azelastine (Rx, OTC)

Brand and Other Names:Astelin Nasal Spray, Astepro, more...Astepro Allergy, Children's Astepro Allergy
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

nasal spray

  • 0.1% (137mcg/spray) (Astelin Nasal Spray [Rx]; Astepro [Rx], generic [Rx])
  • 0.15% (205.5mcg/spray) (Astepro Allergy [OTC]; generic [Rx])

Seasonal Allergic Rhinitis

Astelin 0.1%: 1-2 sprays per nostril q12hr, OR

Astepro 0.15%: 2 sprays per nostril qDay

Perennial Allergic Rhinitis

Astepro 0.15%: 2 sprays per nostril q12hr

Vasomotor Rhinitis

Astelin 0.1%: 2 sprays per nostril q12hr

Dosage Forms & Strengths

nasal spray

  • 0.1% (137mcg/spray) (Astelin Nasal Spray [Rx]; Astepro [Rx], generic [Rx])
  • 0.15% (205.5mcg/spray) (Astepro Allergy [OTC]; Children’s Astepro Allergy [OTC]; generic [Rx])

Seasonal Allergic Rhinitis

Astelin

  • <5 years: Safety and efficacy not established
  • 5 to <12 years: 1 spray per nostril q12hr
  • ≥12 years: 1-2 sprays per nostril q12hr

Astepro

  • <2 years: Safety and efficacy not established
  • 2 to <6 years: 0.1%; 1 spray per nostril q12hr
  • 6-12 years: 0.1% or 0.15%; 1 spray per nostril q12hr
  • ≥12 years
    • 0.1% or 0.15%: 1 or 2 sprays per nostril q12hr, or
    • 0.15%: 2 sprays per nostril qDay

Perennial Allergic Rhinitis

Astepro

  • <6 months: Safety and efficacy not established
  • 6 months to <6 years: 0.1%; 1 spray per nostril q12hr
  • 6 to <12 years: 0.1% or 0.15%; 1 spray per nostril q12hr
  • ≥12 years: 0.15%; 2 sprays per nostril q12hr

Vasomotor Rhinitis

Astelin

  • <12 years: Safety and efficacy not established
  • ≥12 years: 2 sprays per nostril q12hr
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Interactions

Interaction Checker

and azelastine

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      Serious - Use Alternative

        Significant - Monitor Closely

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            Contraindicated (2)

            • calcium/magnesium/potassium/sodium oxybates

              azelastine, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Coadministration with alcohol or sedative hypnotics are contraindicated because of additive CNS depression.

            • sodium oxybate

              azelastine, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Coadministration with alcohol or sedative hypnotics are contraindicated because of additive CNS depression.

            Serious - Use Alternative (4)

            • clonidine

              clonidine, azelastine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Enhanced CNS depressant effects.

            • fedratinib

              azelastine will increase the level or effect of fedratinib by Other (see comment). Avoid or Use Alternate Drug. Avoid coadministration of fedratinib (a CYP3A4 and CYP2C19 substrate) with dual CYP3A4 and CYP2C19 inhibitor. Effect of coadministration of a dual CYP3A4 and CYP2C19 inhibitor with fedratinib has not been studied.

            • lonafarnib

              azelastine will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.

            • stiripentol

              stiripentol, azelastine. Either increases effects of the other by sedation. Avoid or Use Alternate Drug. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

            Monitor Closely (183)

            • albuterol

              azelastine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • alfentanil

              azelastine and alfentanil both increase sedation. Use Caution/Monitor.

            • alprazolam

              azelastine and alprazolam both increase sedation. Use Caution/Monitor.

            • amitriptyline

              azelastine and amitriptyline both increase sedation. Use Caution/Monitor.

            • amobarbital

              azelastine and amobarbital both increase sedation. Use Caution/Monitor.

            • amoxapine

              azelastine and amoxapine both increase sedation. Use Caution/Monitor.

            • apomorphine

              azelastine and apomorphine both increase sedation. Use Caution/Monitor.

            • arformoterol

              azelastine increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • aripiprazole

              azelastine and aripiprazole both increase sedation. Use Caution/Monitor.

            • armodafinil

              azelastine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • avapritinib

              azelastine will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • axitinib

              azelastine increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • baclofen

              azelastine and baclofen both increase sedation. Use Caution/Monitor.

            • belladonna and opium

              azelastine and belladonna and opium both increase sedation. Use Caution/Monitor.

