Sniffing Out New Treatments for COVID (Azelastine) Offers Promise!

First, a confession. I am extremely disappointed in the pharmaceutical industry and modern medicine. If you have been reading my posts for years, you are probably not surprised at such a statement. What is it this time? I am disheartened that researchers haven’t been more committed to developing new treatments for COVID.

The SARS-CoV-2 virus has infected over 700,000,000 people worldwide. Over 7 million have died from this infection. You might think that such extraordinary numbers would have initiated a world-wide iniative to come up with highly effective advances against such viral infections.

In this article, I will describe two new studies that might provide a glimmer of optimism. One involves a readily available over-the-counter nasal spray called azelastine. The other involves a substance your body makes called nitric oxide (NO). Could such compounds represent new approaches for COVID?

Could Azelastine Be a New Preventive Treatment for COVID?

Azelastine is an antihistamine nasal spray. It is sold under the brand names Astelin and Astepro. For reasons that mystify me, Astelin is available only by prescription. It contains 0.1% azelastine hydrochloride (137 mcg/mL).

Over-the-counter Astepro Allergy is “stronger” than its Rx counterpart. Astepro Allergy contains 205.5 mcg of azelastine HCL or 0.15%. By the way, azelastine nasal spray is also available in a generic form. According to GoodRx, the cost is between $18 and $35 for a spray bottle. The OTC brand name Astepro Allergy is around $33 according to GoodRx.

What Does the Research Reveal about Azelastine as a New Treatment for COVID?

A study was published in JAMA Internal Medicine (Sept. 2, 2025). I have another confession. JAMA Internal Medicine is one of my favorite medical journals. I pretty much check this journal first before any other research publications.

Here is the title of the “CONTAIN” study about this OTC antihistamine nasal spray:

“Azelastine Nasal Spray for Prevention of SARS-CoV-2 Infections: A Phase 2 Randomized Clinical Trial“

The authors introduce their research this way:

“The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to significant morbidity and mortality worldwide. Although vaccination and established population immunity have substantially mitigated the severity of acute SARS-CoV-2 infections, infection rates and postacute morbidity continue to pose a considerable public health burden, highlighting the critical need for effective preexposure prophylaxis for the general population, particularly for high-risk groups.”

Amen to that! There are tens of millions of Americans who are highly vulnerable to COVID because they are immune compromised. That includes many who are taking medications for rheumatoid arthritis, inflammatory bowel disorders and skin condition such as atopic dermatitis.

This research was conducted in Germany and involved 450 healthy volunteers. They ranged in age from 18 to 65 years or age. At the start of the trial all subjects were negative for SARS-CoV-2.

The participants were randomly assigned to use either a placebo nasal spray or a 0.1% azelastine nasal spray 3 times a day for 56 days. They were tested twice weekly using a highly sophisticated PCR test for SARS-CoV-2 infection. Over that time, 5 people spritzing azelastine into their noses came down with COVID. In the group using the placebo spray, there were 15 positive cases. That’s an impressive difference, but the overall numbers were small. I want to see a BIGGER study over a longer period of time.

There were additional data that are interesting:

“As secondary end points, azelastine demonstrated an increase in mean (SD) [standard deviation] time to SARS-CoV-2 infection among infected participants (31.2 [9.3] vs 19.5 [14.8] days), a reduction of the overall number of PCR-confirmed symptomatic infections (21 of 227 participants vs 49 of 223 participants), and a lower incidence of PCR-confirmed rhinovirus infections (1.8% vs 6.3%). Adverse events were comparable between the groups.”

In case the reference to rhinovirus didn’t grab your attention, the authors are suggesting that azelastine nasal spray not only prevented COVID infections, it also prevented the common cold (caused by rhinoviruses).

Conclusions About New Treatments for COVID:

“The data from this double-blind, placebo-controlled study demonstrate that azelastine nasal spray was associated with significantly reduced incidence of laboratory-confirmed SARS-CoV-2 infections in both the ITT [intention to treat] and PP [per protocol placebo] populations. Secondary end points further support these findings. Participants applying azelastine had less symptomatic SARS-CoV-2 infections, and an increase in mean time to SARS-CoV-2 infection among infected participants was observed for the azelastine compared with the placebo group. The increase in time to SARS-CoV-2 infection indicates that even in times of higher exposure rates, fewer infections per exposure occurred under treatment compared with placebo. Together, these results suggest that azelastine may provide meaningful protection against SARS-CoV-2 infection in a prophylactic setting.”

Why Would an OTC Azelastine Antihistamine Ward Off COVID or COLDS?

The authors suggest that azelastine has broad antiviral activity. Test tube (in vitro) studies:

“…provide evidence of the antiviral activity of azelastine beyond SARS-CoV-2, including endemic coronavirus, influenza and respiratory syncytial virus.”

They go on to point out that that:

“…there are currently no therapies to treat or prevent rhinovirus infections”

The study in JAMA Internal Medicine (Sept. 2, 2025) produced surprisingly good news. Let’s hope someone decides to expand this preliminary research to include far more patients. It would cool if an OTC nasal spray could help prevent colds, COVID and RSV (respiratory syncytial virus).

Could Nitric Oxide (NO) Be Another One of the New Treatments for COVID?

