From the Guidelines
Post nasal drip is caused by excessive mucus production in the nasal passages that drips down the back of the throat, often resulting from allergies, sinus infections, colds, or environmental irritants, and the most effective treatment approach is to address the underlying cause with a combination of medications and lifestyle changes. The diagnosis of postnasal drip syndrome (PNDS) is based on a combination of symptoms, physical examination, radiographic findings, and response to specific therapy, as there is no objective test for it 1. Treatment depends on the underlying cause but typically includes:
- Over-the-counter antihistamines like loratadine (10mg daily) or cetirizine (10mg daily) for allergy-related drip
- Nasal saline rinses using a neti pot or squeeze bottle with sterile saline solution to flush irritants and thin mucus
- Nasal steroid sprays such as fluticasone (1-2 sprays per nostril daily) to reduce inflammation and mucus production, particularly for allergic causes
- For thick mucus, guaifenesin (400mg every 4-6 hours) can help thin secretions
- Staying hydrated with 8-10 glasses of water daily to thin mucus naturally
- Using a humidifier in the bedroom to moisten dry air that contributes to irritation Recent studies have shown that short courses of systemic corticosteroids can be effective in treating patients with chronic rhinosinusitis with nasal polyps (CRSwNP), with significant improvements in symptoms, nasal airflow, and polyp size 1. However, it is essential to note that if symptoms persist beyond 10 days or are accompanied by fever, facial pain, or discolored discharge, it is crucial to see a doctor as antibiotics may be needed for bacterial infections. In terms of specific treatment regimens, a study by Kirtsreesakul (2012) found that oral prednisolone 50 mg daily for 14 days followed by mometasone furoate nasal spray at 200 micrograms twice daily for 10 weeks resulted in significant improvements in nasal symptoms, nasal airflow, and polyp size compared to placebo 1. Ultimately, the most effective treatment approach will depend on the individual patient's underlying cause of postnasal drip and may require a combination of medications and lifestyle changes.
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 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 cause of postnasal drip is not directly addressed in the label. The treatment of postnasal drip with Fluticasone Propionate Nasal Spray, USP is to decrease the symptom, with a recommended dosage of 100 mcg twice daily for adult patients, which has shown statistically significant decreases in TNSS compared to vehicle 2.
From the Research
Cause of Post Nasal Drip
- Postnasal drip (PND) is a common complaint in primary care and ear-nose-throat offices, and is often, but not always, associated with chronic cough 3
- The traditional pathophysiology of PND related to sinonasal disease does not clearly lead to chronic cough, and the cough from PND may be related to an airway sensory hypersensitivity rather than actual irritation from inflamed nasal secretions 3
Treatment of Post Nasal Drip
- Intranasal corticosteroids, such as mometasone furoate nasal spray, are effective in treating seasonal allergic rhinitis, which can be a cause of postnasal drip 4, 5, 6
- Combination therapy with an intranasal corticosteroid and an antihistamine, such as loratadine, may provide benefits similar to monotherapy with an intranasal corticosteroid 4, 5
- Fluticasone propionate nasal spray has been shown to be effective in reducing nasal symptoms and improving quality of life in patients with seasonal allergic rhinitis 5, 6
- A single dose of loratadine-pseudoephedrine tablet can quickly and significantly improve nasal airflow after allergen exposure, whereas fluticasone propionate nasal spray did not display this same benefit 7