What is the treatment for post nasal drip syndrome?

From the Guidelines

Post nasal drip syndrome can be effectively treated with saline nasal irrigation, as recommended by the most recent and highest quality study 1.

Treatment Approaches

The treatment of post nasal drip syndrome depends on the underlying cause, and the following approaches can be considered:

• Saline nasal sprays or rinses like NeilMed Sinus Rinse or a neti pot, used 1-2 times daily to flush mucus and irritants from nasal passages
• Over-the-counter antihistamines such as loratadine (10mg daily) or cetirizine (10mg daily) if allergies are causing the drip
• Nasal steroid sprays like fluticasone (1-2 sprays per nostril daily) to reduce inflammation and mucus production
• Decongestants such as pseudoephedrine for short-term relief, but not for more than 3-5 days to avoid rebound congestion
• Mucus-thinning medications like guaifenesin (400mg every 4 hours) to make mucus easier to clear

Lifestyle Modifications

Lifestyle modifications are also important:

• Stay hydrated with 6-8 glasses of water daily
• Use a humidifier in dry environments
• Avoid known allergens
• Elevate your head while sleeping
• Avoid irritants like smoke

Recommendation

The most effective treatment for post nasal drip syndrome is saline nasal irrigation, as it improves nasal mucosa function and reduces symptoms 1. If symptoms persist beyond 2-3 weeks despite these measures, consult a healthcare provider as prescription medications or further evaluation may be needed. The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 recommends nasal saline irrigation as an important aspect of the management of CRS, as it improves nasal mucosa function and reduces symptoms 1. Additionally, the clinical practice guideline (update): adult sinusitis recommends saline nasal irrigation, topical intranasal corticosteroids, or both for symptom relief of CRS 1.

From the FDA Drug Label

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. 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 post nasal drip syndrome is Fluticasone Propionate Nasal Spray, USP, with a recommended dosage of 100 mcg twice daily for adult patients, and 100 mcg (1 spray in each nostril once daily) for pediatric patients (4 years of age and older) 2.

• Key points:
  • The dosage can be adjusted based on individual patient response.
  • The maximum total daily doses should not exceed 2 sprays in each nostril (total dose, 200 mcg/day).
  • There is no evidence that exceeding the recommended dose is more effective.

From the Research

Treatment Options for Post Nasal Drip Syndrome

• The treatment for post nasal drip syndrome can vary depending on the underlying cause, with options including:
  • Azelastine nasal spray, which has been shown to be effective in reducing nasal symptoms associated with rhinitis, including post-nasal drip 3, 4, 5
  • Fluticasone propionate nasal spray, which can be used alone or in combination with azelastine nasal spray to improve symptoms 3, 4, 6
  • Other treatments such as flushing the nasal cavity with herbal liquid, using glucocorticoid locally, taking medicine to improve the sticky film cilium function, immunotherapeutic, or operation may be considered depending on the cause of the postnasal drip syndrome 7

Causes of Post Nasal Drip Syndrome

• The causes of postnasal drip syndrome can be complex and varied, including:
  • Chronic rhinitis 7
  • Chronic sinusitis or nasal polyp 7
  • Allergic rhinitis 3, 7, 4
  • Adenoid vegetation 7
  • Chronic nasopharyngitis 7
  • Vasomotor (perennial nonallergic) rhinitis 5

Effectiveness of Treatment

• Studies have shown that treatment with azelastine nasal spray and fluticasone propionate nasal spray can be effective in reducing symptoms of postnasal drip syndrome, with significant improvements in total nasal symptom score (TNSS) and total vasomotor rhinitis symptom score (TVRSS) 3, 4, 5
• Combination therapy with azelastine hydrochloride nasal spray and fluticasone propionate nasal spray may provide a substantial therapeutic benefit for patients with seasonal allergic rhinitis compared with therapy with either agent alone 4
• Treatment targeted towards rhinosinusitis accompanying postnasal drip syndrome and chronic cough may lead to an improvement in cough, although further studies are needed to confirm these findings 6