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Azelastine vs. Zyrtec

Head-to-head comparisons of medication uses, side effects, warnings, and more.

Key takeaways

Azelastine nasal spray and cetirizine (Zyrtec) are both antihistamines used to treat allergy symptoms like a runny nose and sneezing. However, they differ in several ways. Azelastine is a nasal spray, while cetirizine is taken orally in forms like tablets and liquids. Azelastine is available by prescription and over-the-counter, but only the 0.15% strength is available without a prescription. Cetirizine is available both over-the-counter and by prescription. Azelastine is typically used twice a day, whereas cetirizine is usually taken once a day. Common side effects of azelastine include a bitter taste and nasal discomfort, while cetirizine can cause sleepiness and dry mouth. Both medications can cause drowsiness, so you should avoid alcohol and be cautious when driving. Azelastine is not known to cause weight gain, but cetirizine is considered safe during pregnancy.

azelastine nasal spray

 

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Cetirizine

(Zyrtec)

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Summary for Azelastine

Prescription only

Azelastine nasal spray is an antihistamine that treats allergies and nasal symptoms, such as runny or stuffy nose. The 0.1% and 0.15% strengths of the azelastine nasal spray are available with a prescription for adults and children. It's sprayed into the nostrils typically twice a day. Prescription azelastine nasal spray is a lower-cost generic. Possible side effects include a bitter taste in the mouth and nasal discomfort.

Note: Azelastine 0.15% nasal spray is also available over the counter under the brand name Astepro Allergy.

Indications for Azelastine

  • Seasonal allergy symptoms related to the nose
  • Year-round allergy symptoms related to the nose - azelastine 0.15% spray only
  • Runny or stuffy nose that isn't caused by allergies - azelastine 0.1% spray only

Pros and Cons for Azelastine

Pros

  • Works well to relieve nasal symptoms during allergy season
  • Might work faster than steroid nasal sprays and some oral antihistamines
  • Sprayed directly into the nose
  • Available in two different strengths (0.1% and 0.15%)

Cons

  • Doesn't have a counter to keep track of the number of sprays you have left in the bottle
  • Can leave a bitter taste in your mouth (but it goes away)
  • Can cause sleepiness in some people
  • Might need to use twice a day

Common Side Effects for Azelastine

Azelastine 0.1% nasal spray:

  • Bitter taste in the mouth (20%)
  • Headache (15%)
  • Sleepiness (12%)
  • Nasal burning (4%)

Azelastine 0.15% nasal spray:

  • Bitter taste in the mouth (4%)
  • Nasal discomfort (4%)

Warnings for Azelastine

  • Possible sleepiness and difficulty concentrating

Summary for Zyrtec

Prescription or over-the-counter

Cetirizine (Zyrtec) is an antihistamine. It's used for relief of allergy symptoms, such as runny nose or watery eyes, in adults and children. Cetirizine (Zyrtec) is also a safe option for people who are pregnant. This medication is available in different formulations, including tablets and liquid solutions. Typically, cetirizine (Zyrtec) is taken by mouth once per day. The most common side effect of cetirizine (Zyrtec) is sleepiness. But it's less likely to make you drowsy compared to some other antihistamines, such as diphenhydramine (Benadryl).

Indications for Zyrtec

  • Short-term relief of allergy symptoms (sneezing, runny nose, itchy or watery eyes, itching of the nose or throat)
  • Relief of itchiness due to chronic (long-term) hives in children ages 6 months to under 6 years old - certain liquid solutions only

Pros and Cons for Zyrtec

Pros

  • First-choice option for relieving allergy symptoms
  • Taken once per day
  • Available in several formulations (e.g., pills, chewable tablets, orally disintegrating tablets, liquids)
  • Safe to take while pregnant

Cons

  • Can cause you to feel sleepy
  • Higher risk of side effects in people with liver or kidney problems
  • Pills can't be used in children younger than 6 years.

Common Side Effects for Zyrtec

People 12 years of age and older:

  • Sleepiness (14%)
  • Tiredness (6%)
  • Dry mouth (5%)

Children age 6 to under 12 years:

  • Headache (11-14%)
  • Sore throat (3-6%)
  • Stomach pain (4-6%)
  • Cough (3-4%)
  • Sleepiness (2-4%)

Warnings for Zyrtec

  • Sleepiness
  • Accidentally taking too much medication

Prices with our coupons for Azelastine vs. Zyrtec

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Azelastine1 nasal spray / 30ml of 137mcg/spray
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Cetirizine90 tablets / 24 hour of 10mg
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