Safety of Concurrent Use of Azelastine Nasal Spray and Pregabalin

Sedative Properties of Azelastine

Intranasal azelastine has been associated with sedative properties compared to placebo, though typically milder than first-generation antihistamines 1, 2
Clinical trials of nasal azelastine reported somnolence in 11.5% of patients 1, 3
The sedative effect of azelastine is less pronounced than with first-generation antihistamines but still present 2
Azelastine is formulated as a 0.1% aqueous solution with recommended dosing of 2 sprays in each nostril twice daily for patients 12 years of age and older 1

Common side effects of azelastine include bitter taste, application site irritation, and somnolence 1

Pregabalin is commonly used for neuropathic pain conditions 4
Pregabalin can cause sedation as one of its side effects 1
No specific drug interactions between azelastine and pregabalin are mentioned in the guidelines 2

Monitor for increased sedation when using these medications together, especially during initial treatment or dose adjustments 1, 2
Patients should be cautioned about the potential for additive sedative effects when using both medications 1
Avoid activities requiring mental alertness until response to the combination is known 1
Be particularly cautious in patients with low body mass, as they may be more susceptible to sedative effects 2
Elderly patients may require additional monitoring due to potentially increased sensitivity to sedative effects 2

If sedation becomes problematic, consider using alternative nasal antihistamines with lower sedation profiles, such as olopatadine (which has reported somnolence in only 0.9% of patients compared to azelastine's 11.5%) 1
The rapid onset of action of nasal azelastine makes it appropriate for PRN use in episodic allergic rhinitis, which may allow for reduced total exposure when used as needed rather than regularly 1, 5