Azelastine Hydrochloride	(a-ZEL-as-teen HYE-droe-KLOR-ide)
Trade Name(s):	Astelin   ·Nasal spray 137 mcg/spray   Astepro   ·Nasal spray 137 mcg/spray (0.1%)   ·Nasal spray 205.5 mcg/spray (0.15%)   Optivar   ·Ophthalmic solution 0.5 mg/mL Indicates Canadian Trade Name.
Class:	Antihistamine
Action:	Competitively antagonizes histamine at H 1 receptor sites. Absorption: Bioavailability of nasal spray is approximately 40% and C max is 2 to 3 h. Absorption following ocular administration is relatively low, reaching a level of 0.02 to 0.25 ng/mL after 56 days of treatment.
	Distribution: Vd is 14.5 L/kg. Approximately 88% (azelastine) and 97% (desmethylazelastine) are protein bound.
	Metabolism: Oxidatively metabolized to desmethylazelastine (active) by CYP-450 system.
	Excretion: The half-life is 22 h for azelastine and 54 h for desmethylazelastine. Plasma Cl is 0.5 L/h/kg. Approximately 75% was excreted in the feces, with less than 10% as unchanged azelastine.
	Special Populations: Renal Function Impairment - Based on oral doses, AUC and C max increased 70% to 75% in those with CrCl less than 50 mL/min. Hepatic Function Impairment - Pharmacokinetic parameters were not influenced based on oral doses. Gender - Pharmacokinetic parameters were not influenced based on oral doses. Race - Pharmacokinetic parameters were not influenced based on oral doses.
	Age Age - Pharmacokinetic parameters were not influenced based on oral doses.
Indications:	Treatment of symptoms of seasonal allergic rhinitis, such as rhinorrhea, sneezing, and nasal pruritus (nasal spray); treatment of symptoms of vasomotor rhinitis, such as rhinorrhea, nasal congestion, and postnasal drip ( Astelin only); treatment of symptoms of perennial allergic rhinitis ( Astepro only); treatment of itching of eye associated with allergic conjunctivitis (ophthalmic).
Contraindications:	Standard considerations.
Interactions:
	Alcohol, other CNS depressants Effects may be enhanced by azelastine.
	Cimetidine May increase azelastine plasma levels, increasing the risk of side effects.
Lab Test Interferences:	May interfere with diagnostic test results for skin tests using allergen extracts.
Adverse Reactions:
	cardiovascular: Flushing, hypertension, tachycardia (less than 2%); atrial fibrillation, hypertension, palpitations (postmarketing).
	cns: Headache (15%); somnolence (12%); dizziness, fatigue (2%); abnormal thinking, anxiety, depersonalization, depression, hyperkinesias, hypoesthesia, nervousness, sleep disturbances, vertigo (less than 2%); confusion (postmarketing).
	Ophthalmic Headache (15%); fatigue (1% to 10%).
	dermatologic: Contact dermatitis, eczema, furunculosis, hair and follicle infection (less than 2%); application-site irritation, pruritus, rash (postmarketing).
	Ophthalmic Pruritus (1% to 10%).
	eent: Rhinitis (6%); conjunctivitis (5%); nasal burning, pharyngitis (4%); epistaxis, paroxysmal sneezing, sinusitis (3%); burning throat, eye abnormality, eye pain, laryngitis, watery eyes (less than 2%); abnormal vision, nasal congestion, parosmia, xerophthalmia (postmarketing).
	Ophthalmic Transient eye burning/stinging (30%); conjunctivitis, eye pain, pharyngitis, rhinitis, temporary blurring (1% to 10%).
	gi: Bitter taste (20%); dry mouth, nausea (3%); abdominal pain, aphthous stomatitis, constipation, gastroenteritis, glossitis, loss of taste, ulcerative stomatitis, vomiting (less than 2%); diarrhea (postmarketing).
	Ophthalmic Bitter taste (10%).
	gu: Albuminuria, amenorrhea, breast pain, hematuria, increased urinary frequency (less than 2%); urinary retention (postmarketing).
	hepatic: Increased ALT (less than 2%).
	metabolic: Weight increase (2%); increased appetite (less than 2%).
	respiratory: Rhinitis/cold symptoms (17%); cough (11%); asthma (5%); paroxysmal sneezing (3%); rhinitis (2%); bronchospasm (less than 2%); dyspnea (postmarketing).
	Ophthalmic Asthma, dyspnea (1% to 10%).
	miscellaneous: Dysesthesia (8%); allergic reaction, back pain, herpes simplex, malaise, myalgia, pain in extremities, temporomandibular dislocation, viral infection (less than 2%); anaphylactoid reaction, chest pain, facial edema, involuntary muscle contractions, paresthesia, tolerance (postmarketing).
	Ophthalmic Influenza-like symptoms (1% to 10%).
Precautions:
	Monitoring:
	Nasal spray allergy symptoms Assess for allergy symptoms (eg, nasal congestion, nasal itching, rhinitis, sneezing) before and periodically throughout therapy.
	Ophthalmic symptoms Assess ophthalmic symptoms (eg, itching) before and periodically throughout therapy.
	Pregnancy: Category C .
	Lactation: Undetermined.
	Children: Safety and efficacy not established in seasonal allergic rhinitis in children younger than 5 yr of age ( Astelin ) and in children younger than 12 yr of age ( Astepro ). Safety and efficacy not established in children younger than 3 yr of age (ophthalmic).
	Elderly: Select dose with caution, reflecting greater frequency of decreased hepatic, renal, or cardiac function and comorbidity.
Overdosage:	Signs & symptoms Somnolence.
Patient/Family Education:	Advise patient to read patient information leaflet that accompanies each spray bottle of azelastine. Instruct patient to prime spray unit as directed in patient instruction sheet before first use and after storage for 3 or more days. Ensure that patient understands how to properly administer spray. Advise patient that if allergy symptoms are not controlled, not to increase the dose of medication or frequency of use, but to inform health care provider. Inform patient that larger or more frequent dosing does not increase effectiveness and may cause drowsiness or other unwanted effects. Advise patient that medication may cause drowsiness or dizziness and not to drive or perform other activities requiring mental alertness until tolerance is determined. Caution patient that alcohol and other CNS depressants (eg, sedatives) will have additional sedative effects if taken with azelastine. Caution patient not to take any OTC antihistamines while taking this medication unless advised by health care provider. Advise patient to take sips of water, suck on ice chips or sugarless hard candy, or chew sugarless gum if dry mouth occurs. Advise patient that bitter taste is a frequent side effect and to notify health care provider if this occurs and is bothersome. Instruct patient to stop taking drug and immediately report dizziness or excessive drowsiness to health care provider. Advise patient that usual dose is 1 drop instilled into the affected eyes twice daily. Teach patient proper technique for instilling eye drops: wash hands; do not allow dropper tip to touch eye. Tilt head back and look up, pull lower eyelid down, and instill prescribed number of drops. Close eye for 1 to 2 min and apply gentle pressure to bridge of nose for 3 to 5 min. Do not rub eye. Advise patient that if more than 1 topical ophthalmic drug is being used, to administer the drugs at least 10 min apart. Advise patient who wears contact lenses not to wear lenses if eyes are red. Advise patient who wears contact lenses, and whose eyes are not red, to remove lenses before instilling this medicine and to wait at least 10 min after instilling eye drop before inserting lenses. Inform patient that temporary burning or stinging of the eye, headaches, and bitter taste are the most common side effects and to contact health care provider if they occur and are bothersome. Advise patient to notify health care provider if symptoms are not controlled with medication.