Generic Name
Azelastine
Active Ingredient
AzelastineCategory
Other
Salt Form
Hydrochloride
Variants
1
Different strengths and dosage forms
| Strength | Form | Route | NDC |
|---|---|---|---|
| 205.5 ug/1 | SPRAY, METERED | NASAL | 69238-2147 |
Detailed information about Azelastine Hcl
References used for this content
This page is for informational purposes only and does not replace medical advice. Before using any prescription or over-the-counter medication for Azelastine Hcl, you must consult a qualified healthcare professional.
Azelastine is a potent, second-generation H1-receptor antagonist and mast cell stabilizer used primarily as a nasal spray or ophthalmic solution to treat allergic rhinitis and conjunctivitis.
For the treatment of Seasonal Allergic Rhinitis, the standard adult dosage for the 0.1% nasal spray is typically 1 or 2 sprays in each nostril twice daily. If using the 0.15% nasal spray, the dosage may be 1 or 2 sprays in each nostril once daily, or 2 sprays in each nostril twice daily, depending on the severity of symptoms and the specific brand formulation.
For Vasomotor Rhinitis, the recommended dose for adults is 2 sprays in each nostril twice daily using the 0.1% formulation. For Allergic Conjunctivitis, the ophthalmic dose is usually 1 drop in each affected eye twice daily.
Azelastine is approved for use in children, but the age threshold varies by product:
Pediatric dosing must be strictly supervised by a caregiver to ensure proper administration and to avoid accidental ingestion.
Specific dosage adjustments for patients with renal impairment are not provided in the manufacturer's labeling, as systemic absorption is relatively low. However, because the drug is partially excreted renally, healthcare providers should exercise caution in patients with severe kidney disease.
As Azelastine is extensively metabolized by the liver, patients with significant hepatic dysfunction should be monitored closely. While no formal dose reduction is mandated, the potential for increased systemic levels exists.
Clinical trials did not identify significant differences in safety or efficacy between elderly patients and younger adults. However, because older adults are more prone to somnolence and may have age-related declines in liver or kidney function, the lowest effective dose is usually recommended.
Proper technique is critical for the efficacy of Azelastine nasal spray and to minimize side effects like a bitter taste.
If you miss a dose of Azelastine, take it as soon as you remember. If it is almost time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not double the dose to catch up, as this increases the risk of somnolence and other side effects.
Systemic overdose from nasal or ocular administration is rare. However, if the contents of a bottle are accidentally swallowed, especially by a child, it can lead to serious CNS depression. Signs of overdose may include extreme drowsiness, confusion, or dizziness. In the event of a suspected overdose, contact a Poison Control Center or seek emergency medical attention immediately.
> Important: Follow your healthcare provider's dosing instructions exactly. Do not adjust your dose or stop the medication without consulting your doctor, as this may lead to a recurrence of symptoms.
The most frequently reported side effect of Azelastine nasal spray is dysgeusia (a bitter taste in the mouth). This occurs in approximately 10% to 20% of patients and is caused by the medication draining from the nasal cavity into the pharynx. Patients describe it as a sharp, metallic, or chemical taste that can linger for several minutes. Using the correct 'head forward' administration technique significantly reduces this occurrence.
Another common effect is somnolence (drowsiness). Although Azelastine is a second-generation antihistamine, its systemic absorption is high enough to cause sedation in some individuals, particularly at higher doses (e.g., 2 sprays per nostril twice daily).
While Azelastine is generally safe, certain reactions require urgent medical intervention:
> Warning: Stop taking Azelastine and call your doctor immediately if you experience any signs of an allergic reaction or severe respiratory distress.
Chronic use of Azelastine is generally well-tolerated. However, prolonged exposure to the preservative benzalkonium chloride (found in some formulations) may lead to localized irritation of the nasal cilia or 'rhinitis medicamentosa-like' symptoms, though this is far less common than with decongestant sprays (like oxymetazoline). Regular nasal exams are recommended for patients using the spray daily for several months to check for mucosal integrity.
No FDA black box warnings are currently issued for Azelastine. It is considered a low-risk medication when used as directed. However, the potential for CNS depression (sedation) is its most significant safety consideration, particularly when combined with other substances.
Report any unusual symptoms or side effects that interfere with your daily activities to your healthcare provider. They may suggest a lower dose or a different formulation to improve tolerability.
