What is the treatment for post nasal drip?

Treatment for Post Nasal Drip

First-generation antihistamine/decongestant combinations are the most effective first-line treatment for post nasal drip, with a minimum 3-week treatment course recommended for chronic cases. 1, 2

Treatment Algorithm Based on Underlying Cause

Non-Allergic Rhinitis-Related Post Nasal Drip

• First-line: First-generation antihistamine plus decongestant combination 1, 2
  • Effective combinations include dexbrompheniramine maleate plus sustained-release pseudoephedrine sulfate, and azatadine maleate plus sustained-release pseudoephedrine sulfate 2
  • To minimize sedation, start with once-daily dosing at bedtime for a few days before increasing to twice-daily therapy 3
• Alternative: Ipratropium bromide nasal spray for patients who don't respond to antihistamine/decongestant combinations or have contraindications 2

Allergic Rhinitis-Related Post Nasal Drip

• First-line: Nasal corticosteroids, antihistamines, and/or cromolyn 1, 2
• Additional options: Oral leukotriene inhibitors have shown efficacy in decreasing symptoms 1
• Note: Nonsedating antihistamines may be more effective for allergic rhinitis than for non-allergic rhinitis 1

Sinusitis-Related Post Nasal Drip

• For acute bacterial sinusitis: Antibiotics, intranasal corticosteroids, and decongestants 3
• For chronic sinusitis: Minimum 3 weeks of antibiotics effective against H. influenzae, mouth anaerobes, and S. pneumoniae; 3 weeks of oral antihistamine/decongestant; 5 days of nasal decongestant; followed by 3 months of intranasal corticosteroids 3, 2
• Consider endoscopic sinus surgery only for patients with documented chronic sinus infection refractory to medical therapy and with anatomic obstruction 2

Rhinitis Due to Physical or Chemical Irritants

• Avoidance of exposure, improved ventilation, filters, and personal protective devices 3

Rhinitis Medicamentosa

• Key treatment: Patient stopping or weaning off the offending agent (e.g., nasal oxymetazoline hydrochloride) 3
• Can be done one nostril at a time 3
• Consider antihistamine/decongestant or nasal corticosteroids during weaning 3

Adjunctive Treatments

Nasal Saline Irrigation

• Safe and effective for improving mucus clearance and enhancing ciliary activity 4
• More effective than saline spray in expelling secretions and improving quality of life 4
• Can be used as both a sole treatment and as an adjunct to other therapies 4
• Different delivery methods include pot, pulsatile irrigation, atomizer, bulb/syringe, squeeze bottle, and low-pressure irrigation (neti pot) 4

Expected Treatment Response and Duration

• Most patients will see improvement in cough within days to 2 weeks of initiating therapy 1
• For allergic rhinitis with post nasal drip, a 1-month trial of intranasal corticosteroids is recommended 2
• For chronic conditions, longer treatment courses are necessary 2

Side Effects to Monitor

• First-generation antihistamines: Dry mouth, transient dizziness, sedation 3
• More serious side effects: Insomnia, urinary retention (especially in older men), jitteriness, tachycardia, worsening hypertension, increased intraocular pressure in glaucoma patients 3, 2
• Decongestants: Insomnia, jitteriness, tachycardia, worsening hypertension 3
• Anticholinergic medications: Increased problems with urination, increased intraocular pressures in glaucoma 3

Common Pitfalls and Caveats

• Newer-generation antihistamines are less effective for non-allergic causes of post nasal drip cough 1, 2
• Some patients have "silent" post nasal drip with no obvious symptoms yet still respond to treatment 1, 2
• Failure to consider "silent" post nasal drip as a causative factor for chronic cough can lead to missed diagnoses 2
• Post nasal drip can sometimes be confused with other conditions like gastroesophageal reflux disease (GERD) 2
• For patients with severe or persistent post nasal drip that doesn't respond to conventional treatments, posterior nasal nerve ablation may be considered as a newer treatment option 5