What are the treatment options for postnasal drip (PND)?

From the Guidelines

Post nasal drainage can be effectively treated with a combination of over-the-counter medications and home remedies, with nasal steroid sprays being the most effective medication class for controlling symptoms, as recommended by the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 1.

Treatment Options

• Start with saline nasal sprays or rinses like NeilMed Sinus Rinse or a neti pot used 1-2 times daily to flush mucus and irritants from the nasal passages, as suggested by the clinical practice guideline on adult sinusitis 1.
• For medication options, try an oral antihistamine such as loratadine (Claritin) 10mg daily or cetirizine (Zyrtec) 10mg daily if allergies are contributing to your symptoms, as recommended by the diagnosis and management of rhinitis: an updated practice parameter 1.
• Nasal steroid sprays like fluticasone (Flonase) or triamcinolone (Nasacort), used as 1-2 sprays per nostril once daily, can reduce inflammation and mucus production, as recommended by the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 1.
• Decongestants such as pseudoephedrine (Sudafed) 30-60mg every 4-6 hours can provide temporary relief but shouldn't be used for more than 3 days to avoid rebound congestion, as warned by the diagnosis and management of rhinitis: an updated practice parameter 1.

Additional Measures

• Staying hydrated helps thin mucus secretions, while sleeping with your head elevated can prevent mucus from pooling in the back of your throat.
• Avoid known irritants like cigarette smoke, strong perfumes, and allergens.
• If symptoms persist beyond 10 days, worsen, or are accompanied by fever or facial pain, consult a healthcare provider as you may need prescription medications or have an underlying condition requiring specific treatment.

From the FDA Drug Label

Three randomized, double-blind, parallel- group, vehicle placebo-controlled trials were conducted in 1,191 patients to investigate regular use of Fluticasone Propionate Nasal Spray, USP, in patients with perennial nonallergic rhinitis 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.

The treatment for postnasal drainage is Fluticasone Propionate Nasal Spray, USP, which has been shown to decrease symptoms of perennial nonallergic rhinitis, including postnasal drip, in clinical trials 2.

• The recommended dosage is 100 mcg twice daily.
• The treatment has been shown to be effective in reducing symptoms of postnasal drip and other nasal symptoms.

From the Research

Post Nasal Drainage Treatment Options

• Treatment for postnasal drainage often involves addressing the underlying cause of the condition, such as allergic rhinitis or sinusitis.
• According to a study published in 2000 3, a fixed-combination loratadine/pseudoephedrine sulfate was found to be effective in relieving nasal congestion in patients with seasonal allergic rhinitis.
• The study found that treatment led to statistically significant reductions in the amount of nasal edema and nasal secretions, and alleviated nasal and ocular symptoms of rhinoconjunctivitis.

Pathophysiology and Management

• A 2016 article 4 describes the pathophysiology and management of postnasal drip, highlighting that it is often associated with chronic cough, but the traditional pathophysiology of postnasal drip related to sinonasal disease does not clearly lead to chronic cough.
• The article suggests that the cough from postnasal drip may be related to an airway sensory hypersensitivity rather than actual irritation from inflamed nasal secretions.

Comparative Nasal Airflow Studies

• A 2021 study 5 compared the effects of loratadine-pseudoephedrine and fluticasone nasal spray on nasal airflow in patients with allergic rhinitis.
• The study found that a single dose of loratadine-pseudoephedrine resulted in a significant improvement in nasal airflow, with a 31% increase in peak nasal inspiratory flow, whereas fluticasone propionate nasal spray did not produce a significant change.
• The results suggest that loratadine-pseudoephedrine may be a more effective treatment option for improving nasal airflow in patients with allergic rhinitis, as evidenced by the study 5 and supported by earlier research 3.