Azelastine is intended for topical use only (intranasal or ophthalmic). It should never be ingested or injected. Patients must be aware that while it is a 'topical' medication, it is absorbed into the bloodstream and can affect the central nervous system.
There are no FDA black box warnings for Azelastine. It has a high safety profile established over decades of clinical use.
Patients should be cautioned against engaging in hazardous occupations requiring complete mental alertness and motor coordination, such as operating machinery or driving a motor vehicle, after administration of Azelastine until they know how the medication affects them. The sedative effect is dose-dependent and can be potentiated by other CNS depressants.
Healthcare providers should examine the nasal mucosa periodically in patients using Azelastine long-term. There is a risk of nasal ulceration and, in very rare cases, nasal septal perforation. If ulceration occurs, the medication should be discontinued until healing is complete.
While Azelastine treats allergies, it is possible to be allergic to the active ingredient or the inactive components (such as benzalkonium chloride, edetate disodium, or citric acid). If you develop hives, itching, or shortness of breath, discontinue use immediately.
Routine laboratory monitoring (like blood counts or liver tests) is generally not required for patients using Azelastine. However, clinical monitoring should include:
Because Azelastine can cause somnolence in some patients, you should exercise extreme caution when driving or operating heavy machinery. This is especially true during the first few days of treatment or when the dose is increased. If you feel drowsy, do not drive.
The use of Azelastine with alcohol or other central nervous system depressants should be avoided. Alcohol can significantly increase the sedative effects of Azelastine, leading to impaired judgment and motor skills. Even the small amount of systemic absorption from a nasal spray can interact with alcohol in sensitive individuals.
Azelastine does not require a tapering period. You can stop taking it suddenly without risk of withdrawal symptoms. However, your allergy symptoms will likely return within 24 to 48 hours after the last dose. If you are using it for vasomotor rhinitis, symptoms may recur more quickly.
> Important: Discuss all your medical conditions, especially any history of glaucoma, kidney disease, or liver disease, with your healthcare provider before starting Azelastine.
There are no absolute drug-drug contraindications where Azelastine must never be used; however, it should not be used in patients with a known hypersensitivity to any of its components.
Combining Azelastine with other drugs that cause drowsiness can lead to additive CNS depression. This includes:
Clinical Consequence: Increased risk of severe sedation, respiratory depression, and impaired motor coordination.
Management: Avoid these combinations if possible. If necessary, use the lowest effective dose of both medications and monitor the patient closely for safety.
Cimetidine is an H2-blocker used for acid reflux. It is known to inhibit several CYP450 enzymes.
Using Azelastine nasal spray alongside oral antihistamines (like Cetirizine or Loratadine) can increase the total systemic antihistamine load.
There are no significant interactions between Azelastine and specific foods. Unlike some oral medications, its absorption is not affected by high-fat meals or dairy products. However, the bitter taste associated with the spray may be worsened by certain foods or may temporarily alter the flavor of food eaten shortly after administration.
> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking, including over-the-counter nasal decongestants.
Azelastine is absolutely contraindicated in individuals with a known hypersensitivity to azelastine hydrochloride or any of the inactive ingredients in the formulation (such as benzalkonium chloride or edetate disodium). An allergic reaction to the medication itself can range from localized rash to life-threatening anaphylaxis. Because the nasal spray contains preservatives, patients with known sensitivities to benzalkonium chloride should seek preservative-free alternatives if available.
While Azelastine is a second-generation antihistamine with minimal anticholinergic activity, it should be used with caution in patients with narrow-angle glaucoma. Antihistamines can theoretically increase intraocular pressure, although the risk with topical Azelastine is significantly lower than with oral first-generation antihistamines.
Patients with symptomatic prostatic hypertrophy (enlarged prostate) or bladder neck obstruction should use Azelastine with caution. In rare cases, the systemic absorption of the drug may exacerbate urinary retention, although this is not a common clinical finding for the nasal spray.
Because the liver is the primary site of Azelastine metabolism, patients with end-stage liver disease may experience higher systemic levels of the drug. A careful risk-benefit analysis is required, and the patient should be monitored for signs of toxicity.
There is no documented cross-sensitivity between Azelastine and other classes of antihistamines (like alkylamines or ethanolamines). However, patients who have had severe reactions to other phthalazinone derivatives should be monitored closely when starting Azelastine.
