What oral medication can a person with glaucoma take for a runny nose?

Safe Oral Medications for Runny Nose in Patients with Glaucoma

For patients with glaucoma suffering from runny nose, second-generation antihistamines such as fexofenadine or loratadine are the safest oral medication options as they do not have anticholinergic effects that could worsen glaucoma. 1

Understanding the Concern with Glaucoma

Patients with glaucoma must avoid medications with anticholinergic properties, which can:

• Increase intraocular pressure (IOP)
• Precipitate acute angle-closure glaucoma
• Worsen existing glaucoma 1

Safe Medication Options for Runny Nose

First-line Options:

• Second-generation (non-sedating) antihistamines:
  • Fexofenadine (Allegra)
  • Loratadine (Claritin) 2
  • Desloratadine

These medications are specifically noted in guidelines to "not cause sedation at recommended doses" and importantly, lack significant anticholinergic effects that could worsen glaucoma 1.

Avoid These Medications:

• First-generation antihistamines (diphenhydramine, chlorpheniramine) - have strong anticholinergic effects that can precipitate or worsen glaucoma 1
• Oral decongestants (pseudoephedrine, phenylephrine) - can increase IOP and are specifically contraindicated in glaucoma 1, 3
• Combination products containing both antihistamines and decongestants 1

Treatment Algorithm

1. For mild runny nose:

   • Start with fexofenadine or loratadine at standard dosing
   • Loratadine 10mg once daily 2
   • Consider nasal saline irrigation as a safe adjunct therapy 1

2. If inadequate response:

   • Consider intranasal ipratropium bromide (Atrovent nasal spray) WITH A MOUTHPIECE to avoid eye contact
   • The guidelines specifically state: "Because glaucoma may be worsened by ipratropium, the use of a mouthpiece should be considered" 1

3. For severe symptoms:

   • Consider referral to an allergist for evaluation for possible allergen immunotherapy if symptoms are allergic in nature 1

Important Precautions

• Always use the lowest effective dose of any medication
• Avoid eye contact with nasal sprays containing anticholinergic agents
• If using intranasal ipratropium, use a mouthpiece applicator to prevent spray from contacting the eyes 1
• Monitor for any changes in vision or eye discomfort, which could indicate worsening glaucoma

Efficacy Considerations

Second-generation antihistamines are effective for most symptoms of allergic rhinitis, though they may be less effective for nasal congestion than for other nasal symptoms 1. They have a relatively rapid onset of action, making them appropriate for as-needed use in episodic rhinitis 1.

Remember that these medications primarily treat allergic causes of runny nose. If symptoms persist or are severe, further evaluation may be needed to determine if the runny nose is due to non-allergic causes that may require different management approaches.