The Medical Letter on Drugs and Therapeutics
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1310
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Azelastine (Astepro) Nasal Spray for Allergic Rhinitis

A new formulation of the H1-antihistamine azelastine hydrochloride 0.1% nasal spray (Astepro – Meda) has been approved by the FDA for treatment of seasonal allergic rhinitis (SAR) in patients ≥12 years old and is being heavily advertised to the public on radio, television and the Internet. All azelastine products require a prescription.

DRUGS FOR ALLERGIC RHINITIS — The first-line treatment for mild to moderate allergic rhinitis is usually an oral second-generation H1-antihistamine such as loratadine (Claritin, and others), fexofenadine (Allegra, and others) or cetirizine (Zyrtec, and others). These drugs are generally non-sedating. Mild sedation can occur with cetirizine in recommended doses and with loratadine in higher-than-recommended doses; fexofenadine is not sedating. Cetirizine is a more potent histamine antagonist than the other two, and its ... more      

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