> Important: Your healthcare provider will evaluate your complete medical history, including any previous drug allergies, before prescribing Azelastine to ensure it is safe for you.
Azelastine was previously classified as Pregnancy Category C under the old FDA system. Animal studies have shown that high oral doses (many times the human nasal dose) can cause fetal harm, including skeletal abnormalities and low birth weight. However, there are no adequate and well-controlled studies in pregnant women.
It is not known whether Azelastine is excreted in human breast milk. Because many drugs are excreted in milk and because of the potential for adverse reactions in nursing infants (such as somnolence or irritability), caution should be exercised. If a nursing mother must use Azelastine, the infant should be monitored for signs of excessive sleepiness.
Azelastine is widely used in children. The 0.1% nasal spray is approved for children 2 years and older for SAR and 6 months and older for PAR. It is important to use the correct pediatric dose, as children may be more susceptible to the sedative effects. Clinical trials have shown that Azelastine does not affect growth velocity in children, which is a common concern with nasal steroids.
In clinical studies, the safety and efficacy of Azelastine in patients over 65 were similar to those in younger patients. However, the elderly may be more sensitive to the CNS effects (confusion, dizziness, sedation), which can increase the fall risk. Healthcare providers should start at the lower end of the dosing range and monitor for polypharmacy interactions.
No specific dose adjustments are provided for patients with renal impairment. However, since a portion of the drug is excreted in the urine, patients with a GFR < 30 mL/min should be monitored for signs of increased systemic exposure.
Azelastine has not been specifically studied in patients with hepatic impairment. Given its extensive hepatic metabolism, those with Child-Pugh Class B or C impairment should be treated with caution, as the half-life of the drug may be significantly prolonged.
> Important: Special populations require individualized medical assessment. Always inform your doctor if you are pregnant, planning to become pregnant, or breastfeeding.
Azelastine is a highly selective H1-receptor antagonist. At the molecular level, it binds to the H1 receptor in a non-competitive or slowly dissociating manner, which accounts for its long duration of action. Beyond H1 blockade, it inhibits the release of inflammatory mediators from mast cells and basophils. Specifically, it reduces the calcium-dependent release of histamine and inhibits the synthesis of leukotrienes by blocking the 5-lipoxygenase pathway. It also downregulates the expression of ICAM-1 (Intercellular Adhesion Molecule-1) on epithelial cells, which prevents the recruitment of inflammatory cells to the nasal lining.
| Parameter | Value |
|---|---|
| Bioavailability | ~40% (Intranasal) |
| Protein Binding | ~88% |
| Half-life | 22-25 hours (Parent); 54 hours (Metabolite) |
| Tmax | 2-3 hours |
| Metabolism | Hepatic (CYP3A4, 2C19, 2D6) |
| Excretion | Fecal (75%), Renal (25%) |
Azelastine is classified as a second-generation antihistamine and a mast cell stabilizer. Within the therapeutic area of respiratory medicine, it is categorized as an intranasal antihistamine. It is often compared to other drugs in this class, such as Olopatadine (Patanase).
Common questions about Azelastine Hcl
Azelastine is a versatile medication primarily used to treat the symptoms of allergic rhinitis, which include sneezing, an itchy or runny nose, and nasal congestion. It is available as a nasal spray for respiratory symptoms and as an ophthalmic solution for eye-related allergies like itching and redness. Additionally, Azelastine is uniquely FDA-approved to treat vasomotor rhinitis, a condition where the nose reacts to non-allergic triggers like cold air, strong smells, or smoke. Because it works as both an antihistamine and a mast cell stabilizer, it provides more comprehensive relief than many standard over-the-counter options. It is often prescribed when patients do not respond well to oral antihistamines or when they need faster relief of nasal symptoms.
The most frequently reported side effect of Azelastine nasal spray is a bitter taste in the mouth, which affects up to 20% of users. This occurs when the medication drains down the back of the throat, but it can be minimized by keeping your head tilted forward during use. Other common side effects include drowsiness or somnolence, as the medication can be absorbed into the bloodstream. Some users may also experience mild nasal burning, stinging, or occasional nosebleeds due to the drying effect of the spray. In the eye drop form, temporary stinging or blurred vision is the most common complaint. Most of these side effects are mild and tend to diminish as your body adjusts to the medication.