            • benperidol

              azelastine and benperidol both increase sedation. Use Caution/Monitor.

            • benzphetamine

              azelastine increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • brompheniramine

              azelastine and brompheniramine both increase sedation. Use Caution/Monitor.

            • buprenorphine

              azelastine and buprenorphine both increase sedation. Use Caution/Monitor.

            • buprenorphine buccal

              azelastine and buprenorphine buccal both increase sedation. Use Caution/Monitor.

            • butabarbital

              azelastine and butabarbital both increase sedation. Use Caution/Monitor.

            • butalbital

              azelastine and butalbital both increase sedation. Use Caution/Monitor.

            • butorphanol

              azelastine and butorphanol both increase sedation. Use Caution/Monitor.

            • caffeine

              azelastine increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • carbinoxamine

              azelastine and carbinoxamine both increase sedation. Use Caution/Monitor.

            • carisoprodol

              azelastine and carisoprodol both increase sedation. Use Caution/Monitor.

            • chloral hydrate

              azelastine and chloral hydrate both increase sedation. Use Caution/Monitor.

            • chlordiazepoxide

              azelastine and chlordiazepoxide both increase sedation. Use Caution/Monitor.

            • chlorpheniramine

              azelastine and chlorpheniramine both increase sedation. Use Caution/Monitor.

            • chlorpromazine

              azelastine and chlorpromazine both increase sedation. Use Caution/Monitor.

            • chlorzoxazone

              azelastine and chlorzoxazone both increase sedation. Use Caution/Monitor.

            • cimetidine

              cimetidine increases effects of azelastine by decreasing metabolism. Use Caution/Monitor.

            • cinnarizine

              azelastine and cinnarizine both increase sedation. Use Caution/Monitor.

            • clemastine

              azelastine and clemastine both increase sedation. Use Caution/Monitor.

            • clobazam

              azelastine, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

            • clomipramine

              azelastine and clomipramine both increase sedation. Use Caution/Monitor.

            • clonazepam

              azelastine and clonazepam both increase sedation. Use Caution/Monitor.

            • clorazepate

              azelastine and clorazepate both increase sedation. Use Caution/Monitor.

            • clozapine

              azelastine and clozapine both increase sedation. Use Caution/Monitor.

            • codeine

              azelastine and codeine both increase sedation. Use Caution/Monitor.

            • cyclizine

              azelastine and cyclizine both increase sedation. Use Caution/Monitor.

            • cyclobenzaprine

              azelastine and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • cyproheptadine

              azelastine and cyproheptadine both increase sedation. Use Caution/Monitor.

            • dantrolene

              azelastine and dantrolene both increase sedation. Use Caution/Monitor.

            • desipramine

              azelastine and desipramine both increase sedation. Use Caution/Monitor.

            • dexchlorpheniramine

              azelastine and dexchlorpheniramine both increase sedation. Use Caution/Monitor.

            • dexfenfluramine

              azelastine increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dexmedetomidine

              azelastine and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • dexmethylphenidate

              azelastine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dextroamphetamine

              azelastine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dextromoramide

              azelastine and dextromoramide both increase sedation. Use Caution/Monitor.

            • diamorphine

              azelastine and diamorphine both increase sedation. Use Caution/Monitor.

            • diazepam

              azelastine and diazepam both increase sedation. Use Caution/Monitor.

            • diethylpropion

              azelastine increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • difenoxin hcl

              azelastine and difenoxin hcl both increase sedation. Use Caution/Monitor.

            • dimenhydrinate

              azelastine and dimenhydrinate both increase sedation. Use Caution/Monitor.

            • diphenhydramine

              azelastine and diphenhydramine both increase sedation. Use Caution/Monitor.

            • diphenoxylate hcl

              azelastine and diphenoxylate hcl both increase sedation. Use Caution/Monitor.

            • dipipanone

              azelastine and dipipanone both increase sedation. Use Caution/Monitor.

            • dobutamine

              azelastine increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dopamine

              azelastine increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dopexamine

              azelastine increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dosulepin

              azelastine and dosulepin both increase sedation. Use Caution/Monitor.

            • doxepin

              azelastine and doxepin both increase sedation. Use Caution/Monitor.

            • doxylamine

              azelastine and doxylamine both increase sedation. Use Caution/Monitor.

            • droperidol

              azelastine and droperidol both increase sedation. Use Caution/Monitor.