Have you ever heard of NO? Nitric oxide is an absolutely fascinating natural substance made by our bodies. We have frequently written about it for a variety of reasons:

Here are just a few of our articles about nitric oxide:

“Can You Lower Blood Pressure with Nitric Oxide?“

“Beet Juice Was Better Than a Drug for Lowering Blood Pressure“

“Show 1397: The Surprising Secrets of Sunlight’s Health Benefits“

“Power of Pomegranate to Promote Health“

You will learn that sun exposure helps create nitric oxide in the skin and allow it to circulate throughout the body. Our guest, dermatologist Richard Weller, describes the formation of nitric oxide and its distribution throughout the body thank to sun exposure. He believes that the UV-nitric oxide pathway is responsible for cardiovascular benefits and possibly enhanced immunity.

Inhaled Nitric Oxide: Another One of the New Treatments for COVID?

A different study tested the effects of inhaled nitric oxide against COVID-19. The investigators note that this gas is produced naturally in the body and is well-known as a vasodilator. It also has antiviral and anti-inflammatory properties.

A study published in ERJ Open Research (Aug. 26, 2025) was titled:

“Inhaled nitric oxide for the treatment of COVID-19: an open-label, parallel, randomised controlled trial”

The investigators note that nitric oxide is a gas that is produced naturally in the body and is well-known as a vasodilator. It also has antiviral and anti-inflammatory properties.

In this study, 55 patients hospitalized with COVID-associated pneumonia got inhaled nitric oxide (iNO) or usual care. Those who had up to 6 hours exposure to high-dose nitric oxide were released from the hospital more quickly and needed less supplemental oxygen.

According to the investigators, the inhaled nitric oxide treatment was safe and well tolerated. They suggest that this approach might be helpful against other pulmonary infections.

What About Ivermectin? Is it One of the New Treatments for COVID?

A lot of visitors to this website insist that ivermectin is a great drug against COVID. I have written a lot about this extraordinary medicine. There has certainly been a lot of confusion and conflicting research about this anti-parasitic drug. I have been concerned about the protocols that were established with early ivermectin trials against COVID. Researchers had no idea what the right dose or duration of treatment should have been.

An article in the journal Antibiotics (April 30, 2025) offers some fascinating insights into new treatments for COVID, especially ivermectin and another anti-parasite drug, mebendazole (Emverm):

“This meta-analysis evaluates the clinical efficacy of ivermectin and mebendazole in treating COVID-19 by analyzing their impact on viral clearance, symptom resolution, hospitalization duration, and safety profiles.”

The authors go on to explain why they were interested in ivermectin and mebendazole:

“Targeting the importin alpha/beta-1 nuclear transport proteins, which are necessary for viral replication, ivermectin has been shown in vitro to decrease SARS-CoV-2 replication. Ivermectin has also been demonstrated to alter the host immunological response, which may lessen the cytokine storm linked to severe COVID-19 by lowering the synthesis of pro-inflammatory cytokines. Ivermectin is a promising therapy option for COVID-19 because of these characteristics, especially while the illness is still in its early stages.

“Another anthelmintic medication [anti-worm/parasite drugs], mebendazole, is frequently used to treat parasitic infections like hookworm, whipworm, and pinworm. Similar to ivermectin, mebendazole has demonstrated anti-inflammatory and antiviral properties. Its antiviral activity against SARS-CoV-2 is multifaceted and is thought to arise from both direct antiviral effects and modulation of host cellular machinery.”

The conclusions of the meta-analysis:

“The COVID-19 pandemic has underscored the need for repurposing existing drugs to identify cost-effective and widely accessible treatments. This meta-analysis provides valuable insights into the potential role of anthelmintic drugs, particularly ivermectin and mebendazole, in the management of COVID-19. While ivermectin demonstrated some benefits in specific studies, the overall evidence remains inconclusive, warranting further research to establish its optimal dosing and patient selection criteria. Mebendazole, though less studied, showed promising results in reducing viral load and inflammatory markers, making it a potential candidate for further investigation.

“Despite these promising findings, the current evidence does not support the widespread clinical use of ivermectin or mebendazole for COVID-19 outside of well-designed clinical trials. Future research should focus on large-scale, multicenter RCTs [randomized controlled trials] with standardized dosing regimens and well-defined patient subgroups to clarify the efficacy of these drugs. Mechanistic studies exploring their antiviral and immunomodulatory effects could further enhance our understanding of their therapeutic potential.”

Final Words About New Treatments for COVID:

It is way past time that the world’s medical researchers make antiviral drug development their number 1 priority! Viruses are a huge threat to human health. It’s not just the acute infection that can be deadly. Survivors may suffer long-term consequences. If you haven’t read my recent article about this, here is your chance:

The Infection Factor: Rethinking Heart Disease and Dementia
Research links pathogens to heart attacks, strokes, and cognitive decline. Rethinking heart disease prevention could start with vaccination.

We do not have vaccines for all our dangerous viral diseases. And in our anti-vax culture, many people are not interested in vaccines. That’s why we need better antiviral medications.

When I first met with researchers at Burroughs Wellcome many decades ago to learn about their then-new drugs against herpes and HIV, they told me that the FDA was initially reluctant to approve antivirals. The agency feared that antivirals might be too toxic to humans. Those early FDA reviewers were wrong!

Antivirals such as acyclovir (Zovirax) and valacyclovir (Valtrex) are effective against herpes infections and surprisingly safe. Antiviral drugs against HIV/AIDS have saved countless lives. There are now many medications that can cure hepatitis. We have made good progress against viral diseases. But we need new and better antivirals against COVID as well as many other viral infections.

We wish investigators in the US were being well funded to pursue this research. In our view, other countries should also be pursuing new treatments for COVID and other viral diseases. We need a cure for the common cold and influenza!

Final, Final Words:

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