It is generally recommended that you avoid or strictly limit alcohol consumption while using Azelastine. Although Azelastine is applied topically in the nose or eyes, a significant amount can still enter your systemic circulation and cross the blood-brain barrier. Alcohol is a central nervous system (CNS) depressant, and Azelastine also has sedative properties. Combining the two can lead to additive effects, resulting in extreme drowsiness, impaired judgment, and reduced motor coordination. This increases the risk of accidents while driving or operating machinery. If you must drink, do so with extreme caution and only after you know how Azelastine affects you individually.
Azelastine is considered a medication to be used with caution during pregnancy, as there are no definitive, large-scale studies in humans to confirm its safety. In animal studies, very high oral doses were linked to fetal developmental issues, though these doses were much higher than what a human would receive from a nasal spray. Most healthcare providers categorize it as a drug to be used only if the potential benefits clearly outweigh the risks. Many doctors prefer to prescribe intranasal corticosteroids like fluticasone during pregnancy because they have a longer track record of safety data. Always consult with your obstetrician or primary care provider before starting or continuing Azelastine while pregnant.
One of the primary advantages of Azelastine is its rapid onset of action compared to other allergy medications. Most patients begin to feel relief from nasal symptoms like sneezing and itching within 15 to 30 minutes of administration. This is much faster than intranasal steroid sprays, which can take several days or even weeks to reach their full effectiveness. For allergic conjunctivitis, the eye drops typically provide relief from itching within minutes. While the initial effect is quick, the medication continues to work for about 12 hours, which is why it is usually dosed twice daily. For the best results in chronic conditions, it should be used consistently as directed by your doctor.
Yes, you can stop taking Azelastine suddenly without experiencing physical withdrawal symptoms or a 'rebound' effect, which is common with decongestant sprays like Afrin. Azelastine is an antihistamine, not a decongestant, so it does not cause the nasal tissues to become dependent on the drug. However, because Azelastine manages the symptoms of allergies rather than curing the underlying condition, your symptoms (like sneezing and congestion) will likely return shortly after you stop. If you are using it for seasonal allergies, it is best to continue use until the allergen season has passed. Always discuss your treatment plan with your doctor before making changes.
If you miss a dose of Azelastine, you should take it as soon as you remember. However, if it is nearly time for your next scheduled dose, it is better to skip the missed dose entirely and return to your regular routine. You should never 'double up' or take two doses at once to make up for a missed one, as this significantly increases the risk of side effects like excessive sleepiness and a bitter taste. Consistent dosing is key to maintaining a stable level of the medication in your nasal or ocular tissues. Setting a daily reminder on your phone can help you stay on track with your twice-daily applications.
Weight gain is not a recognized or common side effect of Azelastine. Clinical trials and post-marketing surveillance have not shown a significant link between the use of intranasal or ophthalmic Azelastine and changes in body weight. This is a common concern with some older, first-generation oral antihistamines or systemic steroids, but Azelastine's localized application and second-generation profile make it unlikely to affect metabolism or appetite. If you experience unexplained weight gain while taking this medication, it is likely due to other factors or medications, and you should consult your healthcare provider for a thorough evaluation.
Azelastine can be taken with many other medications, but there are important exceptions. You should be cautious when combining it with other drugs that cause drowsiness, such as sleep aids, muscle relaxants, or narcotic pain relievers, as the sedative effects can be additive. It is also important to tell your doctor if you are taking cimetidine, as it may increase the levels of Azelastine in your blood. Many patients successfully use Azelastine in combination with nasal steroid sprays for enhanced allergy relief; in fact, there are prescription products that combine both in one bottle. Always provide your doctor with a full list of your current medications to screen for potential interactions.
Yes, Azelastine is widely available as a generic medication in both its nasal spray and ophthalmic solution forms. Generic versions are typically much more affordable than brand-name products like Astelin or Astepro and are required by the FDA to have the same active ingredient, strength, and effectiveness. You can find generic Azelastine at most retail pharmacies with a prescription. In recent years, some lower-strength formulations of Azelastine nasal spray have also become available over-the-counter (OTC) without a prescription, making it more accessible for those with seasonal allergies. Check with your pharmacist to see which version is most cost-effective for your insurance plan.
Other drugs with the same active ingredient (Azelastine)