Astepro (Azelastine) Nasal Spray: Dosage and Usage for Rhinitis
For adults and children ≥12 years with seasonal allergic rhinitis, use Astepro (azelastine 0.1%) 1-2 sprays per nostril twice daily; for children 6-11 years, use 1 spray per nostril twice daily. 1
Age-Specific Dosing
Seasonal Allergic Rhinitis
- Adults and children ≥12 years: 1-2 sprays per nostril twice daily 2, 1
- Children 6-11 years: 1 spray per nostril twice daily 2, 1
- Children 5 years: 1 spray per nostril twice daily 1
Vasomotor Rhinitis
- Adults and children ≥12 years: 2 sprays per nostril twice daily 1
Proper Administration Technique
Critical technique points to maximize efficacy and minimize side effects:
- Prime the pump before initial use with 4 sprays until a fine mist appears; reprime with 2 sprays if 3+ days have elapsed since last use 1
- Keep head tilted downward toward toes during administration to avoid medication draining into throat 1
- Place spray tip ¼ to ½ inch into nostril, holding bottle vertically upright 1
- Breathe gently during and after spraying to avoid drawing medication into throat where it will be tasted 1
- Alternate sprays between nostrils 1
- Avoid spraying directly at eyes 1
Onset of Action and Efficacy
- Rapid symptom relief begins within 15-30 minutes after administration, with effects lasting up to 12 hours 2, 3
- Particularly effective for nasal congestion compared to oral antihistamines 2
- Shows benefit even in patients who failed oral antihistamine treatment 2
- Demonstrates superior efficacy to oral antihistamines like cetirizine and comparable efficacy to fluticasone propionate 2, 4
Common Side Effects and Management
Most frequent adverse events:
- Bitter taste (most common; minimized by proper head-down technique) 2, 5
- Epistaxis (nosebleeds) 2
- Somnolence (0.4-3% incidence, similar to placebo) 2
- Headache 2
The bitter taste can be significantly reduced by maintaining proper head-down positioning during administration to prevent medication from draining into the throat. 5
Treatment Duration
- Use continuously throughout the allergy season for seasonal allergic rhinitis, not on an as-needed basis 2
- For perennial allergic rhinitis, continue year-round with regular daily dosing 6
- Continuous treatment is superior to episodic use due to ongoing allergen exposure requiring sustained medication effect 6
- Can also be used on an as-needed basis for episodic symptoms or as pretreatment before allergen exposure due to rapid onset 2
Clinical Positioning
- Effective as first- or second-line therapy for allergic rhinitis 2
- Particularly useful for patients requiring rapid symptom relief or those with episodic symptoms 2
- Can be combined with intranasal corticosteroids (e.g., fluticasone propionate) for enhanced efficacy in difficult-to-treat cases 2, 4
- The combination of azelastine and fluticasone shows >40% relative improvement compared to either agent alone 7
Important Cautions
- Monitor for somnolence at therapy initiation 2
- Discontinuation rate due to adverse events is low (2.3%) 8
- In case of accidental ingestion by a young child, contact poison control immediately 1
- If spray nozzle clogs, do not use pointed objects to clear it; soak pump unit in warm water and squirt several times 1