Who Should Not Take Astepro? A Guide to Contraindications

October 8, 2025 •

4 min read

With over a quarter of U.S. adults having a seasonal allergy, many seek relief from medications like Astepro [1.8.2, 1.8.5]. It's crucial to understand who should not take Astepro to ensure it's used safely and effectively.

Quick Summary

This overview details the specific groups and conditions that are contraindicated for Astepro use. It covers patient warnings, drug interactions, and considerations for special populations like children or pregnant women.

Key Points

Allergic Reactions: Do not use Astepro if you've ever had an allergic reaction to azelastine or its ingredients [1.2.4].
CNS Depressants: Avoid alcohol and other sedating medications, as they can significantly increase drowsiness when taken with Astepro [1.2.1, 1.2.3].
Mental Alertness: Astepro can cause drowsiness, so avoid driving or operating machinery until you know how it affects you [1.2.5].
Nasal Conditions: People with recent nasal ulcers, surgery, or unhealed nasal injuries should consult a doctor before use [1.2.2].
Children: The OTC version of Astepro is not recommended for children under the age of 6 [1.10.2, 1.10.5].
Pregnancy/Breastfeeding: Use should be discussed with a healthcare provider due to limited safety data in these populations [1.6.2, 1.6.5].
Elderly Patients: Caution is advised for elderly patients, who may be more sensitive to side effects and should consider starting with a low dose [1.6.5].

Understanding Astepro and Its Mechanism

Astepro, with the active ingredient azelastine hydrochloride, is an over-the-counter (OTC) antihistamine nasal spray designed to relieve allergy symptoms [1.9.1, 1.2.4]. It works by blocking the effects of histamine, a chemical your body releases in response to allergens [1.9.1, 1.9.2]. This action helps alleviate common allergy symptoms such as nasal congestion, sneezing, runny nose, and itchy nose [1.9.1]. Unlike some other nasal sprays that can take days to become fully effective, Astepro starts working in as little as 30 minutes [1.7.2, 1.9.1]. Its active ingredient, azelastine, also has anti-inflammatory properties, further helping to reduce symptoms [1.9.5].

Key Groups Who Should Not Take Astepro

While Astepro is effective for many, certain individuals should avoid it or consult a healthcare professional before use. Officially, the product has no absolute contraindications listed, but there are significant warnings and precautions [1.2.3].

Individuals with a History of Allergic Reaction

You should not use Astepro if you have ever had an allergic reaction to azelastine or any of its other ingredients [1.2.4, 1.3.5]. Signs of a serious allergic reaction can include hives, skin rash, difficulty breathing, or swelling of the face, lips, tongue, or throat [1.5.1, 1.5.3]. If you experience any of these, seek emergency medical help immediately [1.5.2].

Patients with Unhealed Nasal Conditions

Caution is advised for individuals with recent nasal issues. You should ask a doctor before using Astepro if you have [1.2.2, 1.2.4, 1.3.1]:

Recent nose ulcers
Had recent nose surgery
A nose injury that has not fully healed The medication may interfere with the healing process for these conditions [1.3.3].

Important Warnings and Precautions

Beyond specific groups, there are important warnings that apply to anyone considering Astepro.

Activities Requiring Mental Alertness

The most significant warning associated with Astepro is its potential to cause drowsiness and reduce mental alertness [1.2.1, 1.2.5]. This sleepiness can impair your ability to think clearly and react quickly [1.2.2]. Therefore, you should be cautious about driving, operating heavy machinery, or performing any other hazardous tasks until you know how the medication affects you [1.2.3, 1.4.3]. Even when taken at night, it might cause drowsiness upon waking [1.2.1].

Combination with CNS Depressants

The sedative effects of Astepro are amplified when combined with alcohol or other central nervous system (CNS) depressants [1.2.1, 1.2.3]. Concurrent use should be avoided as it can lead to additional reductions in alertness and impairment of nervous system performance [1.2.5].

Examples of CNS depressants include [1.4.1, 1.4.4]:

Alcohol
Sedatives, tranquilizers, or sleeping pills
Certain antidepressants (e.g., amitriptyline)
Opioid pain medicines
Muscle relaxants (e.g., cyclobenzaprine)
Benzodiazepines (e.g., lorazepam, clonazepam)
Other antihistamines like diphenhydramine (Benadryl)

Use in Specific Populations

Certain demographics require special consideration before using Astepro.

