Azelastine Nasal Spray Dosage and Treatment Plan for Allergic Rhinitis

Formulations and Dosing Recommendations

The American Academy of Otolaryngology-Head and Neck Surgery recommends azelastine nasal spray at a dose of 1-2 sprays per nostril twice daily for adults and children 12 years and older, and 1 spray per nostril twice daily for children 6-11 years 1
Azelastine 0.1% (Astelin) is indicated for seasonal allergic rhinitis, vasomotor rhinitis, and is approved for ages 6 years and older 1
The dosing for azelastine 0.1% (Astelin) is 1 spray per nostril twice daily for children 6-11 years, and 1-2 sprays per nostril twice daily or 2 sprays once daily for adults and children ≥12 years 1, 2

Intranasal azelastine has shown equality or superiority to oral antihistamines for nasal symptoms, with an onset of action within 15-30 minutes after administration 1, 2, 3
Azelastine is particularly effective for nasal congestion compared to oral antihistamines, and shows benefit even in patients who fail oral antihistamine treatment 1, 3

Common side effects of azelastine include bitter taste, epistaxis, somnolence, and headache, with somnolence rates ranging from 0.4-3% 1
Caution should be taken at initiation of therapy for signs of somnolence, and follow-up with a clinician is advised to assess response and side effects 1

Intranasal antihistamines like azelastine can be used as first- or second-line therapy for allergic rhinitis, and are especially useful for episodic nasal symptoms or as pretreatment prior to allergen exposure due to rapid onset of action 1
The need for twice-daily dosing and side effects may lead some patients to prefer other medication classes, but once-daily dosing with azelastine 0.15% (2 sprays/nostril once daily) has shown efficacy and may improve adherence 1