Are Adult and Children's Astepro Different?
No, adult and children's Astepro (azelastine) formulations use the same concentration and medication, but the dosing differs based on age and weight. The product itself is identical; what changes is how much you spray and how often, depending on the patient's age group.
Formulation Details
- Astepro 0.15% solution contains 205.5 µg of azelastine per spray and is approved for both seasonal and perennial allergic rhinitis in patients 6 years and older 1
- The medication formulation is the same bottle and concentration for all age groups—there is no separate "children's version" with different ingredients or lower concentration 1
- The 0.15% formulation includes sorbitol and sucralose additives to improve taste, which is particularly important given that bitter taste affects 4.5-19.7% of patients 2, 3
Age-Based Dosing Differences
Children 6-11 Years
- 1 spray per nostril twice daily 1, 4, 2
- This lower frequency reflects appropriate dosing for smaller body size and developing physiology
Adolescents and Adults ≥12 Years
- 1-2 sprays per nostril twice daily, OR 2 sprays per nostril once daily 1, 4, 2
- Greater dosing flexibility allows for symptom severity adjustment and patient preference
Important Age Restriction
- Azelastine is NOT approved for children younger than 6 years 1, 4, 2
- This exclusion exists due to lack of safety and efficacy data in younger children, not because a different formulation is needed
Clinical Implications
- The same bottle can be prescribed across age groups—you simply instruct patients on the appropriate number of sprays based on age 1
- Pharmacokinetic studies show that topical intranasal delivery provides targeted local effects with limited systemic absorption, making age-based dosing adjustments primarily about efficacy rather than safety concerns 5, 3
- Common pitfall: Prescribers sometimes assume they need to order a "pediatric formulation," but this does not exist—simply adjust the dosing instructions 1
Side Effect Profile Across Ages
- Somnolence occurs in 0.9-11.5% of patients regardless of age, though proper administration technique (avoiding post-nasal drip into throat) can minimize this 2, 3
- Bitter taste remains the most common complaint across all age groups at 4.5-19.7% 2, 3
- Headache and epistaxis occur at similar rates in children and adults 1, 2
Practical Prescribing Approach
For children 6-11 years: Write "Astepro 0.15%: 1 spray each nostril twice daily" 1, 2
For patients ≥12 years: Write "Astepro 0.15%: 1-2 sprays each nostril twice daily OR 2 sprays each nostril once daily" based on symptom severity and patient preference 1, 2
The key takeaway is that you're using the identical medication bottle with age-appropriate dosing instructions—there is no separate pediatric product to stock or prescribe 1.