From the Guidelines
To manage post nasal drip, nasal corticosteroids are effective in reducing total symptom score, although the effect is small, and can be considered when reduction of symptoms is necessary 1. Post nasal drip is the sensation of mucus draining from the back of your nose into your throat, causing discomfort and often a persistent cough.
Causes and Management
- The cause of post nasal drip can be allergies, infections, or irritants, leading to excess mucus production in the sinuses, which then drains down the throat instead of out the nose.
- To manage post nasal drip, start with saline nasal sprays or rinses like NeilMed twice daily to thin mucus and flush irritants.
- Over-the-counter antihistamines such as loratadine (10mg daily) or cetirizine (10mg daily) can help if allergies are the cause.
- For inflammation, try nasal steroid sprays like fluticasone (1-2 sprays per nostril daily) for at least 2-3 weeks for full effect, as studies have shown a significant decrease in total symptom score and headache, congestion, and facial pain compared with placebo 1.
Lifestyle Changes
- Stay hydrated with 8-10 glasses of water daily to thin mucus, and use a humidifier at night to moisten dry air.
- Avoid dairy products, alcohol, and spicy foods which can worsen symptoms.
- Elevating your head while sleeping can prevent mucus accumulation.
When to Consult a Healthcare Provider
- If symptoms persist beyond 10 days, worsen, or include fever or colored discharge, consult a healthcare provider as this could indicate sinusitis or another condition requiring antibiotics or further treatment.
- Antibiotics should not be prescribed for post-viral rhinosinusitis in adults, as there is no benefit and more adverse events 1.
From the FDA Drug Label
The trials evaluated the patient-rated TNSS (nasal obstruction, postnasal drip, rhinorrhea) in patients treated for 28 days of doubleblind therapy and in 1 of the 3 trials for 6 months of open-label treatment Astelin® Nasal Spray significantly improved a symptom complex comprised of rhinorrhea, post nasal drip, nasal congestion, and sneezing. Astelin® Nasal Spray is indicated for the treatment of the symptoms of vasomotor rhinitis, such as rhinorrhea, nasal congestion and postnasal drip in adults and children 12 years and older.
Postnasal drip can be treated with fluticasone propionate nasal spray and azelastine nasal spray.
- Fluticasone propionate nasal spray has been shown to decrease the total nasal symptom score (TNSS) which includes postnasal drip in patients with perennial nonallergic rhinitis 2.
- Azelastine nasal spray has been shown to significantly improve a symptom complex comprised of rhinorrhea, postnasal drip, nasal congestion, and sneezing in patients with vasomotor rhinitis 3.
- Azelastine nasal spray is indicated for the treatment of the symptoms of vasomotor rhinitis, such as rhinorrhea, nasal congestion and postnasal drip in adults and children 12 years and older 3.
From the Research
Post Nasal Drip Treatment
- Azelastine nasal spray has been shown to improve nasal symptoms associated with rhinitis, including post-nasal drip 4.
- The spray has a rapid onset of action and is effective at a lower dose of 1 spray per nostril twice daily, with an improved tolerability profile compared to the 2-spray per nostril twice daily regimen 4.
- Combination therapy with azelastine nasal spray and fluticasone propionate nasal spray has been found to exhibit greater efficacy than either agent used alone in treating seasonal allergic rhinitis, which may include post-nasal drip as a symptom 5.
Comparison of Treatments
- A study comparing loratadine-pseudoephedrine and fluticasone nasal spray for allergic rhinitis found that the oral antihistamine-pseudoephedrine combination had a faster onset of action and greater improvement in nasal airflow than the intranasal corticosteroid spray 6.
- However, azelastine nasal spray has been shown to have a faster onset of action and superior efficacy to oral antihistamines in alleviating nasal congestion and post-nasal drip 4.
Efficacy and Safety
- Azelastine nasal spray is well-tolerated in both adults and children with allergic rhinitis, with bitter taste being the most common side effect reported by patients 4.
- The combination of azelastine nasal spray and fluticasone propionate nasal spray has been found to be well-tolerated, with no significant increase in side effects compared to either agent used alone 5.