Azelastine Nasal Spray Dosing
For azelastine nasal spray, use 1 spray per nostril twice daily for children 6-11 years, and either 1-2 sprays per nostril twice daily OR 2 sprays per nostril once daily for adults and children ≥12 years, depending on the formulation (0.1% vs 0.15%). 1
Formulation-Specific Dosing
Azelastine 0.1% (Astelin)
- Children 6-11 years: 1 spray per nostril twice daily 2
- Adults and children ≥12 years: 1-2 sprays per nostril twice daily OR 2 sprays per nostril once daily 2
Azelastine 0.15% (Astepro)
- Children 6-11 years: 1 spray per nostril twice daily 1
- Adults and children ≥12 years: 2 sprays per nostril once daily 3
The 0.15% formulation allows for once-daily dosing with equivalent efficacy to twice-daily regimens, which may improve adherence 2. Clinical trials demonstrate that the 0.15% concentration at 2 sprays/nostril once daily provides significant symptom improvement (19% vs 10% with placebo) over 2 weeks 3.
Lower Dose Option for Better Tolerability
The 1 spray per nostril twice daily regimen (0.1% formulation) is equally effective but significantly better tolerated than the 2 spray per nostril twice daily regimen. 4
- Bitter taste occurs in only 8.3% with 1 spray/nostril twice daily compared to 19.7% with 2 sprays/nostril twice daily 4
- Somnolence occurs in only 0.4% with 1 spray/nostril twice daily compared to 11.5% with 2 sprays/nostril twice daily 4
- Both dosing regimens show statistically significant improvements in total nasal symptom scores compared to placebo 4
Clinical Pharmacology
- Onset of action: 15-30 minutes after administration 1, 5
- Duration of action: Up to 12 hours 1
- Mechanism: H1-receptor antagonist with additional mast cell stabilizing and anti-inflammatory properties 6
Age Restrictions
Do not use azelastine nasal spray in children younger than 6 years due to lack of FDA approval for this age group. 1
Common Side Effects
- Bitter taste: Most common side effect, occurring in 4.5-19.7% depending on dosage 1, 3
- Somnolence: 0.4-11.5% depending on dosage, generally less than first-generation antihistamines 1, 4
- Other effects: Headache, epistaxis, nasal discomfort 1, 3
The bitter taste can be minimized by using correct administration technique 6.
Combination Therapy
For patients with inadequate response to monotherapy, azelastine plus fluticasone propionate (Dymista) is dosed at 1 spray per nostril twice daily for adults and children ≥12 years, providing >40% greater symptom reduction than either agent alone 1.