From the Guidelines
Azelastine nasal spray is generally safe for a 73-year-old female with heart issues and nasal congestion, with a recommended dosage of 1 spray per nostril twice daily to minimize potential side effects. The patient's cardiac concerns warrant a cautious approach, and starting with a lower dose is prudent. Azelastine works locally in the nasal passages with minimal systemic absorption, making it a safer option for patients with heart issues compared to oral decongestants that can raise blood pressure and heart rate 1.
Some key points to consider:
- Azelastine is an antihistamine that blocks histamine receptors locally in the nasal passages, reducing nasal congestion without significantly affecting the heart 1.
- The recommended dosage for adults is 1-2 sprays in each nostril twice daily, but for this elderly patient, starting with 1 spray per nostril twice daily is advisable to minimize side effects 1.
- Common side effects include bitter taste, epistaxis, somnolence, and headache, but the incidence of somnolence is generally lower than with oral antihistamines 1.
- The patient should be advised to use the medication consistently for best results, as it may take several days to reach maximum effectiveness, and to follow up with her healthcare provider if nasal congestion persists after 2 weeks of proper use 1.
Given the patient's age and cardiac concerns, it is essential to monitor her response to azelastine and adjust the treatment plan as needed to minimize potential side effects and ensure the best possible outcome in terms of morbidity, mortality, and quality of life 1.
From the FDA Drug Label
Astelin® Nasal Spray is indicated for the treatment of the symptoms of seasonal allergic rhinitis such as rhinorrhea, sneezing, and nasal pruritus in adults and children 5 years and older, and for the treatment of the symptoms of vasomotor rhinitis, such as rhinorrhea, nasal congestion and postnasal drip in adults and children 12 years and older.
In a placebo-controlled study (95 subjects with allergic rhinitis), there was no evidence of an effect of Astelin® Nasal Spray (2 sprays per nostril twice daily for 56 days) on cardiac repolarization as represented by the corrected QT interval (QTc) of the electrocardiogram
The patient is a 73-year-old female with heart issues and nasal congestion. Azelastine can be used to treat nasal congestion in adults. However, considering her heart issues, it is essential to note that azelastine has been shown to have no significant effect on cardiac repolarization in a placebo-controlled study 2.
- Key points:
- Indication: Azelastine is indicated for the treatment of symptoms of vasomotor rhinitis, including nasal congestion, in adults.
- Cardiac safety: No significant effect on cardiac repolarization was observed in a study.
- Precautions: Although azelastine appears to be safe for patients with heart issues, it is crucial to exercise caution and monitor the patient's condition closely. It is recommended to use azelastine with caution in this patient, considering her age and heart issues, and to monitor her condition closely 2.
From the Research
Azelastine for Nasal Congestion
- Azelastine nasal spray is a fast-acting, efficacious, and well-tolerated H1-receptor antagonist for the treatment of rhinitis, including nasal congestion 3, 4, 5.
- It has mast-cell stabilizing and anti-inflammatory properties, reducing the concentration of leukotrienes, kinins, and platelet activating factor in vitro and in vivo, as well as inflammatory cell migration in rhinitis patients 3, 4, 5.
- Azelastine nasal spray has a rapid onset of action and improves nasal symptoms associated with rhinitis, including congestion and postnasal drip 3, 4, 5.
Efficacy in Combination with Other Treatments
- Azelastine nasal spray in combination with fluticasone propionate nasal spray exhibits greater efficacy than either agent used alone, and this combination may provide benefit for patients with difficult to treat seasonal allergic rhinitis 3, 4, 6.
- The combination of azelastine and fluticasone propionate resulted in a 37.9% improvement in total nasal symptom score, compared to 27.1% with fluticasone nasal spray and 24.8% with azelastine nasal spray alone 6.
Safety and Tolerability
- Azelastine nasal spray is well tolerated in both adults and children with allergic rhinitis, with bitter taste being the most common side effect reported by patients 3, 4, 5.
- The incidence of somnolence may be reduced with the recommended administration technique 4.
Considerations for Patients with Heart Issues
- There is no specific information in the provided studies regarding the use of azelastine in patients with heart issues.
- However, it is essential to consult with a healthcare professional to discuss the potential risks and benefits of using azelastine in patients with heart issues.
Nasal Congestion Treatment
- Nasal congestion can be caused by various factors, including allergic rhinitis, vasomotor rhinitis, chronic sinusitis, and upper respiratory viral infections 7.
- Treatment options for nasal congestion include decongestant pharmacotherapy, antiallergy measures, and nasal dilation devices, as well as surgical procedures 7.