            • ephedrine

              azelastine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • epinephrine

              azelastine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • epinephrine racemic

              azelastine increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • estazolam

              azelastine and estazolam both increase sedation. Use Caution/Monitor.

            • ethanol

              azelastine and ethanol both increase sedation. Use Caution/Monitor.

            • etomidate

              etomidate and azelastine both increase sedation. Use Caution/Monitor.

            • fenfluramine

              azelastine increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • finerenone

              azelastine will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.

            • flibanserin

              azelastine will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.

            • fluphenazine

              azelastine and fluphenazine both increase sedation. Use Caution/Monitor.

            • flurazepam

              azelastine and flurazepam both increase sedation. Use Caution/Monitor.

            • formoterol

              azelastine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • gotu kola

              gotu kola increases effects of azelastine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

            • haloperidol

              azelastine and haloperidol both increase sedation. Use Caution/Monitor.

            • hawthorn

              hawthorn increases effects of azelastine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

            • hops

              hops increases effects of azelastine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

            • hyaluronidase

              azelastine decreases effects of hyaluronidase by Other (see comment). Use Caution/Monitor. Comment: Antihistamines, when given in large systemic doses, may render tissues partially resistant to the action of hyaluronidase. Patients may require larger amounts of hyaluronidase for equivalent dispersing effect.

            • hydromorphone

              azelastine and hydromorphone both increase sedation. Use Caution/Monitor.

            • hydroxyzine

              azelastine and hydroxyzine both increase sedation. Use Caution/Monitor.

            • iloperidone

              azelastine and iloperidone both increase sedation. Use Caution/Monitor.

            • imipramine

              azelastine and imipramine both increase sedation. Use Caution/Monitor.

            • isoproterenol

              azelastine increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ivacaftor

              azelastine increases levels of ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor when coadministered with weak CYP3A4 inhibitors .

            • kava

              kava increases effects of azelastine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

            • ketotifen, ophthalmic

              azelastine and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

            • lemborexant

              azelastine will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.

            • levalbuterol

              azelastine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • levorphanol

              azelastine and levorphanol both increase sedation. Use Caution/Monitor.

            • lisdexamfetamine

              azelastine increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lofepramine

              azelastine and lofepramine both increase sedation. Use Caution/Monitor.

            • lofexidine

              azelastine and lofexidine both increase sedation. Use Caution/Monitor.

            • lomitapide

              azelastine increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.

            • loprazolam

              azelastine and loprazolam both increase sedation. Use Caution/Monitor.

            • lorazepam

              azelastine and lorazepam both increase sedation. Use Caution/Monitor.

            • lormetazepam

              azelastine and lormetazepam both increase sedation. Use Caution/Monitor.

            • loxapine

              azelastine and loxapine both increase sedation. Use Caution/Monitor.

            • loxapine inhaled

              azelastine and loxapine inhaled both increase sedation. Use Caution/Monitor.

            • lurasidone

              lurasidone, azelastine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

            • maprotiline

              azelastine and maprotiline both increase sedation. Use Caution/Monitor.

            • marijuana

              azelastine and marijuana both increase sedation. Use Caution/Monitor.

            • melatonin

              azelastine and melatonin both increase sedation. Use Caution/Monitor.

            • meperidine

              azelastine and meperidine both increase sedation. Use Caution/Monitor.

            • meprobamate

              azelastine and meprobamate both increase sedation. Use Caution/Monitor.

            • metaproterenol

              azelastine increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • metaxalone

              azelastine and metaxalone both increase sedation. Use Caution/Monitor.

            • methadone

              azelastine and methadone both increase sedation. Use Caution/Monitor.

            • methamphetamine

              azelastine increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • methocarbamol

              azelastine and methocarbamol both increase sedation. Use Caution/Monitor.

            • methylenedioxymethamphetamine

              azelastine increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • midazolam

              azelastine and midazolam both increase sedation. Use Caution/Monitor.

            • midazolam intranasal

              azelastine will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.

            • midodrine

              azelastine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • mirtazapine

              azelastine and mirtazapine both increase sedation. Use Caution/Monitor.

            • modafinil

              azelastine increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • morphine

              azelastine and morphine both increase sedation. Use Caution/Monitor.

            • motherwort

              azelastine and motherwort both increase sedation. Use Caution/Monitor.

            • moxonidine

              azelastine and moxonidine both increase sedation. Use Caution/Monitor.

