From the Guidelines
Post nasal drip can be effectively managed with saline nasal irrigation and nasal corticosteroids, as evidenced by the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 1.
Management Options
- Saline nasal irrigation using a neti pot or squeeze bottle 1-2 times daily to flush out mucus and irritants
- Nasal steroid sprays such as fluticasone (1-2 sprays per nostril daily) or mometasone (2 sprays per nostril daily) to reduce inflammation and mucus production
- Over-the-counter antihistamines like loratadine (10mg daily) or cetirizine (10mg daily) if allergies are the cause
- Decongestants like pseudoephedrine (30-60mg every 4-6 hours) for short-term relief, but not for more than 3-5 days to avoid rebound congestion
- Mucolytics such as guaifenesin (400mg every 4 hours) to thin mucus and make it easier to clear
Lifestyle Changes
- Stay well-hydrated with 8-10 glasses of water daily to thin secretions
- Use a humidifier in the bedroom to moisten air, especially during winter or in dry climates
- Elevate the head while sleeping using extra pillows to prevent mucus accumulation in the throat
- Avoid known triggers like cigarette smoke, strong perfumes, and allergens
When to Consult a Healthcare Provider
If symptoms persist beyond 2-3 weeks despite these measures, consult a healthcare provider as persistent post nasal drip may indicate underlying conditions like chronic sinusitis, allergic rhinitis, or gastroesophageal reflux disease requiring specific treatment, as suggested by the clinical practice guideline on adult sinusitis 1 and the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 1.
From the FDA Drug Label
These 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 Two of these trials demonstrated that patients treated with Fluticasone Propionate Nasal Spray, USP, at a dosage of 100 mcg twice daily exhibited statistically significant decreases in TNSS compared with patients treated with vehicle.
Postnasal drip management can be achieved with Fluticasone Propionate Nasal Spray, USP, as it has been shown to decrease TNSS, which includes postnasal drip, in patients with perennial nonallergic rhinitis 2.
- The recommended dosage for adult patients is 200-mcg once-daily regimen (two 50-mcg sprays in each nostril once daily) or 100 mcg twice daily (one 50-mcg spray in each nostril twice daily).
- Pediatric patients (4 years of age and older) should be started with 100 mcg (1 spray in each nostril once daily).
From the Research
Post Nasal Drip Management
- Post nasal drip is a common symptom of seasonal allergic rhinitis (SAR) and can be managed with various treatments, including azelastine nasal spray and oral cetirizine 3.
- Azelastine nasal spray has been shown to be effective in reducing nasal symptoms, including rhinorrhea, sneezing, itchy nose, and nasal congestion, in patients with moderate to severe SAR 3.
- The study found that azelastine nasal spray produced a significantly greater improvement in the 12-hour reflective total nasal symptom score (TNSS) compared to cetirizine, with a 29.3% improvement versus 23.0% improvement, respectively 3.
- Azelastine nasal spray also had a faster onset of action, with significant improvements in the instantaneous TNSS at 60 and 240 minutes after the initial dose, compared to cetirizine 3.
- In addition to reducing nasal symptoms, azelastine nasal spray also improved quality of life, as measured by the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), with significant improvements in all domains and an overall RQLQ score 3.