Astepro (Azelastine) Nasal Spray for Allergies: What You Need to Know - GoodRx (2024)

Finding the right allergy medicine can feel like trying to find the right home. After all, the best real estate hinges on your location, family size, and finances. And there’s not always a clear and obvious choice.

The same goes for allergy medications. The best one depends on your symptoms, medical history, and what you’re able to spend. But if your symptoms are local to your sinuses, you may be leaning towards a nasal spray.

For a while, steroid nasal sprays, like Flonase (fluticasone propionate), were the main over-the-counter (OTC) options for nasal relief. And they’re still first-choice treatments for this purpose. But if you need a different option, your pharmacist may recommend a nasal antihistamine. Astepro Allergy (azelastine) is a relatively new nasal spray for allergies, and it’s the first OTC nasal antihistamine to make it to pharmacy shelves.

What is Astepro?

Astepro is a nasal antihistamine that helps relieve congestion, runny nose, and sneezing caused by allergy symptoms. The FDA initially approved it in 2008 as a prescription-only medication, but they decided to approve it for OTC use in 2021. Astepro works by blocking histamine, a natural substance that’s responsible for most allergy symptoms.

Astepro is administered in one of two ways for people ages 12 and older. One option is spraying 2 sprays in each nostril once daily. Another option is spraying 1 to 2 sprays into each nostril twice daily. But you shouldn’t ever administer more than 4 sprays in each nostril in a 24-hour period. Kids ages 6 to 11 years old should receive it less frequently — no more than 1 spray in each nostril twice daily.

Keep in mind: There are two doses of nasal azelastine available: 0.1% (137 mcg) and 0.15% (205.5 mcg). The 0.1% formulation remains available by prescription-only because of its recommended target population. The stronger 0.15% product is the version that’s approved for OTC use.

Is Astepro available over the counter (OTC)?

Yes. Astepro is available OTC. You can find it online, at pharmacies, and at many big box retailers.

But why does Astepro no longer need a prescription? After analyzing new data, the FDA decided that it’s safe to use Astepro OTC — for adults and children at least 6 years old — without the supervision of a healthcare provider. Bayer Healthcare, which manufactures the medication, showed the FDA that Astepro’s benefits outweigh its risks when used as directed, and that people can appropriately use the medication without a provider’s instructions.

This is not the first time a prescription drug has been cleared for OTC purchase. Pataday (olopatadine), for example, is an antihistamine eye drop that was approved for OTC use in 2020. Voltaren Arthritis Pain Relief Gel (diclofenac) and Narcan (naloxone) nasal spray were also both recently approved for OTC use.

What are the potential side effects of Astepro?

Astepro is usually well-tolerated. As the medication is given in the nose, nasal side effects are most common. Possible Astepro side effects include:

• Bloody nose

• Nasal discomfort

• Sneezing

• Bitter taste

• Headache

Drowsiness is another possible side effect, although it’s rare. Taking Astepro with alcohol or sedatives can increase the risk of drowsiness. Because of this, it’s recommended to avoid alcohol and to be especially mindful of driving while using the medication.

How effective is Astepro for allergies?

In studies that analyzed Astepro’s effectiveness, Astepro was compared to placebo (a substance that has no medicine in it). These studies looked at how well the medication helps relieve certain nasal symptoms, including runny nose, nasal congestion and itching, and sneezing.

Astepro was found to be significantly more effective than placebo at relieving nasal symptoms over a 2-week period.

How does Astepro compare to other allergy nasal sprays?

While nasal steroids are go-to options for allergy relief, Astepro is another medication to consider using. In some cases, your healthcare provider may even recommend taking them together for additive effects. Nasal decongestants and saline nasal sprays are also available.

Keep in mind: Before using any OTC nasal spray, read the product’s packaging so you know how and when to use it. It’s also important to speak with a healthcare provider if you have any questions.

Nasal steroids

Nasal steroids help relieve allergy symptoms such as runny nose, nasal congestion, and sneezing. They can be used by children and adults, and they work by blocking certain allergy responses in the nose. Common OTC nasal steroids are Flonase, Nasacort (triamcinolone), and Rhinocort (budesonide).

But what about Astepro versus Flonase? There are a few key similarities and differences between them, including:

• According to experts, nasal steroids are first-choice options for allergy relief. But nasal antihistamines like Astepro can also serve as go-to treatments.

• Nasal antihistamines may be slightly less effective than nasal steroids, but they start working faster. Astepro kicks in within 15 to 30 minutes, while nasal steroids can take up to 2 weeks. Astepro can also work faster than oral antihistamines.

• Side effects can occur with nasal steroids too — not just Astepro. Although specific side effects vary by product, general steroid side effects include nasal dryness, nasal stinging, and a bloody nose. People with glaucoma, cataracts, and other eye issues should use caution while using nasal steroids too.

• Nasal steroids and Astepro can both be used continuously during allergy season to prevent and relieve allergy symptoms.

Nasal decongestants

Nasal decongestants can temporarily relieve symptoms of congestion, but they don’t treat other symptoms — like runny nose or sneezing. They can be used in children and adults, but the minimum age varies by product. Common OTC decongestant nasal sprays include Afrin (oxymetazoline) and Neo-Synephrine (phenylephrine).

Compared to other nasal sprays, nasal decongestants have more risks and side effects to keep in mind. Because they work by tightening blood vessels, they aren’t good options for people living with diabetes, high blood pressure, or heart disease. They can make these conditions worse.

What’s more, decongestant nasal sprays should only be used to treat active congestion symptoms. They shouldn’t be used for more than 3 days at a time. If you use them for more than 3 days, congestion can come back or worsen (rebound congestion).

By comparison, Astepro hasn’t been frequently linked to conditions like high blood pressure or rebound congestion.

Nasal saline

Nasal saline (sodium chloride) products moisturize your nasal passages to help relieve nasal dryness or irritation. Nasal saline can be used by people of all ages. Common OTC saline nasal sprays include Ayr, Ocean, and Simply Saline.

Saline — considered to be a type of salt solution — isn’t technically a medication; it doesn’t have an active ingredient. It’s not commonly used as a first-choice option for allergy symptoms either. But it’s an option for people who can’t use other nasal sprays or have uncontrolled allergy symptoms.

Nasal saline is generally well-tolerated. Side effects are rare, but they could include sneezing or nose irritation.

How to save on Astepro

Astepro’s cost varies by location. And at this time, OTC Astepro is only available as a brand-name product. Generic equivalents are only available with a prescription from your healthcare provider.

By having your healthcare provider write a prescription for azelastine, GoodRx can help you save over 70% off the average retail price. Generic azelastine’s price at certain pharmacies is as low as $14.11 with a free GoodRx discount.