What medications are used to treat constant throat clearing?

Medications for Constant Throat Clearing

First-generation antihistamine-decongestant combinations are the most effective first-line treatment for constant throat clearing, particularly brompheniramine with sustained-release pseudoephedrine. 1

Understanding Throat Clearing

Constant throat clearing is commonly associated with Upper Airway Cough Syndrome (UACS), previously known as postnasal drip syndrome (PNDS). This condition involves the sensation of mucus accumulation in the throat that triggers the urge to clear the throat repeatedly.

Common Causes of Throat Clearing:

1. Upper Airway Cough Syndrome (UACS) - Most common cause
2. Gastroesophageal Reflux Disease (GERD) or Laryngopharyngeal Reflux (LPR)
3. Asthma or cough variant asthma
4. Post-viral inflammation
5. Chronic rhinosinusitis
6. Allergic rhinitis

Medication Treatment Algorithm

First-Line Treatment:

• First-generation antihistamine-decongestant combinations 1

  • Brompheniramine (6 mg twice daily) with sustained-release pseudoephedrine (120 mg twice daily)
  • Azatadine maleate (1 mg twice daily) with sustained-release pseudoephedrine (120 mg twice daily)

  Note: Newer generation non-sedating antihistamines (like loratadine, cetirizine) are NOT effective for throat clearing and should not be used 1

Second-Line Treatments (based on suspected etiology):

If UACS is suspected:

• Intranasal corticosteroids - Particularly if prominent upper airway symptoms are present 1, 2
• Ipratropium bromide nasal spray - Especially helpful when first-generation antihistamines are contraindicated (e.g., glaucoma, prostatic hypertrophy) 1

If GERD/LPR is suspected:

• Proton pump inhibitors (e.g., omeprazole 40 mg twice daily) with lifestyle modifications for 4-8 weeks 1, 2, 3
  • Lifestyle modifications include:
    • Avoiding heavy meals, fried foods, caffeine, and alcohol
    • Avoiding food and drink within 3 hours of bedtime
    • Elevating the head of the bed on 6-8 inch blocks

If asthma is suspected:

• Inhaled corticosteroids and bronchodilators for 4 weeks 1, 2
• Consider short course of oral corticosteroids for severe symptoms

For Refractory Cases:

• Neuromodulators like gabapentin may be considered for persistent throat clearing not responding to other treatments 2
• Speech pathology therapy for cough suppression techniques 2

Special Considerations

Ice Cold Carbonated Water Therapy

For persistent throat clearing without clear underlying cause, sipping ice cold carbonated water may help break the vicious cycle of throat clearing. This simple intervention has shown 63% improvement in symptom severity in an observational study 4.

Important Caveats:

1. GERD/LPR may not be the cause: Despite common belief, throat clearing has a low probability of being objectively associated with GERD. Studies show that only 13-22% of patients with throat clearing have a positive symptom index for reflux 5, 6.

2. Duration of treatment: Adequate duration of treatment is crucial, especially for GERD (4-8 weeks) and UACS (2-4 weeks) 2.

3. Combination symptoms: Patients reporting both throat clearing and cough are even less likely to have GERD as the underlying cause (only 8% positive symptom index) 6.

4. Medication review: Always review current medications, particularly ACE inhibitors, which can cause persistent throat clearing and should be discontinued regardless of temporal relationship to symptom onset 2.

Follow-up and Reassessment

If throat clearing persists despite appropriate first-line therapy for 2-4 weeks, reassess for other potential causes and consider referral to an otolaryngologist, especially if there are concerning symptoms such as voice changes, dysphagia, or unilateral symptoms 2.