What medications can stop a runny nose?

Medications to Stop a Runny Nose

Intranasal corticosteroids are the most effective first-line treatment for stopping a runny nose, with intranasal anticholinergics like ipratropium bromide being particularly effective for rhinorrhea (runny nose) specifically. 1, 2

First-Line Treatments

Intranasal Corticosteroids

• Most effective overall treatment for nasal symptoms including rhinorrhea
• Options include:
  • Fluticasone propionate (Flonase) - approved for adults and children ≥4 years 3
  • Mometasone furoate (Nasonex) - approved for children ≥2 years 2
  • Budesonide - approved for children ≥6 years 2
• Dosing: Usually 1-2 sprays per nostril once daily 3
• Onset: May begin working within 12 hours, but maximum effect takes several days 3
• Side effects: Minimal when used correctly; may include nasal irritation or occasional bleeding 1

Intranasal Anticholinergics

• Ipratropium bromide nasal spray is specifically effective for rhinorrhea (runny nose) 1
• Does not affect other nasal symptoms like congestion or itching 1
• Particularly useful for nonallergic rhinitis with predominant rhinorrhea (e.g., gustatory rhinitis) 1
• Side effects: Minimal; may include nasal dryness 1

Second-Line Treatments

Intranasal Antihistamines

• Examples: Azelastine, olopatadine 2
• Effective for both allergic and nonallergic rhinitis 1
• Rapid onset of action makes them suitable for as-needed use 1
• Side effects: May include bitter taste and potential sedation 2

Oral Antihistamines

• Second-generation (non-sedating) options are preferred:
  • Cetirizine, fexofenadine, loratadine, desloratadine 1, 4
• More effective for sneezing, itching, and rhinorrhea than for nasal congestion 1
• Less effective than intranasal corticosteroids for nasal symptoms 1
• Avoid first-generation antihistamines (diphenhydramine, chlorpheniramine) due to sedation and performance impairment 1, 5

Treatment Algorithm Based on Symptom Type

For Allergic Rhinitis with Runny Nose:

1. Start with intranasal corticosteroid (e.g., fluticasone) 2
2. If rhinorrhea persists, add ipratropium bromide nasal spray 1
3. For rapid relief or as-needed use, consider intranasal antihistamine 1

For Nonallergic Rhinitis with Runny Nose:

1. Ipratropium bromide nasal spray is particularly effective 1, 6
2. Intranasal corticosteroids may also help 6
3. Oral antihistamines are generally NOT effective for nonallergic rhinitis 1, 6

Special Considerations

For Short-Term/Immediate Relief:

• Intranasal antihistamines provide faster onset of action than intranasal corticosteroids 1
• Ipratropium bromide works quickly for rhinorrhea specifically 1

For Decongestants:

• Oral decongestants (pseudoephedrine) may help with congestion but have minimal effect on rhinorrhea 1
• Topical decongestants should NOT be used for more than 3 days due to risk of rebound congestion (rhinitis medicamentosa) 1, 7

Common Pitfalls to Avoid

1. Using first-generation antihistamines, which cause sedation and impairment even when sedation is not subjectively perceived 1, 5
2. Using topical decongestants for more than 3 days, which can lead to rebound congestion 1, 7
3. Relying on oral antihistamines for nonallergic rhinitis, which is generally ineffective 1, 6
4. Expecting immediate relief from intranasal corticosteroids, which may take several days to reach maximum effectiveness 3
5. Using single or recurrent administration of parenteral (injectable) corticosteroids, which should be discouraged due to potential long-term side effects 1

For optimal treatment of a runny nose, intranasal corticosteroids provide the best overall relief for most patients, while ipratropium bromide nasal spray specifically targets rhinorrhea with minimal side effects.