Nasal Allergy Medications (cont.)
Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Charles Patrick Davis, MD, PhD
Charles Patrick Davis, MD, PhD
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
In this Article
What are side effects of decongestants?
Topical sprays sometimes cause burning or dryness in the nose. The most notorious side effect of topical decongestants is rebound nasal congestion. The longer someone uses the spray, the less effective it becomes and the more they need to use it in order to obtain the desired effect (virtually an addictive quality if used excessively). After prolonged use, the spray begins to cause more congestion than it relieves. The only way to break this cycle is to stop the medication. If the cycle is not broken, permanent changes can occur on the nasal membranes, which lead to a condition known as rhinitis medicamentosa. Rhinitis medicamentosa refers to an inflammation in the nose that is caused by the use of medications. Symptoms include severe stuffiness, burning, bleeding, and dryness of the nose.
Side effects from oral decongestants are more common and potentially more dangerous. They can stimulate the nervous system causing palpitations, insomnia, nervousness, and irritability. Some people may have trouble with urination and a decreased appetite. Although frequently mentioned, high blood pressure is not commonly caused or worsened by these drugs. However, any concerns regarding the side effects of these drugs should be discussed with the doctor.
What about combination antihistamine/decongestant preparations?
Pharmacy shelves are packed with combination preparations. They are useful for runny, itchy, and stuffy noses and are available OTC or by prescription. The liquid preparations are convenient for children as well as the elderly who may need a lesser dosage than is available in tablet forms. 12- and 24-hour preparations are available to make taking the medications more practical. Interestingly, the stimulant effect of the decongestant may counteract the drowsiness effect of the antihistamine and make the combination well tolerated; however, this may not occur in everyone so caution is indicated.
Two broad categories of decongestants are available. Rapid release products need to be taken 3 to 4 times a day and provide a lower dose of both the antihistamine and decongestant. These medicines help people who are more troubled by side effects but they are less practical than the sustained release preparations, which need to be taken only once or twice per day.
Some combinations of these drugs may be more effective in some individuals, If an individual wants to try a new OTC antihistamine/decongestant combination, they should carefully read the label. Make sure the ingredients and the dosages are different from the ones they used to take. Otherwise, the person may be buying the same medication they took previously, only with a different name, color, shape, and price.
Nasal steroid sprays
Steroids are naturally-occurring hormones that are produced by the adrenal glands. The corticosteroids have potent anti-inflammatory effects and are very effective in treating allergic inflammation in the nose. They are a "controller" type medication and work best when used on a regular "preventative" basis. They are usually only available by prescription. With seasonal allergies, daily use of these sprays should begin 1 to 2 weeks before the allergy season and continue throughout the season. In people with relatively constant or perennial allergic rhinitis, particularly if symptoms have been unresponsive to OTC or other treatments, daily use of intranasal steroids has been found very effective in controlling symptoms, particularly nasal congestion. The addition of antihistamines to this nasal spray will likely give even better results.
Nasal steroids may also help improve the sense of smell, which is frequently diminished in allergic rhinitis. The medication may work by reducing swelling high up in the nose, where the area for smell is located. Decreasing the swelling allows more air (containing the odors) to reach the nerves that are responsible for the sense of smell.
Bag-like collections of fluid in the nasal membranes, called nasal polyps, are not uncommonly found in allergic rhinitis. Nasal steroids are helpful in shrinking nasal polyps and in preventing them from recurring.
Nasal steroids are available in two forms, aerosol and a spray pump (aqueous). The aerosol form resembles an asthma spray that delivers a predetermined dose of "dry" medication when activated. The more commonly used pump delivers a "water-based" spray, which may provide some moisturizing and soothing effect as well as an anti-inflammatory action. Patients who feel that the drip in their nose and throat increases when using the spray form may prefer the aerosol. In contrast, the spray is favored if the aerosol causes irritation or excessive drying of the nasal membranes.
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