Key takeaways:
Astepro Allergy (azelastine) is a nasal spray that treats allergies. It’s the first antihistamine nasal spray to be FDA approved for over-the-counter (OTC) use.
Astepro is different from Flonase Allergy Relief (fluticasone propionate). Flonase is a nasal steroid, which is a go-to treatment for managing nasal allergy symptoms. But Astepro starts working faster.
Astepro nasal spray is available OTC as a brand-name medication. But you can also find it as a lower-cost generic with a prescription from your prescriber. GoodRx can help make your medication more affordable.
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Table of contents
Astepro overview
Dosage
OTC availability
Side effects
Effectiveness
Medication comparison
How to save
Bottom line
References
Finding the right allergy medicine can feel like trying to find the right home. 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, such as Flonase Allergy Relief (fluticasone propionate), were the main over-the-counter (OTC) options for nasal relief. And they’re still first-choice treatments for this purpose. But your pharmacist or prescriber could recommend a nasal antihistamine instead.
Astepro Allergy (azelastine) is a relatively new nasal spray for allergies. It’s the first OTC nasal antihistamine to make it to pharmacy shelves. Here’s what to know about it.
What is Astepro nasal spray?
Astepro is a nasal antihistamine that helps relieve congestion, runny nose, and sneezing caused by allergy symptoms. The FDA initially approved Astepro in 2008 as a prescription-only medication, but they decided to approve it for OTC use in 2021. It works by blocking histamine, a natural substance that’s responsible for most allergy symptoms.
Treating nasal allergy symptoms: Nasal antihistamines and nasal steroids can both treat pesky allergy symptoms, such as sneezing and runny nose. But they’re not one and the same. Here’s how Astepro and Flonase stack up.
Other antihistamines: Astepro is only one antihistamine. There’s a full list of other antihistamines to consider, too.
Rx-to-OTC switches: Azelastine, the active ingredient in Astepro, no longer requires a prescription from your prescriber. Several other medications have also gone through a similar transition.
What’s the recommended Astepro dosage?
Astepro is administered in one of two ways for adults and adolescents 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. Either way, you shouldn’t administer more than 4 sprays in each nostril in a 24-hour period.
Kids ages 6 to 11 should receive Astepro less frequently — no more than 1 spray in each nostril twice daily. Kids ages 5 and younger shouldn’t use Astepro at all.
Keep in mind: There are two doses of nasal azelastine available: 0.1% (137 mcg per spray) and 0.15% (205.5 mcg per spray). 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.
How to save using GoodRx
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Is Astepro nasal spray available 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 additional data, the FDA decided that it’s safe for adults and children at least 6 years old to use Astepro without the supervision of a healthcare professional (HCP). Bayer Healthcare, which manufactures the medication, showed the FDA that Astepro’s benefits outweigh its risks when used as directed. People can appropriately use the medication without a HCP’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 both approved for OTC use too.
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What are the potential side effects of Astepro nasal spray?
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 Astepro side effect. 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 nasal spray 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 HCP may even recommend using 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 HCP 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 specifically? There are a few key similarities and differences between them.
The standard choice: According to experts, nasal steroids are first-choice options for allergy relief. But nasal antihistamines such as Astepro can also serve as go-to treatments.
Effectiveness: Nasal antihistamines are similarly effective as nasal steroids. But nasal antihistamines may be better for milder allergy symptoms, while nasal steroids may be more helpful for more intense symptoms. Astepro also kicks in within 15 to 30 minutes, while nasal steroids can take up to 2 weeks.
Side effects and risks: 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.
Chronic use: 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 — such as runny nose or sneezing. They can be used by 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 such as high blood pressure or rebound congestion.
Nasal saline
Nasal saline (sodium chloride) products moisturize your nasal passages to help relieve nasal dryness and 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 nasal spray
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 HCP.
By having your HCP write a prescription for azelastine, GoodRx can help you save over 80% off the average retail price. Generic azelastine’s price at certain pharmacies is as low as $15.50 with a free GoodRx discount.
What’s more, Astepro’s manufacturer offers a coupon for $2 off your purchase without a prescription. The average cash price for OTC Astepro is $36.41.
The bottom line
Astepro Allergy (azelastine) is the first nasal antihistamine to be FDA approved for over-the-counter (OTC) use. It’s considered to be a safe and effective option for treating and preventing nasal allergy symptoms. If you’re unsure if you should use Astepro nasal spray or a different medication, such as a nasal steroid, ask your prescriber or pharmacist.
References
American Academy of Otolaryngic Allergy. (2019). You want me to spray what up my nose?
Bayer Healthcare. LLC. (2023). Astepro allergy - azelastine hcl spray, metered [package insert]. DailyMed.
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Bayer Healthcare LLC. (2023). Children Astepro allergy- azelastine hcl spray, metered [package insert]. DailyMed.
Bryant Ranch Prepack. (2024). Azelastine hydrochloride - azelastine hydrochloride spray, metered [package insert].
Chowdhury, B. A. (2008). Approval letter for Astepro nasal spray. U.S. Department of Health and Human Services.
Dykewicz, M. S., et al. (2017). Treatment of seasonal allergic rhinitis: An evidence-based focused 2017 guideline update. Annals of Allergy, Asthma, and Immunology.
Dykewicz, M. S., et al. (2020). Rhinitis 2020: A practice parameter update. The Journal of Allergy and Clinical Immunology.
Raritan Pharmaceuticals Inc. (2023). Saline - nasal spray [package insert]. DailyMed.
U.S. Food and Drug Administration. (2021). FDA approves a nasal antihistamine for nonprescription use.
GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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