From the Guidelines
Azelastine is typically dosed as 1-2 sprays in each nostril twice daily for the nasal spray formulation (0.1% or 0.15% concentration). The recommended dosing for Azelastine can be found in the study published in 2015, titled "clinical practice guideline: allergic rhinitis" 1. According to this study, the dosing for Azelastine is as follows:
- Age 6-11 years: 1 spray twice a day
- Age ≥12 years: 1-2 sprays twice a day or 2 sprays daily Some key points to consider when using Azelastine include:
- The medication works quickly, with onset within 3 hours, though maximum benefit may take up to 2 weeks of regular use.
- Azelastine is an H1-receptor antagonist that blocks histamine release, reducing allergy symptoms like sneezing, itching, and rhinorrhea.
- The nasal spray may cause a bitter taste and drowsiness in some patients, so caution should be exercised when driving or operating machinery.
- For best results, patients should clear their nasal passages before administration and avoid tilting their head backward after spraying to prevent the medication from draining down the throat. It's also worth noting that the 2017 joint task force on practice parameters recommends the combination of an intranasal corticosteroid and an intranasal antihistamine for initial treatment of moderate to severe seasonal allergic rhinitis in persons aged 12 years or older 1. However, the study from 2015 provides the most direct and relevant information regarding the dosing of Azelastine.
From the FDA Drug Label
The safety and effectiveness of Astelin Nasal Spray at a dose of 1 spray per nostril twice daily has been established for patients 5 through 11 years of age for the treatment of symptoms of seasonal allergic rhinitis.
The recommended dosing for Azelastine is 1 spray per nostril twice daily for patients 5 through 11 years of age. However, the label does not provide a clear recommendation for adults. 2
From the Research
Recommended Dosing for Azelastine
The recommended dosing for Azelastine nasal spray varies, but studies suggest the following:
- 1-2 sprays per nostril twice daily 3, 4, 5
- 2 sprays per nostril once daily for a 0.15% concentration 6 Some studies also suggest that Azelastine can be used on an as-needed basis without compromising clinical efficacy 3, 4
Efficacy and Safety
Azelastine nasal spray has been shown to be effective and well-tolerated in patients with seasonal allergic rhinitis, with a rapid onset of action and improved nasal symptoms 3, 4, 6, 5, 7
- The most common side effect reported is bitter taste, which can be minimized with correct dosing technique 3, 5
- Azelastine has been compared to other agents, such as oral antihistamines and intranasal corticosteroids, and has shown superior efficacy and a better safety profile 3, 4, 7
Dosage Comparison
Studies have compared the efficacy and safety of different Azelastine concentrations and dosing regimens:
- A 0.15% concentration once daily was shown to be effective and well-tolerated 6
- A 0.10% concentration twice daily was also effective, but with a slightly lower improvement in symptoms compared to the 0.15% concentration 5
- Azelastine nasal spray was compared to oral cetirizine and showed significantly greater improvements in symptoms and quality of life 7