Can I use Ipratropium (ipratropium) nasal spray for postnasal drip?

From the Guidelines

Yes, ipratropium bromide nasal spray can be used to treat postnasal drip, particularly when it's caused by allergic or non-allergic rhinitis. The typical dosage is 2 sprays (42 mcg) in each nostril 2-3 times daily. Ipratropium works by blocking acetylcholine receptors in the nasal passages, which reduces mucus secretion from the glands lining the nose, as shown in a study published in the Journal of Allergy and Clinical Immunology 1. This mechanism helps decrease the amount of nasal discharge that can lead to postnasal drip.

The medication begins working within minutes and can provide relief for up to 6 hours. Common side effects include nasal dryness, irritation, headache, and occasionally nosebleeds, with mild transient episodes of epistaxis (9%) and nasal dryness (5%) being the most frequently reported adverse events 1. It's essential to note that ipratropium nasal spray treats the symptoms but not the underlying cause of postnasal drip. If your symptoms persist beyond a few weeks or are accompanied by fever, facial pain, or foul-smelling discharge, you should consult a healthcare provider as these could indicate a more serious condition requiring different treatment.

Key points to consider when using ipratropium bromide nasal spray for postnasal drip include:

• The effectiveness of ipratropium bromide nasal spray in reducing rhinorrhea associated with eating (gustatory rhinitis) and cold-induced rhinitis 1
• The potential for increased efficacy when used concomitantly with antihistamines or intranasal corticosteroids without an increase in adverse events 1
• The importance of proper dosage and administration to minimize side effects and maximize therapeutic benefits.

From the FDA Drug Label

Ipratropium bromide nasal solution, 0. 03% does not relieve nasal congestion, sneezing, or postnasal drip associated with allergic or nonallergic perennial rhinitis. Ipratropium bromide 0.03% does not relieve nasal congestion, sneezing, or postnasal drip associated with allergic or nonallergic perennial rhinitis. There was no effect of ipratropium bromide 0. 03% on degree of nasal congestion, sneezing, or postnasal drip.

Ipratropium nasal spray is not indicated for postnasal drip. The FDA drug label explicitly states that ipratropium bromide nasal solution 0.03% does not relieve postnasal drip associated with allergic or nonallergic perennial rhinitis 2, 2, 2.

From the Research

Ipratropium Nasal Spray for Postnasal Drip

• Ipratropium nasal spray can be used to treat postnasal drip, as it has been shown to reduce nasal hypersecretion and improve symptoms of perennial allergic rhinitis 3, 4, 5.
• The spray works by blocking the action of acetylcholine, a neurotransmitter that stimulates nasal secretions, and has been found to be effective in reducing rhinorrhea and improving quality of life in patients with perennial allergic rhinitis 3, 5.
• However, the effect of ipratropium nasal spray on postnasal drip specifically may be modest, as one study found that both placebo and ipratropium bromide nasal spray induced a modest reduction of nasal congestion, sneezing, and postnasal drip 4.
• Another study found that ipratropium bromide significantly decreased the rhinorrhea of perennial allergic rhinitis, but no statistically significant differences occurred among treatment groups in duration or severity of postnasal drip, congestion, or sneezing 5.

Efficacy and Safety

• Ipratropium nasal spray has been found to be well-tolerated and not associated with serious drug-related adverse events or clinically significant anticholinergic side effects 3, 4, 5.
• The most common drug-related adverse events were nasal dryness, epistaxis/nose bleed, and increased rhinitis, but most adverse events were mild and resulted in drug discontinuation in less than 10% of patients 3.
• However, one study found that ipratropium potentiates inflammatory mechanisms when used in subjects with an allergy in the nasal mucosa, which may be a concern for some patients 6.

Alternative Treatments

• For patients with postnasal drip who do not respond to ipratropium nasal spray, other treatment options may be considered, such as posterior nasal nerve ablation, which has been found to be effective in reducing postnasal drip symptoms in some patients 7.