What is the dosage and treatment protocol for Astepro (azelastine hydrochloride) for allergic rhinitis?

Astepro (Azelastine Hydrochloride) Dosage and Treatment Protocol for Allergic Rhinitis

For adults and children 12 years and older with allergic rhinitis, Astepro (azelastine hydrochloride) should be administered as one or two sprays per nostril twice daily. 1

Dosage Recommendations by Age and Condition

• Adults and children ≥12 years with seasonal allergic rhinitis:

  • One or two sprays per nostril twice daily 1
  • Alternatively, two sprays per nostril once daily may be effective for some patients 2, 3

• Children 5-11 years with seasonal allergic rhinitis:

  • One spray per nostril twice daily 1

• Adults and children ≥12 years with vasomotor rhinitis:

  • Two sprays per nostril twice daily 1

Administration Instructions

• Before initial use:

  • Prime the delivery system with 4 sprays or until a fine mist appears 1
  • When 3 or more days have elapsed since last use, repriming with 2 sprays is necessary 1

• Important caution:

  • Avoid spraying in the eyes 1
  • Patient instructions for proper use accompany each package 1

Efficacy and Onset of Action

• Azelastine provides rapid symptom relief, with onset of action within 15-30 minutes after administration 2, 4
• Effects last for up to 12 hours in patients with seasonal allergic rhinitis 5, 6
• Particularly effective for nasal congestion compared to oral antihistamines 2
• Shows benefit even in patients who fail oral antihistamine treatment 2

Side Effects and Safety Considerations

• Most common side effects include:

  • Bitter taste (most frequent adverse event) 2, 3
  • Epistaxis (nasal bleeding) 2
  • Somnolence (0.4-3% of patients) 2, 3
  • Headache 6

• The 1-spray per nostril twice daily regimen has improved tolerability compared to the 2-spray regimen:

  • Bitter taste: 8.3% with 1-spray vs 19.7% with 2-spray regimen 3
  • Somnolence: 0.4% with 1-spray vs 11.5% with 2-spray regimen 3

Treatment Considerations

• Azelastine can be used as first- or second-line therapy for allergic rhinitis 2
• Especially useful for episodic nasal symptoms or as pretreatment prior to allergen exposure due to rapid onset of action 2
• For moderate-to-severe allergic rhinitis, consider azelastine-fluticasone combination spray as it provides superior symptom control compared to either agent alone 7
• Azelastine nasal spray monotherapy has shown comparable efficacy to combination therapy with oral loratadine plus intranasal beclomethasone in some studies 8

Clinical Pearls

• The lower dose (1 spray per nostril twice daily) may provide sufficient efficacy with fewer side effects for many patients 3
• Once-daily dosing with 2 sprays per nostril may improve adherence while maintaining efficacy 2, 3
• Patients should be advised about the possibility of bitter taste and mild somnolence, particularly at treatment initiation 2
• Unlike many oral antihistamines, intranasal azelastine may help reduce nasal congestion 6