azelastine vs hydroxyzine
PlainMeds reviewed this comparison against our methodology in August 2026. It places FDA and CMS record fields side by side, without recommending either medication.
Side-by-side comparison of azelastine and hydroxyzine. Data from FDA drug databases (Orange Book, NDC Directory, recalls, shortages) covering 20,000+ approved drugs, plus CMS pricing; see our methodology.
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Azelastine nasal spray is an antihistamine medicine. It helps relieve allergy and non-allergy nasal symptoms.
Hydroxyzine is an antihistamine that can also help with anxiety. It works by reducing the effects of histamine, a substance in the body that can cause allergic symptoms.
This medicine treats symptoms of seasonal allergies in adults and kids 5 years and older. It also treats symptoms of vasomotor rhinitis (stuffy or runny nose not caused by allergies) in adults and teens 12 years and older. It works by blocking histamine, a substance in the body that causes allergy symptoms.
Hydroxyzine is used to relieve anxiety and tension, especially when related to mental health conditions or other illnesses. It can also help manage itching caused by allergies like hives and eczema. Hydroxyzine can also be used as a sedative before and after surgery.
Azelastine is an antihistamine. It blocks histamine, a natural substance that your body makes during an allergic reaction. By blocking histamine, azelastine helps reduce allergy symptoms like sneezing, runny nose, and itchy eyes.
Hydroxyzine blocks histamine, a natural substance your body makes during an allergic reaction. By blocking histamine, it helps reduce itching and other allergy symptoms. It also has a calming effect on the brain, which helps reduce anxiety.
- • Bitter taste
- • Headache
- • Sleepiness
- • Nasal burning
- • Sore throat
- • Dry mouth
- • Drowsiness
- Treatment Failure 1,876
- Fatigue 1,144
- Headache 883
- Nausea 879
- Dyspnoea 836
- Pruritus 2,965
- Nausea 2,612
- Fatigue 2,605
- Toxicity To Various Agents 2,302
- Pain 2,188
Azelastine nasal spray can cause sleepiness. Be careful driving or operating machinery until you know how this medicine affects you. Avoid drinking alcohol or taking other medicines that can cause sleepiness while using this spray.
You should not take this medicine if you are pregnant, especially in early pregnancy, as it may harm the baby. Also, do not take hydroxyzine if you have a heart condition called prolonged QT interval or if you are allergic to hydroxyzine, cetirizine, or levocetirizine.
There is limited information about the safety of azelastine nasal spray during pregnancy. Talk to your doctor if you are pregnant or plan to become pregnant. It is not known if azelastine passes into breast milk, so talk to your doctor if you are breastfeeding.
Do not take hydroxyzine if you are pregnant, especially in early pregnancy. It may cause harm to your unborn baby. Talk to your doctor if you are breastfeeding before taking this medicine.
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How to Read This azelastine vs hydroxyzine Comparison
azelastine is classified in the Antihistamine (Nasal) drug class, while hydroxyzine sits within the Antihistamine / Anxiolytic class. Drugs from different classes work through distinct mechanisms, so a head-to-head comparison illustrates trade-offs rather than equivalence. Both drugs are split between OTC and prescription status, which affects access and supervision.
Adverse event totals above are pulled from the FDA's Adverse Event Reporting System (FAERS). For these top-ranked reactions alone, azelastine has 5,618 submissions while hydroxyzine has 12,672. Those figures reflect cumulative reporting volume, not per-patient risk, so older, widely dispensed drugs typically look worse on count alone. No direct interaction between these two drugs is listed in our FDA-derived dataset, though co-prescription still warrants pharmacist review. Serious warnings, pregnancy guidance, and contraindications can differ even when indications overlap.
A table cannot represent individual circumstances. Data here is sourced from FDA Structured Product Labels (SPL) and FAERS, both of which update as manufacturers and clinicians submit new information. This registry does not provide medical, treatment, substitution, or medication-change directions for azelastine or hydroxyzine.
Registry boundary: This comparison displays source-record fields and does not provide individualized medical direction.