Is azelastine a steroid?

In this article:

• Why the confusion?
• Azelastine vs. Flonase
• Disadvantages of azelastine
• Does it clear your sinuses?
• Interactions
• Cost and savings

In this article

• Why the confusion?
• Azelastine vs. Flonase
• Disadvantages of azelastine
• Does it clear your sinuses?
• Interactions
• Cost and savings

Azelastine (sold under the brand name Astepro) is a second-generation antihistamine nasal spray (also available as eye drops). It’s used to treat allergy symptoms like itching, sneezing, a runny nose, and watery eyes. Available both by prescription and over-the-counter for kids age 6 and older, plus adults, it’s often mistaken for a steroid nasal spray, but it works differently. Learn where the confusion comes from, how azelastine compares to steroid sprays like Flonase, and what you should know about using it for allergies.

Allergy medicine coupons & resources

Why do people think azelastine is a steroid?

We’ve just established that azelastine is not a steroid, so why do people think it is? There are a few reasons. The first is because of who their neighbors are in the allergy treatment aisle. Fraidy N. Maltz, Pharm.D., an associate professor of pharmacy practice at Touro College of Pharmacy in New York City, explains that people might assume azelastine is in the same class as steroid nasal sprays like Flonase (fluticasone), Rhinocort (budesonide), and Nasonex (mometasone) because they are all available over the counter and shelved together in the allergy section. 

Likewise, both antihistamine and steroid nasal sprays were initially available only by prescription before OTC options became available in stores, further stoking confusion, says Kara Wada, MD, an allergist and immunologist and the founder of the Immune Confident Institute in Columbus, OH.

Finally, there’s the fact that azelastine is available in a combination prescription product with fluticasone, sold as Dymista (azelastine-fluticasone). This medication contains azelastine and would be considered a steroid nasal spray, but that’s because of the fluticasone, not the azelastine. 

Azelastine vs. Flonase: Which works better for allergies?

“Both sprays have their place in the treatment of nasal and eye allergy symptoms,” Dr. Wada says. The one that’s better for you may depend on your specific symptoms as well as their severity and how quickly you need relief. “Azelastine may work better than steroid nasal sprays such as Flonase for eye symptoms, sneezing, itching, and runny nose,” Dr. Maltz says. “However, nasal steroids such as Flonase work better for congestion.” Still, a study that compared the two sprays head-to-head found that they had comparable efficacy in controlling symptoms in patients with nasal allergies.

The bigger difference is in the time it takes them to work. “Azelastine works more quickly, kicking in within 15 to 30 minutes of use,” Dr. Wada says. While Flonase may begin working within a few hours, “it can take about two weeks of daily use to reach its full potential,” Dr. Wada adds. 

For these reasons, using both at the same time is not uncommon. “I often recommend combining an intranasal antihistamine with an intranasal corticosteroid,” Dr. Wada says. “Double-blind, placebo-controlled trials have demonstrated that the combination is more effective and has a faster onset of action than either spray separately.” Combining the two treatments is generally recommended when your symptoms are not responding to a single medication on its own. Dr. Maltz notes that you can either get a prescription for Dymista or buy both azelastine and Flonase separately over-the-counter and just use them at the same time. 

Azelastine vs. Flonase: Key differences
Feature	Axelastine (generic Astepro)	Fluticasone (generic Flonase)
Drug class	Antihistamine	Corticosteroid
How it works	Blocks histamine and reduces inflammation	Blocks six substances, including histamine
Onset of action	Within 30 minutes	2 to 12 hours initial relief, 1-2 weeks for full effect
Best for	Eye symptoms, sneezing, itching, and runny nose	Congestion, also reduces sneezing, itching, and runny nose
Contains a steroid?	No	Yes
OTC availability?	Yes	Yes
Average cost before discounts	Price varies by pharmacy per 30 mL bottle of nasal spray	Price varies by pharmacy per 16 gm bottle
Average cost with SingleCare	Price varies by pharmacy per 30 mL bottle of nasal spray	Price varies by pharmacy per 16 gm bottle

What are the disadvantages of azelastine?

