7 Astepro Side Effects: Sneezing, Nosebleeds, and More

Allergy season affects millions of people in the U.S. every year. With blooming flowers and an increasing pollen count comes runny nose, sneezing, and nasal congestion. Antihistamines are popular choices for treating these symptoms.

Astepro (azelastine) is an over-the-counter (OTC) antihistamine nasal spray. And it’s a first-choice option when it comes to managing seasonal allergies. While many people can use Astepro without major problems, that doesn’t mean side effects aren’t possible. But most of Astepro’s side effects, such as bitter taste and nasal discomfort, are mild and resolve quickly.

Astepro side effects at a glance

Azelastine nasal spray has been on the U.S. market since 1996. And researchers have thoroughly studied its safety and potential side effects since then. Originally, it was only available with a prescription. But in 2021, it became available OTC under the brand name Astepro.

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Most people experience Astepro side effects around the nose and throat. And they’re generally mild and go away quickly on their own. Astepro has a lower risk of whole-body effects compared to oral antihistamines, such as Benadryl (diphenhydramine).

Common or mild Astepro side effects include:

• Bitter taste

• Nasal discomfort

• Nosebleeds

• Sneezing

• Headache

• Drowsiness

• Sinusitis (sinus swelling)

Serious Astepro side effects are rare, but may include:

• Severe, frequent nosebleeds

• Allergic reactions

This isn’t a full list of all possible side effects. Always contact a healthcare professional for severe or persistent side effects — even if they’re not listed here.

EXPERT PICKS: WHAT TO READ NEXT

• Your over-the-counter (OTC) treatment guide: Learn more about the best OTC options for managing allergy symptoms, including decongestants, steroid nasal sprays, and eye drops.

• Astepro (azelastine) vs. Flonase (fluticasone propionate): See how these two popular OTC nasal sprays compare for allergies.

• How do you use Astepro? Get pharmacist-backed advice on recommended Astepro dosages and how to use it.

Below, we review seven Astepro side effects and pharmacist-backed tips to manage them.

1. Bitter taste

Bitter taste is one of the most common Astepro side effects. This is because the active ingredient, azelastine, is naturally bitter. Manufacturers added sweeteners, such as sucralose and sorbitol, to the nasal spray’s original formulation to help mask the taste. But bitter taste is still common. And it’s a main reason that people stop using Astepro.

It’s likely you’ll experience this unpleasant taste if the medication gets into your throat. But it shouldn’t last long. Eating or drinking something with a strong flavor to it may help the taste fade faster.

You can help avoid this Astepro side effect by tilting your head downward when spraying the medication into your nose. You should also avoid tilting your head backward after using it. This lowers the chance of azelastine dripping into your throat.

2. Nasal discomfort

It’s also common to experience nasal discomfort when using Astepro. But it’s usually mild and goes away quickly after using a dose.

Using Astepro properly can help reduce nasal discomfort. Point the nozzle away from the middle part of your nose (septum). Using a saline nasal spray a few minutes before using Astepro may also help.

Keep in mind that nasal discomfort or stinging are also common allergy symptoms. Astepro may make it worse for some people. If you feel like Astepro has worsened your symptoms, talk to a healthcare professional. They may suggest trying a different allergy medication.

3. Nosebleeds

Mild nosebleeds can happen when using Astepro. It may be more likely to happen if allergies are already irritating your nose.

If you experience a nosebleed, pinch your nose and tilt your head forward. Apply constant pressure for about 5 to 10 minutes. Nosebleeds should stop within that time. If they last longer than this, contact a healthcare professional.

Using a saline nasal spray shortly before Astepro may help prevent nosebleeds. Using a humidifier may also help. And avoid picking your nose or sticking cotton swabs in your nose.

If you experience severe or persistent nosebleeds, seek medical assistance. This isn’t common with Astepro, and you should get an evaluation to figure out the cause.

4. Sneezing

Sneezing is another possible Astepro side effect. Although, it’s not common. This side effect is typically most noticeable right after using Astepro. And it should stop shortly afterwards.

Keep in mind that sneezing is also a common allergy symptom. It’s possible that Astepro isn’t the cause of your sneezing.

If your sneezing comes with a fever, body aches, or other symptoms of illness, speak with a healthcare professional. You may have a respiratory tract infection.

5. Headache

All antihistamines can cause headaches. But this side effect is uncommon with Astepro. If you do experience headaches, they should be mild and manageable at home.

Tips to help manage headaches include:

• Drinking more fluids

• Getting enough rest at night

• Practicing mindfulness exercises or meditation to help lower stress levels

• Limiting alcohol, which can trigger or worsen headaches

• Asking a healthcare professional whether you can safely take OTC headache medications, such as Tylenol (acetaminophen)

If these suggestions don’t help relieve your headaches, talk to a healthcare professional. Severe or persistent headaches aren’t typical with Astepro.

6. Drowsiness

Drowsiness is another side effect that’s possible with all antihistamines. But it’s fairly rare with Astepro. That’s because most of its effects stay local (in and around the nose). Most people can use this nasal spray at any time of day.

Take your first dose of Astepro when you don’t have to focus on anything important, such as driving. If it makes you sleepy, try using it once a day before bedtime. That way, the drowsiness you experience may happen when you’ll already be asleep.

While using Astepro, it’s best to avoid alcohol and other medications that can make you tired, such as sleep aids. These can raise your risk of this side effect.

7. Allergic reactions

Although rare, allergic reactions can occur when using Astepro. Reactions can range from mild to life threatening. Milder allergic reactions could include rashes or hives. Life-threatening reactions can include swelling of the lips, tongue, or throat (anaphylaxis).

For mild reactions, contact a healthcare professional. They may want to examine you or provide treatment to help. But if you notice severe symptoms or have trouble breathing, call 911 or go to the ER. Serious allergic reactions need emergency care.

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Written by:

Kristina D. Carter, PharmD, MBA, MHA

Kristina D. Carter, PharmD, MBA, MHA, has over 25 years of experience working in healthcare. She is registered as a licensed pharmacist in Georgia, Indiana, and Tennessee.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

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