            • nabilone

              azelastine and nabilone both increase sedation. Use Caution/Monitor.

            • nalbuphine

              azelastine and nalbuphine both increase sedation. Use Caution/Monitor.

            • norepinephrine

              azelastine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nortriptyline

              azelastine and nortriptyline both increase sedation. Use Caution/Monitor.

            • olanzapine

              azelastine and olanzapine both increase sedation. Use Caution/Monitor.

            • opium tincture

              azelastine and opium tincture both increase sedation. Use Caution/Monitor.

            • orphenadrine

              azelastine and orphenadrine both increase sedation. Use Caution/Monitor.

            • oxazepam

              azelastine and oxazepam both increase sedation. Use Caution/Monitor.

            • oxycodone

              azelastine and oxycodone both increase sedation. Use Caution/Monitor.

            • oxymetazoline intranasal

              oxymetazoline intranasal, azelastine. Other (see comment). Modify Therapy/Monitor Closely. Comment: Oxymetazoline has been known to slow the rate, but not affect the extent of absorption of concomitantly administered intranasal products. Do not administer other intranasal products with oxymetazoline intranasal.

            • oxymorphone

              azelastine and oxymorphone both increase sedation. Use Caution/Monitor.

            • paliperidone

              azelastine and paliperidone both increase sedation. Use Caution/Monitor.

            • papaveretum

              azelastine and papaveretum both increase sedation. Use Caution/Monitor.

            • papaverine

              azelastine and papaverine both increase sedation. Use Caution/Monitor.

            • passion flower

              passion flower increases effects of azelastine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

            • pentazocine

              azelastine and pentazocine both increase sedation. Use Caution/Monitor.

            • pentobarbital

              azelastine and pentobarbital both increase sedation. Use Caution/Monitor.

            • perphenazine

              azelastine and perphenazine both increase sedation. Use Caution/Monitor.

            • phendimetrazine

              azelastine increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenobarbital

              azelastine and phenobarbital both increase sedation. Use Caution/Monitor.

            • phentermine

              azelastine increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenylephrine

              azelastine increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenylephrine PO

              azelastine increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • pholcodine

              azelastine and pholcodine both increase sedation. Use Caution/Monitor.

            • pimozide

              azelastine and pimozide both increase sedation. Use Caution/Monitor.

            • pirbuterol

              azelastine increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • primidone

              azelastine and primidone both increase sedation. Use Caution/Monitor.

            • prochlorperazine

              azelastine and prochlorperazine both increase sedation. Use Caution/Monitor.

            • promethazine

              azelastine and promethazine both increase sedation. Use Caution/Monitor.

            • propylhexedrine

              azelastine increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • protriptyline

              azelastine and protriptyline both increase sedation. Use Caution/Monitor.

            • quazepam

              azelastine and quazepam both increase sedation. Use Caution/Monitor.

            • quetiapine

              azelastine and quetiapine both increase sedation. Use Caution/Monitor.

            • ramelteon

              azelastine and ramelteon both increase sedation. Use Caution/Monitor.

            • risperidone

              azelastine and risperidone both increase sedation. Use Caution/Monitor.

            • salmeterol

              azelastine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • scullcap

              azelastine and scullcap both increase sedation. Use Caution/Monitor.

            • secobarbital

              azelastine and secobarbital both increase sedation. Use Caution/Monitor.

            • shepherd's purse

              azelastine and shepherd's purse both increase sedation. Use Caution/Monitor.

            • sufentanil

              azelastine and sufentanil both increase sedation. Use Caution/Monitor.

            • tapentadol

              azelastine and tapentadol both increase sedation. Use Caution/Monitor.

            • tazemetostat

              azelastine will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • temazepam

              azelastine and temazepam both increase sedation. Use Caution/Monitor.

            • terbutaline

              azelastine increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • thioridazine

              azelastine and thioridazine both increase sedation. Use Caution/Monitor.

            • thiothixene

              azelastine and thiothixene both increase sedation. Use Caution/Monitor.

            • tinidazole

              azelastine will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • topiramate

              azelastine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

            • tramadol

              azelastine and tramadol both increase sedation. Use Caution/Monitor.

            • trazodone

              azelastine and trazodone both increase sedation. Use Caution/Monitor.

            • triazolam

              azelastine and triazolam both increase sedation. Use Caution/Monitor.

            • triclofos

              azelastine and triclofos both increase sedation. Use Caution/Monitor.

