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INTRODUCTION

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azelastine (a-zel-as-teen)

Astelin

Classification

Therapeutic: allergy, cold, and cough remedies, antihistamines

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Indications
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Management of the symptoms of seasonal allergic rhinitis in patients ≥5 yr. Management of vasomotor rhinitis in patients ≥12 yr.

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Action
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Locally antagonizes the effects of histamine at H1 receptor sites; does not bind to or inactivate histamine. Therapeutic Effects: Decreased sneezing, nasal rhinitis, pruritus, and postnasal drip.

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Adverse Reactions/Side Effects
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CNS: drowsiness, dizziness, dysesthesia, fatigue, headache. EENT: epistaxis, nasal burning, pharyngitis, sinusitis, sneezing. GI: bitter taste, dry mouth, nausea. Metab: weight gain. MS: myalgia.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Assess dizziness and drowsiness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

  • Assess any muscle pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

  • Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or unexplained weight gain or increased body fat.

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Interventions
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  • Guard against falls and trauma (hip fractures, head injury, and so forth). Implement fall prevention strategies, especially in older adults or if balance is impaired (See Appendix E).

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Patient/Client-Related Instruction
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  • Advise patient about the risk of daytime drowsiness and decreased attention and mental focus. These problems can be severe in certain people. Use care if driving or in other activities that require quick reactions and strong concentration.

  • Advise patient to avoid alcohol and other CNS depressants because of the increased risk of sedation and adverse effects.

  • Instruct patient to report prolonged or severe nasal irritation, including excessive sneezing, nosebleeds, burning sensations, or other troublesome nasopharyngeal symptoms.

  • Instruct patient and family/caregivers to report severe or prolonged headache, fatigue, or GI problems (nausea, dry mouth, bitter taste).

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Pharmacokinetics
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Absorption: 40% absorbed after intranasal administration.

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Distribution: 14.5 L/kg.

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Metabolism and Excretion: Most of absorbed azelastine is metabolized by the liver (converted to an active metabolite.

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Half-life: 22 hr.

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TIME/ACTION PROFILE (relief of symptoms)

ROUTE ONSET PEAK DURATION
intranasal rapid 2–3 hr* 12 hr

*Plasma concentration.

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity.

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Use Cautiously in: OB/Lactation: Safety not established; Pedi: Safety not established in children <5 yr.

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Interactions
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Drug-Drug: Additive CNS depression with CNS depressants, including alcohol, sedative/hypnotics, and opioid analgesics. Concurrent use of cimetidine...

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