Astelin itself is not available over the counter. It remains a prescription-only nasal spray. However, a closely related product called Astepro Allergy (and Children’s Astepro Allergy) was switched from prescription to over-the-counter status by the FDA, making it the first antihistamine nasal spray you can buy without a prescription. Both products contain the same active ingredient, azelastine, but they differ in concentration and formulation.
How Astepro Differs From Astelin
Astelin contains azelastine at a 0.10% concentration, while Astepro contains it at 0.15%, a 50% higher concentration per spray. That difference matters: in pharmacokinetic testing, Astepro delivered nearly twice the peak drug levels in the bloodstream compared to Astelin. Astepro also uses a bitterness-masking technology that the original Astelin formulation lacks, which helps address one of the most common complaints about azelastine nasal sprays.
So if you’re looking for an OTC version of Astelin, Astepro Allergy is the closest option available. It treats the same conditions (seasonal and year-round allergic rhinitis) and works through the same mechanism, blocking histamine receptors in the nasal passages to reduce sneezing, congestion, and runny nose.
Who Can Use OTC Astepro
The OTC version is approved for adults and children ages 6 and older. Children younger than 6 should not use it without a doctor’s guidance. If you’ve had recent nose surgery, a nose injury, or have sores inside your nose, check with a healthcare provider before starting. The same applies if you’re pregnant or breastfeeding.
How to Use It
For seasonal allergies, the typical dose is one or two sprays in each nostril twice daily. Astepro 0.15% can also be used as two sprays per nostril once daily, which is a convenience the lower-concentration Astelin doesn’t offer. For year-round allergies, the recommended dose is two sprays per nostril twice daily.
Azelastine works faster than many oral antihistamines because it’s applied directly where inflammation occurs. It blocks histamine receptors locally in the nasal lining rather than circulating through your entire body first.
Side Effects to Expect
The most notable side effect is a bitter taste that drips down the back of your throat after spraying. In clinical trials of the original Astelin formulation, about 20% of users experienced this. The OTC Astepro version was specifically reformulated to reduce that bitterness, though some users still notice it. Tilting your head slightly forward while spraying and avoiding sniffing hard afterward can help keep the liquid from reaching your throat.
Drowsiness is the other side effect worth knowing about. Roughly 12% of Astelin users in trials reported feeling sleepy, compared to about 5% on placebo. This is unusual for a nasal spray but makes sense because azelastine is an antihistamine, and some of it does get absorbed into the bloodstream. Avoid combining it with alcohol or sedating medications, as the drowsiness effect can stack. If you take other cold or allergy products, particularly those containing antihistamines, be aware you may be doubling up.
What It Costs Without a Prescription
A 30 mL bottle of generic azelastine nasal spray at the higher OTC concentration (205.5 mcg per spray) has a retail price around $134, though discount coupons through services like GoodRx can bring it closer to $20. The lower-concentration version (137 mcg per spray, equivalent to the Astelin strength) retails around $27 and can drop to roughly $13 with coupons. Brand-name Astepro Allergy typically falls somewhere between these prices at major pharmacies and is stocked alongside other allergy medications in the nasal spray aisle.
Prescription Azelastine Still Exists
Even though Astepro went OTC, prescription azelastine hasn’t disappeared. Your doctor can still prescribe azelastine nasal spray, which may be worthwhile if your insurance covers prescription medications but not OTC products. Some prescription options also combine azelastine with a steroid nasal spray in a single bottle, offering two mechanisms of allergy relief at once. That combination product remains prescription-only.
If you previously used Astelin and your doctor hasn’t renewed the prescription, picking up OTC Astepro Allergy gives you the same drug at a slightly higher concentration without needing an appointment. For most people with seasonal or year-round nasal allergies, the OTC version is a straightforward substitute.