Azelastine Nasal Spray Dosage Recommendations
For adults and children 12 years and older, azelastine nasal spray should be administered as 1-2 sprays per nostril twice daily or 2 sprays per nostril once daily, depending on the formulation used. 1
Dosage by Age and Formulation
Azelastine 0.1% (Astelin)
- Ages 6-11 years: 1 spray per nostril twice daily 1
- Ages 12 years and older: 1-2 sprays per nostril twice daily OR 2 sprays per nostril once daily 1
- FDA Indications: Seasonal allergic rhinitis, vasomotor rhinitis 1
Azelastine 0.15% (Astepro)
- Ages 6-11 years: 1 spray per nostril twice daily 1
- Ages 12 years and older: 1-2 sprays per nostril twice daily OR 2 sprays per nostril once daily 1, 2
- FDA Indications: Seasonal allergic rhinitis, perennial allergic rhinitis 1
- Note: This formulation contains sorbitol and sucralose to improve taste 1
Azelastine plus Fluticasone (Dymista)
- Ages 12 years and older only: 1 spray per nostril twice daily 1
- FDA Indications: Seasonal allergic rhinitis 1
Administration Considerations
- Onset of action: Clinically significant effects begin within 15-30 minutes 1, 3
- Duration of action: Effects last up to 12 hours 4
- Pediatric use: Not approved for children younger than 6 years 1, 5
- Geriatric use: Start at lower end of dosing range due to potential for decreased hepatic, renal, or cardiac function 5
Common Side Effects
- Bitter taste: Most common side effect (reported in 4.5-19.7% of patients) 1, 2
- Somnolence: Reported in 0.9-11.5% of patients, generally less than with first-generation antihistamines 1
- Other common side effects: Headache, epistaxis (nosebleeds) 1
Clinical Pearls
- Taste issues: Bitter taste can be minimized with correct dosing technique 6
- Lower dose option: For adults, the pediatric dose (1 spray per nostril twice daily) may be effective with improved tolerability compared to the standard adult dose 7
- Once-daily option: The 0.15% formulation can be effective with once-daily dosing 2
- Nasal congestion: Unlike most oral antihistamines, azelastine nasal spray is effective in alleviating nasal congestion 6
- Therapeutic failure: Intranasal antihistamines show benefit even in patients who fail oral antihistamine treatment 1
Comparison to Other Treatments
- Intranasal antihistamines have shown equal or superior efficacy to oral antihistamines for nasal symptoms 1, 3
- Azelastine has comparable efficacy to fluticasone propionate (intranasal corticosteroid) and superior efficacy to mometasone furoate 3
- Combination therapy with intranasal fluticasone propionate may provide enhanced clinical benefit for difficult-to-treat allergic rhinitis 3