Xyzal vs. Astelin

See how Xyzal and Astelin compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Xyzal is a once-daily pill or liquid, while Astelin is a nasal spray used one to two times a day in each nostril.

  • Both drugs can cause drowsiness, so avoid driving or drinking alcohol until you know how each one affects you.

  • Astelin is also approved for vasomotor (nonallergic) rhinitis, a use Xyzal does not have on its label.

Xyzal vs. Astelin Drug Summary

Xyzal

Xyzal is an oral antihistamine (H1-receptor blocker) used to relieve sneezing, itchy eyes, and runny nose from seasonal and perennial allergies, and to treat chronic hives. It comes as a tablet or liquid taken once daily, usually in the evening.

Astelin

Astelin is a nasal antihistamine spray used to treat seasonal allergic rhinitis and vasomotor (nonallergic) rhinitis. It is sprayed directly into each nostril, one or two sprays per side, twice daily.

Xyzal vs. Astelin Side Effects

Xyzal

Most common
somnolence (≥2%)
nasopharyngitis (≥2%)
fatigue (≥2%)
dry mouth (≥2%)

Astelin

Most common
somnolence (≥2%)
bitter taste (≥2%)
headache (≥2%)
nasal burning (≥2%)

Xyzal vs. Astelin Dosage

Xyzal

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 1.25 mg once daily At the start
Maximum dose 5 mg once daily If needed
Dose changes 2 increases As tolerated

Astelin

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 1 spray/nostril twice daily At the start
Maximum dose 2 sprays/nostril twice daily If needed
Dose changes 1 increase As tolerated

Xyzal vs. Astelin Indications

Xyzal

Xyzal is FDA-approved for seasonal and perennial allergic rhinitis in adults and children as young as 6 months, and for chronic idiopathic urticaria (hives) in the same age range. It relieves sneezing, itchy watery eyes, runny nose, and itchy skin from hives.

  • Seasonal allergic rhinitis

  • Perennial allergic rhinitis

  • Chronic idiopathic urticaria (hives)

  • Approved for children as young as 6 months

Astelin

Astelin is FDA-approved for seasonal allergic rhinitis in adults and children 5 and older, and for vasomotor rhinitis in adults and adolescents 12 and older. It works locally in the nose to reduce sneezing, congestion, and runny nose from allergens or irritants.

  • Seasonal allergic rhinitis (age 5+)

  • Vasomotor (nonallergic) rhinitis (age 12+)

  • Nasal congestion and sneezing relief

  • Not approved under age 5 (SAR) or 12 (vasomotor)

Xyzal vs. Astelin Pros and Cons

Xyzal

Xyzal offers once-daily oral dosing, is available over the counter, and covers both allergy symptoms and chronic hives, giving it a broader label than Astelin. It still carries a risk of sedation and needs dose adjustment in kidney disease.

Pros

  • Once-daily dosing, no repeat application needed

  • Also treats chronic hives, not just rhinitis

  • Available over the counter without a prescription

Cons

  • Requires dose adjustment or avoidance in kidney disease

  • Not approved for vasomotor (nonallergic) rhinitis

  • Systemic absorption can cause whole-body drowsiness or fatigue

Astelin

Astelin acts directly in the nose, which can bring faster relief of congestion for some patients, and it is the only one of the two approved for vasomotor rhinitis. It requires spraying into each nostril up to twice daily and often leaves a bitter taste.

Pros

  • Approved for vasomotor (nonallergic) rhinitis

  • Delivers medication directly to nasal tissue

  • No renal dose adjustment specified on label

Cons

  • Requires spraying into each nostril, twice daily

  • Common bitter taste after each use

  • Not approved for children under 5 years

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