{"id":637257,"date":"2026-09-28T09:00:11","date_gmt":"2026-09-28T13:00:11","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=637257"},"modified":"2026-09-28T13:22:58","modified_gmt":"2026-09-28T17:22:58","slug":"is-azelastine-over-the-counter","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/is-azelastine-over-the-counter\/","title":{"rendered":"Is azelastine over the counter?"},"content":{"rendered":"

When it comes to most medications, it\u2019s easy to tell and to remember whether you can buy them over the counter (OTC) or if they require a prescription. Ibuprofen? Definitely OTC. Antibiotics? Prescription all the way. But for some drugs, the line can get a little fuzzy. One of these is azelastine<\/a> antihistamine nasal spray, which can refer to both an OTC brand-name product and a prescription-only generic.<\/p>\n

So, what\u2019s the difference? Keep reading to learn exactly what azelastine-based medications you can find on drugstore shelves and which ones require a prescription, plus how to determine the right treatment for your allergy symptoms.<\/p>\n\n

Is azelastine over the counter?<\/h2>\n

Yes, you can get azelastine nasal spray over the counter, but it is sold under a different name. \u201cThe OTC version is called Astepro Allergy<\/a>,\u201d says Oluwatosin Ajao, MD<\/a>, an internal medicine physician and founder of Hydration Bar MD. \u201cIt contains 0.15% azelastine.\u201d In 2021, the U.S. Food and Drug Administration (FDA) approved\u00a0 over-the-counter Astepro<\/a>, making it the first nasal antihistamine available without a prescription. Astepro is approved for use in children and adults ages 6 and older. Next to Astepro Allergy on the shelf is Children\u2019s Astepro Allergy, which is actually the exact same FDA-approved formulation as regular Astepro, just with different directions on how to use it (and a different label).<\/p>\n

Now, the key distinction is that unlike many other OTC medications, you won\u2019t find a generic version on the shelf next to Astepro. Generic azelastine<\/a> is still only available with a prescription. Why? \u201c[Prescription] azelastine exists in different formulations and strengths,\u201d explains Sue Ojageer, Pharm.D.<\/a>, a pharmacist and founder of PharmaSue, a concierge health practice. \u201cFor example, azelastine 0.1% nasal spray has prescription products, and combination nasal sprays containing azelastine plus fluticasone may also be prescription products. Azelastine is also available in an ophthalmic formulation for the eyes.\u201d Only the precise formulation used in Astepro Allergy has been approved by the FDA for sale over the counter.<\/p>\n

What’s the difference between OTC Astepro and prescription azelastine?<\/h2>\n

On the inside? Very little. \u201cThe active ingredient and strength are the same in OTC Astepro Allergy and [one formulation of] prescription azelastine. Both contain azelastine 0.15%,\u201d Dr. Ajao says. \u201cThe main differences are how authorities approve and label them, not how the medicine works.\u201d<\/p>\n

However, additional strengths and formulations of azelastine are prescription only, including 0.1% and all azelastine eye drops.<\/p>\n

Ultimately though, the main difference is a regulatory issue. \u201cThe fact that a medication moves from prescription to OTC status does not mean the active ingredient suddenly became different,\u201d Dr. Ojageer explains. \u201cIt means the FDA determined that the specific product can be used safely and effectively by consumers according to the OTC labeling without the supervision required for a prescription.\u201d<\/p>\n

What does azelastine treat?<\/h2>\n

\u201cAzelastine is an antihistamine,\u201d Dr. Ojageer says. It\u2019s not a steroid<\/a>, despite being shelved next to steroid nasal sprays like Flonase<\/a> (fluticasone) and Nasonex<\/a> (mometasone). Azelastine works by blocking the action of histamine<\/a>, the substance that causes allergy symptoms, to quickly get rid of nasal congestion, runny nose, sneezing, and nasal itching. \u201cOne of the biggest benefits is that it starts working quickly, usually within about 15 minutes,\u201d Dr. Ajao adds.<\/p>\n

OTC Astepro Allergy is approved to treat allergy symptoms caused by allergic rhinitis, while some prescription azelastine sprays are approved to treat a runny or stuffy nose that is not caused by allergies (vasomotor rhinitis). Prescription azelastine eye drops treat allergic conjunctivitis, or itchy eyes caused by allergies.<\/p>\n

How do you use azelastine nasal spray?<\/h2>\n

Children between 6 and 11 years old should use 1 spray of Astepro Allergy in each nostril every 12 hours and no more than 2 sprays per nostril every 24 hours. Adults and children older than 12 may use 2 sprays in each nostril once daily or 1 to 2 sprays in each nostril every 24 hours, not exceeding 4 sprays per nostril every 24 hours. If you are using prescription azelastine nasal spray, make sure to follow the specific instructions from your prescribing provider, as the formulation or strength may be different.<\/p>\n

\u201cTechnique can make a big difference with nasal sprays,\u201d Dr. Ojageer says. \u201cFirst, blow your nose gently to clear the nasal passages. Keep your head tilted slightly downward rather than leaning it backward, insert the spray tip into the nostril and sniff gently while spraying.\u201d Even though it may seem counterintuitive, Dr. Ojageer warns against tilting your head back immediately after using the spray. \u201c[Keeping your head forward] can help prevent the medication from running down the throat and may reduce the bitter taste that some people experience with azelastine,\u201d she explains.<\/p>\n

It\u2019s also important to prime the bottle, which just means that you\u2019re getting it ready to spray when you put it in your nose. \u201cBefore you use it for the first time, spray it into the air four times until you see a fine mist. If you have not used it for three days or more, spray it into the air two times before using it again,\u201d Dr. Ajao suggests. This way, you can be sure that you\u2019re getting a full dose of the medication when you use it.<\/p>\n

What are the side effects of azelastine?<\/h2>\n

Azelastine may cause side effects. While none are serious, you should call your healthcare provider if any of the following become severe or don\u2019t go away:<\/p>\n