What are the common oral medications for treating sore throat and rhinitis?

Oral Medications for Sore Throat and Rhinitis

Second-generation oral antihistamines and NSAIDs are the first-line oral medications for treating sore throat and rhinitis, with intranasal corticosteroids recommended for more severe cases of rhinitis. 1, 2

Medications for Rhinitis

First-Line Oral Medications for Rhinitis

1. Second-generation antihistamines

   • Preferred options: fexofenadine, loratadine, desloratadine
   • These medications effectively reduce rhinorrhea, sneezing, and itching associated with allergic rhinitis
   • They have minimal sedative effects at recommended doses 1, 3
   • Less effective for nasal congestion than for other nasal symptoms
   • Generally ineffective for nonallergic rhinitis syndromes

2. Oral decongestants

   • Examples: pseudoephedrine, phenylephrine
   • Effectively reduce nasal congestion
   • Often combined with antihistamines for better symptom control
   • Side effects: insomnia, irritability, palpitations, hypertension 1
   • Caution: Use with care in patients with cardiovascular disease, hypertension, glaucoma, hyperthyroidism, or bladder neck obstruction

3. Leukotriene receptor antagonists (LTRAs)

   • Example: montelukast
   • Useful for allergic rhinitis, especially when combined with antihistamines
   • Particularly beneficial for patients with both allergic rhinitis and asthma 1

Second-Line Oral Medications for Rhinitis

1. Oral corticosteroids
   • Reserved for very severe or intractable nasal symptoms or significant nasal polyposis
   • Short course (5-7 days) may be appropriate in severe cases
   • Single or recurrent administration of parenteral corticosteroids is discouraged due to potential side effects 1

Medications for Sore Throat

First-Line Oral Medications for Sore Throat

1. NSAIDs

   • Preferred option: ibuprofen (400 mg every 6-8 hours as needed)
   • Most effective for pain and fever management in sore throat 2, 4
   • Studies show ibuprofen 400 mg is more effective than acetaminophen 1000 mg for sore throat pain 4

2. Acetaminophen/Paracetamol

   • Alternative to NSAIDs (500-1000 mg every 4-6 hours as needed)
   • Recommended as first-line treatment for acute sore throat in some guidelines 5
   • Less effective than ibuprofen but has fewer contraindications 4

3. Antibiotics (for bacterial pharyngitis only)

   • First-line: Penicillin V (500 mg 2-3 times daily for 10 days in adults)
   • Alternatives for penicillin allergy:
     • Amoxicillin (50 mg/kg once daily, maximum 1000 mg) 6
     • Cephalexin (for non-anaphylactic penicillin allergy)
     • Clindamycin or macrolides (azithromycin, clarithromycin) for severe penicillin allergy 2, 7
   • Only indicated for confirmed streptococcal pharyngitis, not viral sore throat

Combination Approaches

1. For rhinitis with sore throat:

   • Second-generation antihistamine + NSAID
   • For severe congestion: Add pseudoephedrine

2. For allergic rhinitis with pain:

   • Studies show that the combination of ibuprofen/pseudoephedrine/chlorpheniramine provides superior relief of pain and allergy symptoms compared to pseudoephedrine/chlorpheniramine alone 8

Important Considerations

• Avoid first-generation antihistamines when possible due to sedation, performance impairment, and anticholinergic effects 1, 3
• Avoid aspirin in children due to risk of Reye syndrome 2
• Patient education is crucial for effective use of medications, especially for paracetamol/acetaminophen which is often underdosed by patients 5
• For severe rhinitis symptoms, intranasal corticosteroids are more effective than oral medications alone 1, 9

Common Pitfalls to Avoid

1. Overuse of decongestants - Can lead to rebound congestion (rhinitis medicamentosa)
2. Inappropriate antibiotic use for viral sore throats - Contributes to antibiotic resistance
3. Undertreatment with acetaminophen/paracetamol - Many patients don't take adequate doses or frequency
4. Using first-generation antihistamines during daytime - Can cause sedation and impair performance
5. Not addressing both components when rhinitis and sore throat co-occur

By selecting appropriate oral medications based on symptom severity and type, most cases of rhinitis and sore throat can be effectively managed with minimal side effects.