What medications and sprays can be used to treat congested turbinates?

From the Guidelines

For treating congested turbinates, the most effective treatment is the use of intranasal corticosteroids, such as fluticasone (Flonase), mometasone (Nasonex), or budesonide (Rhinocort), which are used once or twice daily to reduce inflammation, as recommended by the 2017 joint task force on practice parameters 1.

Treatment Options

• Intranasal corticosteroids: These are the first-line treatments for congested turbinates, used once or twice daily to reduce inflammation.
• Saline nasal sprays or irrigation: These can be used multiple times daily to moisturize nasal passages and flush out irritants.
• Oral or topical decongestants: Such as oxymetazoline (Afrin), provide quick relief but should be limited to 3 days maximum to prevent rebound congestion, as cautioned by the package insert for oxymetazoline nasal spray 1.
• Antihistamines: Like loratadine (Claritin) or cetirizine (Zyrtec), can help if allergies are causing the congestion, taken once daily.

Important Considerations

• The use of oral decongestants, such as pseudoephedrine or phenylephrine, should be done with caution, especially in patients with certain medical conditions, such as hypertension, arrhythmias, or glaucoma, as noted in the 2008 update of the Joint Task Force's rhinitis practice parameter 1.
• Topical decongestants can cause local stinging or burning, sneezing, and dryness of the nose and throat, and their use should be limited to short-term treatment, as advised by the 2008 update of the Joint Task Force's rhinitis practice parameter 1.

Lifestyle Modifications

• Using a humidifier to add moisture to the air
• Elevating the head while sleeping to reduce congestion
• Avoiding known allergens or irritants to prevent exacerbation of symptoms

Persistent Cases

• Prescription options, such as ipratropium bromide nasal spray or montelukast (Singulair), may be necessary for persistent cases.
• Medical evaluation is recommended if symptoms persist beyond 7-10 days despite treatment, as structural issues may require additional intervention, as suggested by the 2017 joint task force on practice parameters 1.

From the FDA Drug Label

Fluticasone Propionate Nasal Spray, USP relieves allergy symptoms caused by pollen, mold, dust and pets. Fluticasone Propionate Nasal Spray, USP not only relieves sneezing, itchy nose, runny nose and itchy, watery eyes, but also relieves nasal congestion. 24 HOUR Relief of: • Itchy, Watery Eyes • Nasal Congestion • Runny Nose • Itchy Nose • Sneezing

Medications and Sprays to Use:

• Fluticasone Propionate Nasal Spray, USP can be used to relieve nasal congestion and other allergy symptoms.
• It is a glucocorticoid that works directly in the nose to help block allergic reactions.
• Key Benefits:
  • Relieves nasal congestion
  • Relieves itchy, watery eyes
  • Relieves runny nose
  • Relieves itchy nose
  • Relieves sneezing
• Important: Always follow the instructions on the label and consult a doctor if you have any questions or concerns 2 2

From the Research

Medications for Congested Turbinates

• Azelastine nasal spray is a second-generation antihistamine that can be used to treat allergic and nonallergic rhinitis, which may help alleviate congested turbinates 3.
• Oxymetazoline nasal spray is a vasoconstrictor that can help relieve nasal obstructive symptoms by reducing the size of the turbinates 4.
• Fluticasone propionate aqueous nasal spray is a corticosteroid that can help reduce inflammation and swelling in the nasal passages, including the turbinates 5.

Sprays for Congested Turbinates

• Azelastine nasal spray can be used as needed or as a fixed dose, and it has been shown to be effective in reducing symptoms of allergic rhinitis 3.
• Oxymetazoline nasal spray can be used to provide quick relief from nasal congestion, but it should not be used for more than 3-5 days to avoid rebound congestion 4.
• Fluticasone propionate nasal spray can be used alone or in combination with azelastine to provide long-term relief from nasal congestion and inflammation 5, 6.

Combination Therapy

• Combining azelastine and fluticasone propionate nasal sprays may provide better relief from symptoms of allergic rhinitis than using either medication alone 3, 6.
• The combination of azelastine and fluticasone propionate nasal sprays has been shown to be effective in reducing symptoms of persistent allergic rhinitis 6.

Important Considerations

• The distribution of nasal sprays to the middle meatus can be affected by inferior turbinate hypertrophy, and reducing the size of the turbinates may improve the efficacy of topical nasal therapy 7.
• It is essential to follow the instructions for use and dosage recommendations for each medication to ensure safe and effective treatment of congested turbinates.