            • trifluoperazine

              azelastine and trifluoperazine both increase sedation. Use Caution/Monitor.

            • trimipramine

              azelastine and trimipramine both increase sedation. Use Caution/Monitor.

            • triprolidine

              azelastine and triprolidine both increase sedation. Use Caution/Monitor.

            • valerian

              valerian increases effects of azelastine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

            • xylometazoline

              azelastine increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • yohimbine

              azelastine increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ziconotide

              azelastine and ziconotide both increase sedation. Use Caution/Monitor.

            • ziprasidone

              azelastine and ziprasidone both increase sedation. Use Caution/Monitor.

            • zotepine

              azelastine and zotepine both increase sedation. Use Caution/Monitor.

            Minor (7)

            • ashwagandha

              ashwagandha increases effects of azelastine by pharmacodynamic synergism. Minor/Significance Unknown. May enhance CNS depression.

            • brimonidine

              brimonidine increases effects of azelastine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • eucalyptus

              azelastine and eucalyptus both increase sedation. Minor/Significance Unknown.

            • nettle

              nettle increases effects of azelastine by pharmacodynamic synergism. Minor/Significance Unknown. (High dose nettle; theoretical interaction) May enhance CNS depression.

            • ruxolitinib

              azelastine will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • sage

              azelastine and sage both increase sedation. Minor/Significance Unknown.

            • Siberian ginseng

              Siberian ginseng increases effects of azelastine by pharmacodynamic synergism. Minor/Significance Unknown. May enhance CNS depression.

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            Adverse Effects

            >10%

            Bitter taste (8-19.7%)

            Headache (8-14.8%)

            Somnolence (1-11.5%)

            Cold symptoms/rhinitis (2-17%)

            Cough (11%)

            1-10%

            Nasal burning (4.1%)

            Sneezing (3.1%)

            Dry mouth (2.8%)

            Nausea (2.8%)

            Conjunctivitis (2-5%)

            Asthma (5%)

            Fatigue (2.3%)

            Rhinitis (2.3%)

            Pharyngitis (4%)

            Dizziness (2%)

            Weight increase (2%)

            Myalgia (<2%)

            <1%

            Amenorrhea

            Breast pain

            Constipation

            Contact dermatitis

            Eczema

            Flushing

            Glossitis

            Hyperkinesia

            Hypertension

            Tachycardia

            Vertigo

            Vomiting

            Postmarketing Reports

            Anaphylactoid reaction

            Application site irritation

            Atrial fibrillation

            Chest pain

            Confusion

            Dyspnea

            Facial edema

            Involuntary muscle contractions

            Nasal sores

            Palpitations

            Paresthesia

            Parosmia

            Pruritus

            Rash

            Disturbance or loss of sense of smell and/or taste

            Tolerance

            Urinary retention

            Vision abnormal

            Xerophthalmia

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            Warnings

            Contraindications

            Documented hypersensitivity

            Cautions

            May cause CNS depression/drowsiness; use caution when performing tasks requiring mental alertness eg, operating heavy machinery

            Avoid administering concurrent CNS depressants that may add to somnolence

            Caution in premature newborns and neonates

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            Pregnancy & Lactation

            Pregnancy

            Limited data from postmarketing experience over decades of use in pregnant women have not identified any drug associated risks of miscarriage, birth defects, or other adverse maternal or fetal outcomes

            Animal data

            • In animal reproduction studies, there was no evidence of fetal harm at oral doses approximately 5 times the clinical daily dose; oral administration to pregnant mice, rats, and rabbits, during the period of organogenesis, produced developmental toxicity that included structural abnormalities, decreased embryo-fetal survival, and decreased fetal body weights at doses 270 times and higher than maximum recommended human daily intranasal dose of 1.096 mg; relevance of these findings in animals to pregnant women considered questionable based upon high animal to human dose multiple

            Lactation

            There are no data on presence in human milk, effects on breastfed infant, or on milk production; breastfed infants should be monitored for signs of milk rejection during use by lactating women; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed infant from drug or from underlying maternal condition

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            H1-receptor antagonist; inhibits release of histamine and other mediators involved in allergic response; may reduce hyperactivity of airways if used intranasally

            Absorption

            Bioavailability: 40%

            Onset: 1-3 hr

            Duration: 12 hr

            Peak serum time: 2-4 hr

            Distribution

            Protein bound: 88%

            Vd: 14.5 L/kg

            Metabolism

            Metabolized by hepatic P450

            Metabolites: Desmethylazelastine

            Elimination

            Half-life: 22 hr

            Clearance: 0.5 L/hr/kg

            Excretion: Feces (75%)

