Astelin: Uses, dosage, side effects, warnings & patient reviews

What is Astelin (Azelastine)?

Astelin is the brand name for a prescription nasal spray containing the active ingredient azelastine hydrochloride. It is classified as an antihistamine, a type of medication that blocks the effects of histamine, a substance your body releases during an allergic reaction. For a broader understanding of this medication class, see our guide to antihistamines and allergy season.

Unlike oral allergy medications that work throughout the body, Astelin nasal spray delivers the medication directly to the nasal passages where allergy symptoms often originate. This can provide faster, more targeted relief from nasal symptoms. It is available as a generic under the name azelastine hydrochloride.

Key Characteristics

Astelin is distinctive among nasal allergy sprays for two reasons. First, it can begin to relieve symptoms within 15-30 minutes of use. Second, as an antihistamine, it may cause drowsiness in some individuals, unlike steroid nasal sprays. A common, transient side effect is a bitter taste in the mouth, which can often be minimized with proper administration technique.

How to Use Astelin Nasal Spray

Correct administration is crucial for effectiveness and to minimize the common side effect of a bitter taste.

Priming and Preparation

Before first use or if the spray has not been used for 3 or more days, the pump must be primed. Remove the safety clip and dust cap. Hold the bottle upright and pump the spray unit several times until a fine mist appears. The pump is now ready. To avoid contamination, do not spray the medication toward anyone and never insert the tip into your nose.

Proper Administration Technique

1. Gently blow your nose to clear your nostrils.
2. Shake the bottle gently before each use.
3. Close one nostril by pressing a finger against the side of your nose.
4. Tilt your head slightly forward. Keeping the bottle upright, insert the tip into the other nostril.
5. While breathing in gently through your nose, press down firmly and quickly on the pump to release one spray.
6. Breathe out through your mouth. Avoid tilting your head back, as this can cause the medication to run down your throat and cause a bitter taste.
7. Repeat steps for the other nostril if directed by your doctor.

For more on correctly using medication instructions, see this guide to understanding medication information.

Duration of Use

Use Astelin exactly as prescribed by your doctor, typically twice daily. Do not use it more frequently. It is for controlling allergy symptoms, not for immediate relief of an asthma attack. For more on managing related conditions, see information on asthma medications.

Side Effects of Astelin

Note on Drowsiness

While applied locally, a portion of azelastine can be absorbed into the bloodstream. Therefore, Astelin can cause central nervous system effects like drowsiness in some patients, similar to older oral antihistamines. The risk is higher if combined with alcohol or other sedating substances.

What is Astelin Used For?

Astelin (azelastine) nasal spray is approved by the FDA for the treatment of symptoms associated with allergic rhinitis.

Primary Medical Uses

• Seasonal Allergic Rhinitis (Hay Fever): Treatment of symptoms such as sneezing, itchy or runny nose, and nasal congestion in adults and children 5 years and older.
• Vasomotor Rhinitis: Treatment of nasal symptoms such as congestion, post-nasal drip, and runny nose in adults and children 12 years and older where an allergic cause is not identified.

Mechanism of Action

Azalastine is an H1-receptor antagonist (antihistamine). It works by blocking the action of histamine at receptor sites in the nasal tissues. Histamine is a key chemical released during an allergic reaction that causes itching, swelling, and mucus production. By blocking it locally, Astelin helps relieve these symptoms.

It is important to note that Astelin is a treatment for symptom relief and does not cure the underlying allergy. For nasal congestion, it may be combined with other medications like decongestants, but this should only be done under a doctor’s guidance to avoid interactions. For context on multi-symptom relief, see our guide to cold and flu medicines.

Important Safety Concerns and Considerations

Risk of Sedation

Although administered nasally, systemic absorption of azelastine can occur, leading to central nervous system effects. Patients should be aware of the potential for drowsiness and avoid concurrent use of alcohol or other central nervous system depressants.

Local Nasal Effects

Some patients may experience transient local irritation of the nasal mucous membranes, including burning, stinging, dryness, or epistaxis (nosebleed). These effects are usually mild. If severe irritation, ulceration, or bleeding occurs, discontinue use and consult a healthcare provider.

