Azelastine Nasal Spray Dosage and Administration

Dosage by Age and Formulation

The American Academy of Otolaryngology-Head and Neck Surgery recommends azelastine nasal spray 1-2 sprays per nostril twice daily or 2 sprays per nostril once daily for adults and children 12 years and older, depending on the formulation used 1, 2
For children 6-11 years, the recommended dose is 1 spray per nostril twice daily for both azelastine 0.1% (Astelin) and azelastine 0.15% (Astepro) formulations 1, 2
Azelastine plus fluticasone (Dymista) is recommended for adults and children 12 years and older at a dose of 1 spray per nostril twice daily 1, 2

The onset of action for azelastine nasal spray is within 15-30 minutes, with clinically significant effects beginning within this timeframe 3
The duration of action for azelastine nasal spray is up to 12 hours, although this may vary depending on individual factors 3
The American Academy of Otolaryngology-Head and Neck Surgery recommends that azelastine nasal spray not be used in children younger than 6 years due to lack of approval for this age group 1

Bitter taste is the most common side effect of azelastine nasal spray, reported in 4.5-19.7% of patients 1, 3
Somnolence is reported in 0.9-11.5% of patients, generally less than with first-generation antihistamines 1, 3
Other common side effects include headache and epistaxis (nosebleeds) 1, 2

Intranasal antihistamines, such as azelastine, have shown benefit even in patients who fail oral antihistamine treatment 1

Intranasal antihistamines have shown equal or superior efficacy to oral antihistamines for nasal symptoms 1