Chronic Rhinitis (cont.)

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What medications can be used to treat rhinitis and post-nasal drip?

In addition to measures noted above, medications may also be used for the treatment of rhinitis and post-nasal drip.

For allergic rhinitis and post-nasal drip many medications are used.

Steroid nasal sprays

The experts recommend using intra-nasal glucocorticoids (steroid sprays applied directly into the nose) as the first line of treatment. Steroids are known to be potent anti-inflammatory and anti-allergic agents and they are known to relieve most of the associated symptoms of runny and itchy nose, nasal congestion, sneezing, and post-nasal drip.

Their use must be monitored and tapered by the prescribing physician as long-term use may have significant side effects. Examples of the nasal steroids include:

These are generally used once or twice daily. It is recommended to tilt the head forward during the administration to avoid from spraying the back of the throat instead of the nose.

Oral steroids

These drugs [prednisone, methylprednisolone (Medrol), hydrocortisone (Hydrocortone, Cortef)] are highly effective in allergic patients. A patient can experience potential serious side effects when using these medications for extended periods, however. They are best used for the short-term management of allergic problems, and a physician must always monitor their use. These are reserved only for very severe cases that do not respond to the usual treatment with nasal steroids and antihistamines.

Antihistamines

Allergy medications, such as antihistamines, are also frequently used to allergic rhinitis and post-nasal drip. These are generally used as the second line of treatment after the nasal steroids or in combination with them. Histamines are naturally occurring chemicals released in response to an exposure to an allergen, which are responsible for the congestion, sneezing, and runny nose typical of an allergic reaction. Antihistamines are drugs that block the histamine reaction. These medications work best when given prior to exposure.

Antihistamines can be divided into two groups:

  1. Sedating, or first generation [diphenhydramine (Benadryl),chlorpheniramine (Chlor-Trimeton), clemastine (Tavist)]. Sedating antihistamines should be avoided in those patients who need to drive or use dangerous equipment.
  2. Non-sedating or second generation [loratadine (Claritin), cetirizine (Zyrtec),fexofenadine (Allegra)]. Non-sedating antihistamines can have serious drug interactions. Most of these are found over the counter.

There is also a nasal antihistamine preparation that has been shown to be very effective in treating allergic rhinitis, called azelastine nasal (Astelin).

Decongestant sprays

Examples of decongestant sprays include:

  • oxymetazoline (Afrin), and
  • phenylephrine (Neo-Synephrine)

Decongestant sprays quickly reduce swelling of nasal tissues by shrinking the blood vessels. They improve breathing and drainage over the short-term. Unfortunately, if they are used for more than a few days they can become highly addictive (rhinitis medicamentosa). Long-term use can lead to serious damage. Therefore, their use should limited to only 3 to 5 days.

Oral decongestants

Oral decongestants temporarily reduce swelling of sinus and nasal tissues leading to an improvement of breathing and a decrease in obstruction. They may also stimulate the heart and raise the blood pressure and should be avoided by patients who have high blood pressure, heart irregularities, glaucoma, thyroid problems, or difficulty in urination. The most common decongestant is pseudoephedrine (Sudafed).

Cromolyn sodium (Nasalcrom)

Cromolyn sodium (Nasalcrom) is a spray helps to stabilize allergy cells (mast cells) by preventing release of allergy mediators, like histamine. They are most effective if used before the start of allergy season or prior to exposure to a known allergen.

Montelukast (Singulair)

Montelukast (Singulair) is an agent that acts similar to antihistamine, although it is involved in another pathway in allergic response. It has been shown to be less beneficial than the steroid nasal sprays, but equally as effective as some of the antihistamines. It may be useful in patients who do not wish to use nasal sprays or those who have co-existing asthma.

Ipratropium (Atrovent nasal)

Ipratropium (Atrovent nasal) is used as a nasal spray and helps to control nasal drainage mediated by neural pathways. It will not treat an allergy, but it does decrease nasal drainage.

Mucus thinning agents

Mucus thinning agents are utilized to make secretions thinner and less sticky. They help to prevent pooling of secretions in the back of the nose and throat where they often cause choking. The thinner secretions pass more easily. Guaifenesin (Humibid, Fenesin, Organidin) is a commonly used formulation. If a rash develops or there is swelling of the salivary glands, they should be discontinued. Inadequate fluid intake will also thicken secretions. Increasing the amount of water consumed, and eliminating caffeine from the diet and the use of diuretics are also helpful.

Immunotherapy

Immunoptherapy treatment has a goal of reducing a person's response to an allergen. After identification of an allergen, small amounts are given back to the sensitive patient. Over time, the patient will develop blocking antibodies to the allergen and they become less sensitive and less reactive to the substance causing allergic symptoms. The allergens are given in the form of allergy shots or by delivery of the allergen under the tongue (sub-lingual therapy). Sublingual therapy has been more common in Europe. In either method, the goal is to interfere with the allergic response to specific allergens to which the patient is sensitive

Combinations

These drugs are made up of one or more anti-allergy medications. They are usually a combination of an antihistamine and a decongestant. Other common combinations include mucus thinning agents, anti-cough agents, aspirin, ibuprofen (Advil), or acetaminophen (Tylenol). They help to simplify dosing and often will work either together for even more benefit or have counteracting side effects that eliminate or reduce total side effects.

There are some combination nasal preparations available as well to target the tissue of the nose. The combination of azelastine and fluticasone (Dymista) combines a nasal anti-histamine and steroid to help provide relief of seasonal allergic rhinitis symptoms.

Medically Reviewed by a Doctor on 11/27/2013

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