What are the treatments for nasal congestion and associated symptoms?

From the Guidelines

Nasal congestion can be effectively managed with a combination of saline nasal irrigation, over-the-counter medications like acetaminophen or ibuprofen for pain and inflammation, antihistamines for allergic symptoms, and nasal corticosteroid sprays for reducing inflammation. The treatment approach should be tailored to the cause and severity of the congestion. For mild to moderate congestion, saline nasal sprays or rinses can be used multiple times daily to flush irritants and thin mucus 1. Over-the-counter decongestants like pseudoephedrine or phenylephrine can provide temporary relief by reducing swelling in nasal passages, but should be used for no more than 3-5 days to avoid rebound congestion 1. For congestion with allergies, antihistamines such as loratadine (Claritin) or cetirizine (Zyrtec) can help by blocking histamine release, and are generally preferred over first-generation antihistamines due to their lower risk of side effects 1. Nasal corticosteroid sprays like fluticasone (Flonase) or mometasone (Nasonex) are typically the most effective medication class for controlling sneezing, itching, rhinorrhea, and nasal congestion, and can be used daily for longer periods 1. In cases of severe nasal polyposis, a short course of oral prednisone can be effective in reducing symptoms and polyp size, and maintaining the beneficial effects with subsequent administration of maintenance intranasal corticosteroids 1. It is essential to seek medical attention if congestion persists beyond 10 days, worsens, or is accompanied by high fever, severe headache, or facial pain, as these may indicate a bacterial infection requiring antibiotics or other underlying conditions. Additionally, staying hydrated, using a humidifier, and elevating your head while sleeping can provide additional relief. Some key points to consider when treating nasal congestion include:

• Using saline nasal irrigation to clear mucus and irritants
• Avoiding overuse of decongestants to prevent rebound congestion
• Choosing the right antihistamine or nasal corticosteroid spray based on the cause and severity of symptoms
• Considering combination products for allergy-related congestion
• Monitoring for potential side effects of medications, such as sedation or anticholinergic effects with antihistamines, or local side effects with nasal corticosteroids.

From the FDA Drug Label

CLINICAL TRIALS A total of 13 randomized, double-blind, parallel-group, multicenter, vehicle placebo-controlled clinical trials were conducted in the United States in adults and pediatric patients (4 years of age and older) to investigate regular use of Fluticasone Propionate Nasal Spray, USP, in patients with seasonal or perennial allergic rhinitis The studies demonstrated significantly greater reduction in TNSS (sum of nasal congestion, rhinorrhea, sneezing, and nasal itching) with Fluticasone Propionate Nasal Spray, USP, 200 mcg compared to placebo. Individualization of Dosage Patients should use Fluticasone Propionate Nasal Spray, USP, at regular intervals for optimal effect Adult patients may be started on a 200-mcg once-daily regimen (two 50-mcg sprays in each nostril once daily).

The treatments for nasal congestion and associated symptoms include:

• Nasal corticosteroid sprays like fluticasone (Flonase) at 200 mcg once daily (two 50-mcg sprays in each nostril once daily)
• Saline nasal irrigation using a neti pot or spray bottle with 1/4 teaspoon of salt in 8 ounces of distilled water
• Over-the-counter medications like acetaminophen (Tylenol) at 325-650mg every 4-6 hours or ibuprofen (Advil, Motrin) at 200-400mg every 6-8 hours to reduce pain and inflammation
• Antihistamines such as loratadine (Claritin) 10mg daily or cetirizine (Zyrtec) 10mg daily if allergies are contributing to symptoms 2

From the Research

Treatments for Nasal Congestion and Associated Symptoms

• Saline nasal irrigation using a neti pot or spray bottle with a saline solution can help clear mucus and irritants from the nasal passages 3, 4, 5
• Over-the-counter medications such as acetaminophen or ibuprofen can reduce pain and inflammation
• Antihistamines like loratadine or cetirizine may help if allergies are contributing to symptoms 6
• Nasal corticosteroid sprays like fluticasone or mometasone can reduce inflammation in the nasal passages 7, 6

Nasal Irrigation Devices

• Squeeze bottle nasal irrigation has been shown to be effective in reducing allergic rhinitis symptoms 3
• Neti Pot irrigation can deliver saline solution to the nasal cavity, especially on the contralateral side of irrigation 4
• Hypertonic saline nasal irrigation can improve sinus symptoms and quality of life, and decrease medication use in patients with frequent sinusitis 5

Medication Treatments

• Mometasone furoate nasal spray has been shown to be effective in treating seasonal allergic rhinitis, with or without combination with loratadine 6
• Loratadine can provide benefits for treating allergic rhinitis, but may not be as effective as mometasone furoate nasal spray 6
• Corticosteroid treatment, including nasal sprays and oral steroids, can reduce inflammation and improve nasal symptoms in patients with chronic rhinosinusitis 7