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            Administration

            Intranasal Preparation

            Prime with 4 sprays before initial use to obtain fine mist when sprayed; if idle for 3 days, reprime with 2 sprays

            Intranasal Administration

            For intranasal administration only

            Avoid spraying into eyes

            Keep head tilted downward when spraying into nostril

            Breathe gently and do not tip head back after spraying avoid medicine from running down into throat

            May experience bitter taste in mouth after administration

            Storage

            Store at controlled room temperature 20-25ºC (68-77ºF)

            Protect from freezing

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            azelastine nasal
            -
            137 mcg (0.1 %) aerosol
            azelastine nasal
            -
            205.5 mcg (0.15 %) aerosol
            azelastine nasal
            -
            137 mcg (0.1 %) aerosol
            azelastine nasal
            -
            205.5 mcg (0.15 %) aerosol
            azelastine nasal
            -
            137 mcg (0.1 %) aerosol
            azelastine nasal
            -
            137 mcg (0.1 %) aerosol
            azelastine nasal
            -
            137 mcg (0.1 %) aerosol
            azelastine nasal
            -
            137 mcg (0.1 %) aerosol
            azelastine nasal
            -
            205.5 mcg (0.15 %) aerosol
            azelastine nasal
            -
            137 mcg (0.1 %) aerosol
            azelastine ophthalmic (eye)
            -
            0.05 % drops
            azelastine ophthalmic (eye)
            -
            0.05 % drops
            azelastine ophthalmic (eye)
            -
            0.05 % drops
            azelastine ophthalmic (eye)
            -
            0.05 % drops

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Select a drug:
            Patient Education
            azelastine ophthalmic (eye)

            AZELASTINE DROPS - OPHTHALMIC

            (AY-ze-LAS-teen)

            COMMON BRAND NAME(S): Optivar

            USES: This medication is used to treat itching eyes caused by allergies (allergic conjunctivitis). Azelastine belongs to a class of drugs known as antihistamines. It works by blocking certain natural substances called histamines that are responsible for allergic symptoms.Do not use this medication to treat redness and irritation due to wearing contact lenses.

            HOW TO USE: Use this medication in the affected eye(s) as directed by your doctor, usually twice daily.To apply eye drops, wash hands first. To avoid contamination, do not touch the dropper tip or let it touch your eye or any other surface.If you are wearing contact lenses, remove them before using eye drops. Wait at least 10 minutes before replacing your contact lenses. Tilt your head back, look upward, and pull down the lower eyelid to make a pouch. Hold the dropper directly over your eye and place one drop into the pouch. Look downward, gently close your eyes, and place one finger at the corner of your eye (near the nose). Apply gentle pressure for 1 to 2 minutes before opening your eyes. This will prevent the medication from draining out. Try not to blink or rub your eye. Repeat these steps if your dose is for more than one drop. If directed to use this medication in both eyes, repeat these steps for your other eye. Do not rinse the dropper. Replace the dropper cap after each use.If you are using another kind of eye medication (such as drops or ointments), wait at least 5 minutes before applying other medications. Use eye drops before eye ointments to allow the drops to enter the eye.Use this medication regularly to get the most benefit from it. To help you remember, use it at the same times each day.Do not increase your dose or use this drug more often or for longer than prescribed. Your condition will not improve any faster, and your risk of side effects will increase.Tell your doctor if you do not get better or if you get worse.

            SIDE EFFECTS: This medication may temporarily sting or burn your eyes for a minute or two after use. Temporary blurred vision, headache, or a bitter taste in your mouth may also occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: eye pain.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before using azelastine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history.After you apply this drug, your vision may become temporarily blurred. Do not drive, use machinery, or do any activity that requires clear vision until you are sure you can perform such activities safely.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

            OVERDOSE: This medicine may be harmful if swallowed. If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

            NOTES: Do not share this medication with others.Ask your doctor for ways to reduce your exposure to substances (such as pollen, pet dander, dust mites, mold, smoke) that can worsen allergy symptoms.

            MISSED DOSE: If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.

            STORAGE: Keep the bottle upright and tightly closed. Different brands of this medication have different storage needs. Check the product package for instructions on how to store your brand, or ask your pharmacist. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

            Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.