Azelastine adverse effects

In controlled studies, azelastine nasal spray produced a high incidence of itching and burning of the nasal mucosa together with taste disturbance and sometimes unpleasant smell. Sedation does not seem to be frequent in most studies, the frequency of fatigue and drowsiness was not significantly different from placebo. In an open trial in which 119 patients with various types of pruritic dermatoses were treated with oral azelastine, 27 patients reported mild adverse effects such as drowsiness (15 cases, 12.5%) and a bitter after-taste (six cases, 5%). In four patients the treatment was withdrawn because of adverse effects (SEDA-15, 2). 

Ketoconazole raises the levels of desloratadine, emedastine, fexofenadine but as no adverse cardiac effects were seen these combinations are considered safe. No interaction occurs between ketoconazole and azelastine, cetirizine, intranasal levocabastine, and none is expected with levocetirizine. 

Etesloratadine, emedastine and fexofenadine levels are raised by ketoconazole but because this does not result in adverse cardiac effects concurrent use is considered safe. Azelastine, cetirizine (and therefore probably... 

There is a case of torsade de pointes possibly due to spiramycin with the sedating antihistamine mequitazine. The situation with erythromycin and loratadine is unclear as one study found that the combination caused a very slight increase in QT interval. Both azithromycin and erythromycin raise fexofenadine levels, but this had no effect on the QT interval, or on adverse events. Azelastine, cetirizine, desloratadine, and intranasal levocabastine seem to be free of clinically relevant interactions with macrolides. 

Fexofenadine levels are raised by both azithromycin and erythromycin but because this does not result in adverse cardiac effects concurrent use is considered safe. Azelastine, cetirizine (and therefore probably its isomer levocetirizine) desloratadine and levocabastine seem to be free from clinically significant pharmacokinetic interactions, and have no cardiac effects, and so may therefore provide suitable alternatives if a non-sedating antihistamine is needed in a patient taking macrolides. 

---