From the Guidelines
For a persistently runny nose, try an over-the-counter antihistamine like loratadine (Claritin) 10mg or cetirizine (Zyrtec) 10mg once daily, especially if allergies are the cause, as recommended by the most recent guidelines 1.
Treatment Options
The treatment for persistent rhinorrhea depends on the underlying cause, which can be allergic or nonallergic in nature.
- For allergic rhinitis, nasal steroid sprays such as fluticasone (Flonase) or triamcinolone (Nasacort), used as 1-2 sprays per nostril daily, can effectively reduce inflammation and mucus production 1.
- Saline nasal rinses using a neti pot or squeeze bottle once or twice daily can flush out irritants and thin mucus, providing relief from symptoms 1.
- Decongestants like pseudoephedrine (Sudafed) 30-60mg every 4-6 hours may help temporarily but shouldn't be used for more than 3-5 days to avoid rebound congestion, as cautioned by clinical guidelines 1.
When to Seek Medical Attention
If your runny nose persists beyond 7-10 days, is accompanied by fever, facial pain, or discolored discharge, consult a healthcare provider as this could indicate sinusitis or another condition requiring different treatment 1.
Underlying Cause
Persistent rhinitis often results from inflammation in the nasal passages, which these medications help reduce by blocking histamine receptors or decreasing inflammatory responses in the nasal tissues 1. In nonallergic rhinitis, intranasal corticosteroids and intranasal antihistamines may relieve both congestion and rhinorrhea associated with vasomotor rhinitis, while intranasal anticholinergics are useful in nonallergic rhinitis with predominant rhinorrhea 1. Avoiding aggravating irritants may be helpful, particularly in patients suspected to have vasomotor rhinitis, and discontinuation of nasal decongestant sprays and treatment with either intranasal or systemic corticosteroids may be necessary for patients with rhinitis medicamentosa 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 persistent rhinorrhea is Fluticasone Propionate Nasal Spray, USP, with a recommended dosage of:
- 100 mcg twice daily for patients with perennial nonallergic rhinitis
- 200 mcg once daily for adult patients, or an alternative 100 mcg twice daily regimen 2
From the Research
Treatment for Persistent Rhinorrhea
The treatment for persistent rhinorrhea depends on the underlying cause, which can be allergic or nonallergic rhinitis.
- For allergic rhinitis, first-line treatment for mild intermittent or mild persistent allergic rhinitis may include a second-generation H1 antihistamine (eg, cetirizine, fexofenadine, desloratadine, loratadine) or an intranasal antihistamine (eg, azelastine, olopatadine) 3.
- For persistent moderate to severe allergic rhinitis, treatment should be initiated with an intranasal corticosteroid (eg, fluticasone, triamcinolone, budesonide, mometasone) either alone or in combination with an intranasal antihistamine 3.
- In contrast, first-line therapy for patients with nonallergic rhinitis consists of an intranasal antihistamine as monotherapy or in combination with an intranasal corticosteroid 3.
- Corticosteroid nasal irrigations have been shown to be more effective than simple sprays in controlling symptoms and signs of chronic rhinosinusitis after sinus surgery 4.
- Other treatment options for allergic rhinitis include immunotherapy, leukotriene antagonists, and anti-immunoglobulin E therapy 5, 6.
Treatment Options
- Second-generation H1 antihistamines: cetirizine, fexofenadine, desloratadine, loratadine 3, 5
- Intranasal antihistamines: azelastine, olopatadine 3
- Intranasal corticosteroids: fluticasone, triamcinolone, budesonide, mometasone 3, 4, 5
- Immunotherapy 5, 6
- Leukotriene antagonists 5
- Anti-immunoglobulin E therapy 5
- Cromolyn derivates 6
- Systemic corticosteroid therapy (reserved for severe cases) 6