What is Azelastine: Uses, Warnings & Interactions

Updated Sep 2, 2025  •  Published Dec 30, 2020

Azelastine is an antihistamine and the active ingredient in a number of nonsteroidal over-the-counter hay fever nasal sprays. It’s also found in prescription eye drops to relieve itchy eyes. As a nasal spray, azelastine works faster at reducing hay fever symptoms than oral antihistamines and can be used with a steroid nasal spray. The nasal spray can be used once or twice daily.

Azelastine overview

BRAND NAMES:

  • Astepro

Generic Names:

  • Azelastine HCl

Uses:

  • Treats itching of the eye caused by allergies

  • Treats symptoms of allergic rhinitis (hay fever)

Therapeutic Classes:

  • Antihistamine, nasal agent, ocular agent

Forms:

  • Nasal spray, eye drops

How it’s taken:

  • Into the nose, onto the surface of the eye

What is Azelastine used for?

Azelastine temporarily relieves the upper respiratory tract symptoms of hay fever or other allergic reactions, including a runny nose, itchy nose, nasal congestion, and sneezing. Azelastine eye drops are a prescription medication that relieves eye itching due to allergies.

What form(s) does Azelastine come in

  • Nasal spray (OTC)

    • 0.1% (137 mcg/spray)

  • Eye drops (Rx)

    • 0.05%

What are common Azelastine doses?

  • For allergic rhinitis:

    • In adults and children 12 years of age and older: Two sprays in each nostril once daily OR one to two sprays in each nostril every 12 hours

    • In children 6–12 years of age: One spray in each nostril every 12 hours

  • For allergic conjunctivitis: One eye drop instilled in each eye twice daily

Common Azelastine prescriptions

  • Azelastine HCl
    30ml of 0.1% bottle

  • Azelastine HCl
    30ml of 137mcg/spray bottle

  • Azelastine HCl
    6ml of 0.05% bottle

  • Azelastine HCl
    30ml of 0.1% (137mcg/spray) bottle of nasal spray

  • Azelastine HCl
    30ml of 0.1% (205.5mcg/spray) bottle of nasal spray

  • Azelastine HCl
    6ml of 0.05% eye dropper

  • Azelastine HCl
    30ml of 0.15% spray btl

How to take Azelastine

  • Please read any instructions that come with this medicine.

  • How to prime the nasal spray:

    • You will need to prime the nasal spray before you use it for the first time, each time you clean it out, or if you have not used the medicine for three days or longer.

    • To prime the nasal spray, pump the bottle until a spray comes out.

  • How to use the nasal spray:

    • Use only in the nose.

    • An adult should always supervise children using this medicine.

    • Gently blow your nose to clear the nostrils.

    • Tilt your head downwards.

    • Hold the bottle with two fingers at the nozzle and the thumb at the bottom.

    • Close one nostril.

    • Place the tip into the nose and aim it at the back of the nose.

    • While sniffing, press to spray one or two doses.

    • Repeat for the other nose.

    • Do not tilt your head back right away.

    • Wipe the tip with a clean tissue and replace the cap.

    • Store the capped bottle at room temperature. Do not freeze.

  • How to administer eye drops:

    • Follow all the prescriber’s instructions.

    • Take two doses daily.

    • Never touch the tip of the eye drop bottle to your eye, skin, or other surface. Never rinse the eyedropper tip.

    • Remove any contact lenses.

    • Lie down or tilt your head back. 

    • With your index finger, pull down the eye's lower lid to form a pocket.

    • Hold the dropper close to your eye with the other hand. 

    • Place a drop into the pocket made between your lower lid and eyeball. 

    • Gently close your eye. 

    • Repeat the process for the other eye.

    • Replace the cap.

    • If you’re administering other eye drops or need to replace your contact lenses, follow the prescriber's instructions.

    • Store the capped bottle upright at room temperature or in the refrigerator. Do not freeze.

What to do if you miss a dose of Azelastine

  • Take a dose as soon as you remember.

  • If it is almost time for your next dose, wait until then and take a regular dose.

  • Do not take extra medicine to make up for a missed dose.

Azelastine contraindications

  • This medicine is not right for everyone. 

  • Do not use if you have had an allergic reaction to azelastine.

  • Do not use azelastine nasal spray in children younger than 6.

Azelastine warnings

  • Before using azelastine nasal spray, talk to a healthcare provider first if you have:

    • Had recent nose surgery

    • Had recent nose sores

    • An unhealed nose injury

  • Stop using azelastine nasal spray and talk to a healthcare provider if you experience:

    • An allergic reaction

    • Frequent nosebleeds

  • Azelastine nasal spray can make you dizzy or drowsy. Be careful when driving or engaging in other risky activities.

  • The nasal spray can cause a bad taste in the mouth. To avoid this, make sure the head is tilted downwards when administering doses.

  • Before using azelastine eye drops, tell the prescriber if you are pregnant or breastfeeding.

  • Azelastine eye drops can cause serious problems, including:

    • Asthma

    • Difficulty breathing

    • Severe allergic reactions

  • Do not allow anyone else to use the nasal spray or eye drop bottle to avoid spreading or getting an infection.

Azelastine interactions

  • Before using azelastine eye drops, tell the prescriber about all medications being used, particularly:

    • Drugs that make you sleepy, such as narcotic pain medications, other allergy medications, sleeping pills, or alcohol.

  • If you are using other eye drop medications, ask the prescriber if you need to separate doses.

    • Most medicated eye drops need to be administered at least five minutes after other eye medications have been instilled.

  • Avoid alcohol when using either azelastine eye drops or nasal spray.

  • Drinking alcohol or using drugs that make you sleepy may cause increased drowsiness when combined with azelastine.

Azelastine side effects

Serious side effects

Talk to a healthcare provider if you notice any signs or symptoms of a possible serious side effect, including:

  • Frequent or heavy nosebleeds (nasal spray)

  • Eye pain (eye drops)

  • Allergic reaction: Skin rash, itching, asthma, trouble breathing, wheezing, swelling of the face, mouth, or throat, lightheadedness, low blood pressure, weak pulse

Less serious side effects

  • Burning or stinging of your eye when you put the drops in (eye drops)

  • Nasal discomfort or sneezing right after use (nasal spray)

  • Headaches (eye drops)

  • Bitter taste in your mouth (nasal spray and eye drops)

  • Sleepiness or unusual drowsiness (nasal spray)

Sources:

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