From the Guidelines
Azelastine is an effective treatment option for posterior rhinorrhea, particularly for allergic causes, as it reduces nasal congestion and rhinorrhea, with a rapid onset of action, making it suitable for episodic use 1.
Key Points to Consider
- Azelastine is an intranasal antihistamine that works by blocking histamine receptors, reducing inflammation, and decreasing mucus production in the nasal passages 1.
- The typical dosage for azelastine is 1-2 sprays in each nostril twice daily, with improvement often noticed within hours but optimal benefit achieved with consistent use for 1-2 weeks 1.
- Azelastine is particularly effective for rhinorrhea caused by allergies but may be less effective for non-allergic causes such as acid reflux or structural issues 1.
- Common side effects of azelastine include bitter taste, somnolence, and nasal irritation, but it is generally well-tolerated 1.
- For persistent posterior rhinorrhea, combination therapy with intranasal corticosteroids may be considered for enhanced efficacy, as intranasal corticosteroids are the most effective monotherapy for seasonal and perennial allergic rhinitis 1.
Clinical Considerations
- The choice of azelastine should be based on the underlying cause of posterior rhinorrhea, with consideration of its efficacy in allergic rhinitis 1.
- Patients should be advised on the proper use of azelastine, including clearing nasal passages before use and aiming the spray toward the back and outer side of the nose 1.
- Monitoring for side effects and adjusting treatment as necessary is crucial for optimal outcomes 1.
From the FDA Drug Label
Astelin® Nasal Spray significantly improved a symptom complex comprised of rhinorrhea, post nasal drip, nasal congestion, and sneezing. The FDA drug label indicates that azelastine works for posterior rhinorrhea (also known as postnasal drip) in patients with vasomotor rhinitis, as it significantly improved this symptom complex in clinical trials 2.
- Key symptoms improved by azelastine include:
- Rhinorrhea
- Post nasal drip
- Nasal congestion
- Sneezing The label also mentions that azelastine is indicated for the treatment of symptoms of vasomotor rhinitis, including rhinorrhea, nasal congestion, and postnasal drip in adults and children 12 years and older 2.
From the Research
Azelastine Efficacy for Posterior Rhinorrhea
- Azelastine nasal spray has been shown to be effective in improving nasal symptoms associated with rhinitis, including post-nasal drip 3, 4, 5.
- The spray has a rapid onset of action, with benefits evident as early as 15 minutes to 2 hours after administration, and a prolonged duration of activity of 12 to 24 hours 5, 6.
- Azelastine has been found to be effective in alleviating nasal congestion, a symptom that is often difficult to treat with oral antihistamines 3, 5.
- Studies have demonstrated that azelastine is as effective as, or even superior to, other antihistamine agents and intranasal corticosteroids in reducing the symptoms of allergic rhinitis, including posterior rhinorrhea 3, 4, 6.
Mechanism of Action
- Azelastine works as a histamine H1-receptor antagonist, and also has mast-cell stabilizing and anti-inflammatory properties, reducing the concentration of leukotrienes, kinins, and platelet activating factor in vitro and in vivo 3, 5.
- The spray inhibits the production or release of many chemical mediators of the allergic response, providing relief from symptoms of allergic rhinitis 5.
Safety and Tolerability
- Azelastine nasal spray has been found to be well-tolerated, with a favorable safety profile and minimal side effects, including bitter taste, application site irritation, and rhinitis 3, 4, 6.
- The spray has been shown to be effective and safe for use in both adults and children, with a low incidence of sedation and no significant alterations in cardiovascular parameters 4, 5.