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Azelastine for COVID-19
4 studies with >700 patients
Significantly lower risk for cases.
4 studies from 2 independent teams in 3 countries show significant benefit.
COVID-19 Azelastine studies. Dec 2025. c19early.org
0 0.5 1 1.5+ All studies 39% Recovery 13% Cases 53% Viral clearance 19% RCTs 44% Prophylaxis 53% Early 66% Late 12% Favorsazelastine Favorscontrol
Recent:
Lehr.
Dec 1
 Covid Analysis Azelastine for COVID-19: real-time meta analysis of 4 studies
Significantly lower risk is seen for cases. 4 studies from 2 independent teams in 3 countries show significant benefit. Meta analysis using the most serious outcome reported shows 39% [0‑62%] lower risk. Results are similar for..
Sep 2
 Lehr et al., JAMA Internal Medicine, doi:10.1001/jamainternmed.2025.4283 Azelastine Nasal Spray for Prevention of SARS-CoV-2 Infections
72% fewer symptomatic cases (p=0.02), 69% fewer cases (p=0.03), and 34% faster viral clearance (p<0.0001). RCT 450 healthy adults showing lower PCR-confirmed and symptomatic SARS-CoV-2 infections with azelastine 0.1% nasal spray (1 puff/nostril 3x/day for 56 days) versus placebo. The placebo formulation (hypromellose) may also have efficacy vi..
Jan 10
 Hamdan et al., Turkish Journal of Pharmaceutical Sciences, doi:10.4274/tjps.galenos.2024.49768 In silico Evaluation of H1-Antihistamine as Potential Inhibitors of SARS-CoV-2 RNA-dependent RNA Polymerase: Repurposing Study of COVID-19 Therapy
In silico study showing that H1RA antihistamines, including bilastine, fexofenadine, mizolastine, rupatadine, terfenadine, and the leukotriene receptor antagonists montelukast and zafirlukast, may inhibit SARS-CoV-2 RNA-dependent RNA poly..
Oct 31
2024
 Meiser et al., Viruses, doi:10.3390/v16121914 (date from preprint) Azelastine Nasal Spray in Non-Hospitalized Subjects with Mild COVID-19 Infection: A Randomized Placebo-Controlled, Parallel-Group, Multicentric, Phase II Clinical Trial
13% improved recovery (p=0.42) and 6% improved viral clearance (p<0.0001). RCT 294 low-risk subjects with mild COVID-19 showing significantly greater reduction in viral load with azelastine 0.1% nasal spray vs. placebo. There was no COVID-19 related hospitalization in either group. The reduction in viral load wa..
Apr 26
2023
 Klussmann et al., Scientific Reports, doi:10.1038/s41598-023-32546-z Early intervention with azelastine nasal spray may reduce viral load in SARS-CoV-2 infected patients
14% improved viral clearance (p=0.22). RCT 90 outpatients showing potential benefit of azelastine nasal spray for reducing viral load. Patients were randomized to receive placebo, 0.02%, or 0.1% azelastine nasal spray for 11 days. The 0.1% azelastine group showed greater viral..
Jan 31
2021
 Reznikov et al., Biochemical and Biophysical Research Communications, doi:10.1016/j.bbrc.2020.11.095 Identification of antiviral antihistamines for COVID-19 repurposing
45% fewer cases (p=0.03). Retrospective 219,000 patients showing lower risk of COVID-19 with antihistamine H1RA use. In vitro study showing these drugs exhibit direct antiviral activity against SARS-CoV-2. Molecular docking suggests hydroxyzine and azelastine may ..