Children

The over-the-counter Astepro Allergy product is not recommended for children under 6 years of age [1.10.2, 1.10.5]. Prescription versions of azelastine may be used in younger children under a doctor's supervision for specific conditions [1.10.1, 1.10.3]. For children aged 6 to 11, the recommended dosage is one spray per nostril every 12 hours, and an adult should supervise its use [1.10.5].

Pregnant or Breastfeeding Women

There is not enough information to know if Astepro is safe to use during pregnancy, and it should only be used if the potential benefit justifies the potential risk to the fetus [1.2.2, 1.4.2]. Animal studies showed developmental toxicity at very high doses, but the relevance to humans is considered questionable [1.4.2]. If you are pregnant or planning to become pregnant, you should consult a health professional before use [1.2.4, 1.6.2].

For breastfeeding mothers, it is unknown if azelastine passes into human milk [1.6.5]. Using it may cause the breast milk to taste bitter, potentially leading to the infant not nursing as well [1.6.3]. Small, occasional doses are not expected to cause adverse effects in the infant, but prolonged use could cause drowsiness [1.6.4]. Caution should be exercised, and it is best to discuss the risks and benefits with a doctor [1.6.5].

The Elderly

Clinical trials of Astepro did not include a sufficient number of patients aged 65 and over to determine if they respond differently than younger patients [1.6.5]. However, because elderly individuals are more likely to have decreased kidney, liver, or heart function, dose selection should be cautious, typically starting at the lower end of the dosing range [1.6.5].

Comparison with Other Nasal Sprays

It is helpful to understand how Astepro compares to other common types of nasal sprays.


Feature	Astepro (Antihistamine)	Flonase (Corticosteroid)	Afrin (Decongestant)
Mechanism	Blocks histamine to stop allergy symptoms [1.7.2, 1.9.4].	Reduces inflammation in the nasal passages over time [1.7.2, 1.7.4].	Tightens blood vessels in the nose for immediate congestion relief [1.7.3].
Onset of Action	Fast-acting, works within 30 minutes [1.7.2, 1.9.1].	Slower onset, may take several days to 2 weeks for full effect [1.7.2].	Provides very fast, temporary relief [1.7.1].
Primary Use	Daily or as-needed for allergy symptoms including congestion, sneezing, and runny nose [1.7.1].	Daily use for long-term control of nasal inflammation and allergy symptoms [1.7.1, 1.7.2].	Short-term use (max 3 days) for severe congestion [1.7.1, 1.7.3].
Key Precaution	May cause drowsiness [1.2.3].	Long-term use in children may affect growth [1.2.2].	Risk of rebound congestion (worsening symptoms) if used for more than 3 days [1.7.3].

Conclusion

While Astepro is a widely accessible and fast-acting option for allergy relief, it is not suitable for everyone. Individuals with a known allergy to its ingredients or with unhealed nasal injuries should not take Astepro. The most critical warning is the potential for drowsiness, which is intensified by alcohol or other CNS depressants. Users should avoid driving or operating machinery until they understand how Astepro affects them. Special populations, including children under six, pregnant or breastfeeding women, and the elderly, must consult a healthcare professional to weigh the risks and benefits. By understanding these precautions, patients can use Astepro safely and achieve effective relief from their allergy symptoms.

For more detailed drug information, you can visit the FDA's drug database. [1.2.3]

Frequently Asked Questions

No, you should avoid drinking alcohol while using Astepro. The combination can increase drowsiness and impair your alertness more than the medication alone [1.2.1, 1.2.3].

Astepro may cause drowsiness and impair your ability to react quickly. You should not drive or operate machinery until you know how the medication affects you [1.2.5, 1.4.3].

You should not take Astepro if you have had a prior allergic reaction to it [1.2.4]. You should also consult a doctor if you are pregnant, breastfeeding, have recent nasal ulcers or surgery, or are taking other sedating medications [1.2.2, 1.6.2].

The over-the-counter Astepro Allergy nasal spray is not recommended for children under 6 years old. Different formulations and dosages may be prescribed by a doctor for younger children [1.10.2, 1.10.3].

Combining Astepro with other antihistamines or medicines that cause drowsiness (like some cold or allergy pills) can increase the sedative effects. You should check with your doctor before combining treatments [1.4.1].

The most common side effects are a bitter taste in the mouth, drowsiness, headache, and nasal discomfort or nosebleeds [1.2.2, 1.5.1]. Drowsiness is a key safety concern [1.2.3].

There is limited data on the safety of Astepro during pregnancy. It is recommended to ask a health professional before use to discuss the potential risks and benefits [1.2.4, 1.6.1].