Can Astepro (azelastine) nasal spray be used in an elderly patient with macular degeneration?

Astepro Nasal Spray Can Be Safely Used in Elderly Patients with Macular Degeneration

Yes, Astepro (azelastine) nasal spray can be used safely in elderly patients with macular degeneration, as there are no contraindications listed for this medication and no known interactions between intranasal antihistamines and AMD or its treatments. 1, 2

No Contraindications Exist

• The American Academy of Otolaryngology-Head and Neck Surgery guidelines explicitly state that Astepro (azelastine 0.15% solution) has no contraindications for use in any patient population, including elderly patients. 1
• The FDA drug label for azelastine nasal spray does not list macular degeneration, age-related eye conditions, or any ophthalmologic disorders as contraindications or precautions. 2

Elderly-Specific Considerations

• The FDA label states that clinical studies did not identify differences in responses between elderly and younger patients, though dose selection should be cautious in elderly patients due to greater frequency of decreased hepatic, renal, or cardiac function. 2
• For elderly patients, starting at the standard adult dose (1-2 sprays per nostril twice daily or 2 sprays once daily) is appropriate, with monitoring for side effects. 1, 2

No Interaction with AMD or Its Treatments

• Intranasal azelastine provides targeted delivery to nasal tissues while limiting systemic effects, which is a key advantage that minimizes potential systemic drug interactions. 1
• There is no evidence in the literature or guidelines suggesting any interaction between intranasal antihistamines and anti-VEGF therapy (the primary treatment for wet AMD), AREDS2 supplements (used for dry AMD), or any other AMD-related treatments. 3, 4, 5
• The mechanism of action of azelastine (H1-receptor antagonist in nasal tissues) does not interfere with retinal pathophysiology or AMD treatment pathways. 1

Safety Profile in Elderly Patients

• Common side effects include bitter taste (most frequent), epistaxis, somnolence, and headache—none of which affect vision or AMD progression. 1
• Somnolence rates with intranasal antihistamines are low (0.4-3%) and comparable to placebo, though caution should be taken at initiation to assess for this side effect, particularly in elderly patients at risk for falls. 1
• The reformulated Astepro with sorbitol and sucralose was specifically developed to reduce bitter taste and has been shown safe and well-tolerated in long-term use with no evidence of increased nasal irritation or severe epistaxis. 6

Clinical Pitfalls to Avoid

• Do not confuse systemic antihistamine effects with intranasal administration—the intranasal route provides targeted delivery with minimal systemic absorption, making it safer than oral antihistamines in elderly patients. 1
• Monitor for somnolence at initiation, as elderly patients with AMD may already have mobility limitations and increased fall risk; follow-up assessment is advised. 1, 2
• Ensure proper administration technique to maximize efficacy and minimize side effects, particularly bitter taste which can affect compliance. 1

AMD Management Remains Unchanged

• Continue AREDS2 supplementation if the patient has intermediate or advanced AMD, as this reduces progression risk by up to 36% over 10 years. 3
• Continue anti-VEGF therapy if the patient has wet AMD, as this is the gold standard treatment and should not be delayed or modified due to concurrent use of nasal antihistamines. 3, 4, 5
• Regular ophthalmologic monitoring should continue as scheduled, independent of allergic rhinitis treatment. 3