Written by Babatunde Carew
Spoon Feed
Azelastine nasal spray used three times daily for 56 days significantly reduced PCR-confirmed SARS-CoV-2 infections versus placebo.
An old spray’s new trick?
According to the most recent Centers for Disease Control and Prevention data, COVID continues to impose significant morbidity and mortality in the US. In the face of this risk, some patients turn to medications that lack robust evidence or may be harmful to aid in COVID-19 prevention. Clearly, there is a need and desire for safe and effective prophylactic measures.
This phase 2 double-blind, placebo-controlled trial (n = 450 healthy adults) sought to evaluate whether azelastine 0.1% nasal spray may prevent COVID-19 infection. Participants used azelastine nasal spray or placebo three times daily for 56 days with twice-weekly rapid antigen testing. PCR-confirmed infection occurred in 2.2% vs. 6.7% (OR 0.31, 95%CI 0.11-0.87) in the treatment vs. placebo group. Adverse events were mild and comparable. Limitations include small sample size, single-center design, low event rate, and potential unblinding.
How does this change my practice?
Using azelastine nasal spray three times daily for potential reduction in COVID-19 risk seems burdensome, but some patients may find it worthwhile. While this small phase 2 trial alone doesn’t justify a blanket recommendation, azelastine appears to be a safe option for highly cautious patients seeking additional protection. Given its safety profile, I’d much rather direct such patients toward azelastine than unproven and potentially harmful alternatives like ivermectin.
Source
Azelastine Nasal Spray for Prevention of SARS-CoV-2 Infections: A Phase 2 Randomized Clinical Trial. JAMA Intern Med. 2025 Sep 2:e254283. doi: 10.1001/jamainternmed.2025.4283. Epub ahead of print. PMID: 40892398; PMCID: PMC12406145.