Worsening of Underlying Conditions

Patients with narrow-angle glaucoma or urinary retention should use azelastine nasal spray with caution, as anticholinergic effects (though less common with topical use) are possible.

Proper Administration to Avoid Taste Disturbance

The most frequently reported adverse event is bitter taste. This is often a result of improper administration technique where the spray drips from the nasal cavity into the throat. Careful adherence to the administration instructions (keeping head tilted slightly forward, not sniffing forcefully) can significantly reduce this effect.

Critical Warnings for Astelin Use

Immediate Hypersensitivity Reactions

Although rare, immediate hypersensitivity reactions may occur after administration of azelastine hydrochloride nasal spray. Signs include rash, pruritus (itching), swelling of the face/tongue/lips, and difficulty breathing. If such a reaction occurs, discontinue use immediately and initiate appropriate therapy.

Effect on Wound Healing

The safety and effectiveness of Astelin in patients with nasal septum ulcers, nasal surgery, or nasal trauma have not been established. Use in these patients is not recommended until healing has occurred.

Risk of Accidental Exposure to Eyes

The spray should be administered intranasally only. Accidental exposure to the eyes may cause transient eye irritation or redness. If this occurs, rinse eyes thoroughly with water.

Storage and Stability

Store Astelin nasal spray at room temperature (between 15°C and 30°C or 59°F and 86°F). Do not freeze. The bottle should be discarded after the number of sprays on the label have been used, even if it is not completely empty, as the amount of azelastine per spray may no longer be consistent.

Astelin Dosage Information

Dosage is based on the condition being treated, patient’s age, and response to therapy. The following are general guidelines; always use as directed by your doctor.

Administration Notes

• Priming: Prime the pump before first use (see General Instructions).
• Consistency: For best results, use regularly at the same times each day.
• Maximum Dose: Do not exceed the prescribed number of sprays per day.
• Onset of Action: Symptom relief may begin within 15-30 minutes.
• Missed Dose: If you miss a dose, use it as soon as you remember. If it is almost time for the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

Drug Interactions with Astelin

While significant pharmacokinetic drug interactions with intranasal azelastine are not commonly reported, additive pharmacodynamic effects are a primary concern.

Important: This is not a complete list. Always provide your doctor and pharmacist with a full list of all prescription, over-the-counter, and herbal products you are using.

Additional Information

Storage and Disposal

Store at room temperature away from light and moisture. Do not store in the bathroom. Keep the bottle tightly closed when not in use. Keep all medications away from children and pets. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Discard the bottle safely after you have used the number of sprays indicated on the label, even if liquid remains.

Cost and Generic Availability

Astelin is the brand-name version of azelastine hydrochloride nasal spray. Generic versions are widely available and are typically less expensive. Both require a prescription.

Reporting Side Effects

You are encouraged to report negative side effects of prescription drugs to the U.S. Food and Drug Administration (FDA) at 1-800-FDA-1088 or online at www.fda.gov/medwatch. Reporting helps the FDA monitor drug safety.

References and Medical Sources

1. U.S. Food and Drug Administration (FDA). Astelin (azelastine hydrochloride) Nasal Spray Prescribing Information. [Updated 2012]. https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/020114s023lbl.pdf
2. MedlinePlus. Azelastine Nasal Spray. U.S. National Library of Medicine; [Updated 2020]. https://medlineplus.gov/druginfo/meds/a608026.html
3. Drugs.com. Azelastine Nasal Professional Monograph. Drugs.com; [Updated 2024]. https://www.drugs.com/mtm/azelastine-nasal.html
4. American Academy of Allergy, Asthma & Immunology (AAAAI). Overview of Allergic Rhinitis. https://www.aaaai.org/tools-for-the-public/allergy,-asthma-immunology-glossary/allergic-rhinitis-defined

Disclaimer: The information on this site is provided for informational purposes only and is not medical advice. It does not replace professional medical consultation, diagnosis, or treatment. Do not self-medicate based on the information presented on this site. Always consult with a doctor or other qualified healthcare professional before making any decisions about your health.