Azelastine is quite effective for treating nasal allergy symptoms. The American Academy of Allergy, Asthma, and Immunology considers it a first-line treatment for allergies, meaning it’s among the best allergy nasal sprays. However, there are some notable drawbacks. Here are the ones our experts say you should know.

• Bitter taste. “Azelastine has a very bitter taste, which is hard for some consumers to tolerate,” Dr. Maltz says. “To minimize this, it is recommended to lean forward when administering the nasal spray to avoid dripping in the back of the throat.” Also sniff gently while angling the bottle tip slightly towards the outside of the nostril when spraying the dose. These techniques serve to coat the sinuses with the spray and minimize the amount that passes through and into the throat. In addition, brand name Astepro includes sweeteners to largely mask the bitter taste.
• Drowsiness and fatigue. Drowsiness is reported in just over 10% of people using azelastine, Dr. Wada says. “This is unusual for a nasal spray and distinguishes azelastine from intranasal corticosteroids,” she adds. “Patients should be cautioned about driving or operating machinery and the possible additive effect with other sedating medications or substances.”
• Frequent dosing. While a newer high strength 0.15% spray may be used once daily, some patients will require twice-daily dosing for best results. In contrast, most steroid nasal sprays only need to be dosed once a day, Dr. Wada says. This can be a negative for some, especially if they also experience side effects such as drowsiness or have difficulty tolerating the bitter taste.

Does azelastine clear your sinuses?

“Azelastine does help with nasal congestion, but it is not a decongestant,” Dr. Wada says. Decongestant medications, such as Afrin (oxymetazoline) and Sudafed (pseudoephedrine), work by narrowing and reducing swelling in the blood vessels and tissues in the nose, according to the Cleveland Clinic. “Azelastine works through a fundamentally different mechanism,” Dr. Wada explains. “It blocks histamine-mediated inflammation and swelling, which clinical trials show significantly reduces a symptom complex that includes nasal congestion, rhinorrhea, post-nasal drip, and sneezing.”

Still, if you have severe congestion, Afrin will be more effective. “If someone has a lot of congestion, they may try a product like Afrin for short-term use along with the azelastine,” Dr. Maltz says. The short-term use is key, though. “Afrin carries the significant risk of rebound congestion with use beyond 3–5 days, and guidelines recommend limiting its use to short-term or episodic therapy,” Dr. Wada says. “Azelastine has no such rebound risk and is safe for long-term daily use.”

What should you not take with azelastine?

Dr. Wada says that one of the biggest advantages of azelastine is that it does not interact with many other medications. The most important ones to know about are those that can exacerbate the drowsiness caused by azelastine, which can be dangerous. The table below contains the most relevant ones, though it’s not an exhaustive list. 

Azelastine drug interactions
Drug or substance	Interaction	What to do
Alcohol	May worsen drowsiness	Avoid situations in which extreme drowsiness could put you or others in harm’s way
Central nervous system depressants, such as benzodiazepines, opioids, or sedating antihistamines	May worsen drowsiness	Avoid situations in which extreme drowsiness could put you or others in harm’s way
Cimetidine	Increases azelastine levels in the body, worsening side effects	Talk with your doctor or pharmacist about switching to a different acid-reducer such as famotidine.

How much does azelastine cost, and how can you save?

Azelastine retail prices vary widely from pharmacy to pharmacy. The current average price for a 30 mL bottle at Walgreens is $28, while the same bottle costs $64 at Kroger. But with a SingleCare coupon, OTC azelastine could cost $16.99 at Kroger.

That said, it’s worth checking with your pharmacist and/or your insurance company before buying Astepro over the counter. Many commercial insurance plans cover the generic form of azelastine, so getting a prescription for the generic option may be less expensive than buying Astepro OTC.