Safety of Concurrent Use of Azelastine Nasal Spray and Pregabalin
Yes, it is generally safe to use azelastine nasal spray and oral pregabalin concurrently, but patients should be monitored for potential additive sedative effects.
Sedative Properties of Azelastine
- Intranasal azelastine has been associated with sedative properties compared to placebo, though typically milder than first-generation antihistamines 1
- Clinical trials of nasal azelastine reported somnolence in 11.5% of patients 1
- The sedative effect of azelastine is less pronounced than with first-generation antihistamines but still present 1
- Azelastine is formulated as a 0.1% aqueous solution with recommended dosing of 2 sprays in each nostril twice daily for patients 12 years of age and older 1
Pharmacological Considerations
- Azelastine is a second-generation histamine H1 receptor antagonist that is effective for allergic rhinitis 2
- After nasal administration, azelastine is systemically absorbed with a bioavailability of about 40% 3
- Common side effects of azelastine include bitter taste (reported in 19.7% of patients), application site irritation, and somnolence 1, 3
- Some studies suggest that the sedation experienced by patients with allergic rhinitis may be partly due to the condition itself rather than solely from antihistamine treatment 4
Pregabalin Considerations
- Pregabalin is commonly used for neuropathic pain conditions 1
- Pregabalin can cause sedation as one of its side effects
- No specific drug interactions between azelastine and pregabalin are mentioned in the guidelines
Recommendations for Concurrent Use
- Monitor for increased sedation when using these medications together, especially during initial treatment or dose adjustments 1
- Patients should be cautioned about the potential for additive sedative effects when using both medications 1
- Consider the following precautions:
- Avoid activities requiring mental alertness until response to the combination is known 1
- Be particularly cautious in patients with low body mass, as they may be more susceptible to sedative effects 1
- Elderly patients may require additional monitoring due to potentially increased sensitivity to sedative effects
Clinical Considerations
- If sedation becomes problematic, consider:
- Using azelastine at the lowest effective dose
- Administering azelastine earlier in the day and pregabalin in the evening
- Exploring alternative nasal antihistamines with lower sedation profiles, such as olopatadine (which has reported somnolence in only 0.9% of patients compared to azelastine's 11.5%) 1
- The rapid onset of action of nasal azelastine (15 minutes) makes it appropriate for PRN use in episodic allergic rhinitis, which may allow for reduced total exposure when used as needed rather than regularly 1
Conclusion
While no direct studies specifically examining the interaction between azelastine nasal spray and pregabalin were identified in the evidence, the known sedative properties of both medications suggest caution but not contraindication for concurrent use. Patients should be informed about the potential for increased sedation but can generally use both medications together with appropriate monitoring.