Drugs acting on the Nose

Drugs used in nasal allergy

Mild allergic rhinitis is controlled by antihistamines or topical nasal corticosteroids; systemic nasal decongestants are of doubtful value. Topical nasal decongestants can be used for a short period to relieve congestion and allow penetration of a topical nasal corticosteroid.

More persistent symptoms and nasal congestion can be relieved by topical nasal corticosteroids or cromoglicate (cromoglycate); although it may be less effective, cromoglicate is often the first choice in children.

LEVOCABASTINE:

Indications: Short term symptomatic treatment of seasonal allergic rhinitis e.g. sneezing, itchy nose, and rhinorrhoea.

Contraindications: Hypersensitivity to any of the ingredients. Safety in pregnancy and lactation has not been established.

Dose and Administration: The usual dose is 2 puffs of Levocabastine per nostril, twice daily for up to 8 weeks. CHILDREN 6 MONTHS TO 5 YEARS: The usual dose is 1 puff of Levocabastine per nostril, twice daily for up to 4 weeks.

BUDESONIDE:

Indications: Seasonal and perennial allergic rhinitis and vasomotor rhinitis. Treatment of nasal polyps.

Contraindications: Hypersensitivity to any of the ingredients. Not recommended for children.

Dose and Administration: Two applications of 64 micrograms into each nostril each morning or if good effect is achieved, one application of 64 micrograms. Or one application of 64 micrograms into each nostril morning and evening.

FLUTICASONE PROPIONATE:

Indications: for the regular treatment of nasal polyps and associated symptoms of nasal obstruction.

Contraindications: contra-indicated in patients with a history of hypersensitivity to the active substance or to any of the excipients.

Dose and Administration: The contents of one container (400 micrograms) to be instilled once or twice daily. The dose should be divided between the affected nostrils. There are insufficient data at present to recommend the use of fluticasone propionate in children less than 16 years.

FLUTICASONE FUROATE:

Indications: indicated for the treatment of: the symptoms of allergic rhinitis.

Contraindications: contra-indicated in patients with a history of hypersensitivity to the active substance or to any of the excipients.

Dose and Administration: The recommended starting dose is two spray actuations (27.5 micrograms of fluticasone furoate per spray actuation) in each nostril once daily (total daily dose, 110 micrograms). Once adequate control of symptoms is achieved, dose reduction to one spray actuation in each nostril (total daily dose 55 micrograms) may be effective for maintenance. Children (6  to 11 years of age) The recommended starting dose is one spray actuation (27.5 micrograms of fluticasone furoate per spray actuation) in each nostril once daily (total daily dose, 55 micrograms).

MOMETASONE FUROATE:

Indications: indicated for use in adults and children 12 years of age and older to treat the symptoms of seasonal allergic or perennial rhinitis. NASONEX Nasal Spray is also indicated for use in children 6 to 11 years of age to treat the symptoms of seasonal allergic or perennial allergic rhinitis.

Contraindications: Hypersensitivity to any of the ingredients. Also should not be used in the presence of untreated localised infection involving the nasal mucosa.

Dose and Administration: Adults (including geriatric patients) and children 12 years of age and older: The usual recommended dose is two actuations (50 micrograms/actuation) in each nostril once daily (total dose 200 micrograms). Once symptoms are controlled, dose reduction to one actuation in each nostril (total dose 100 micrograms) may be effective for maintenance. Under 6 years, not recommended; 6 – 11 years, one spray in each nostril once daily; over 12 years, as for adults.

Topical nasal decongestants

Symptoms of nasal congestion associated with vasomotor rhinitis and the common cold can be relieved by the short-term use (usually not longer than 7 days) of decongestant nasal drops and sprays. These all contain sympathomimetic drugs which exert their effect by vasoconstriction of the mucosal blood vessels which in turn reduces oedema of the nasal mucosa. They are of limited value because they can give rise to a rebound congestion (rhinitis medicamentosa) on withdrawal, due to a secondary vasodilation with a subsequent temporary increase in nasal congestion.

XYLOMETAZOLINE HYDROCHLORIDE:

Indications: For the symptomatic relief of nasal congestion, perennial and allergic rhinitis (including hay fever), sinusitis.

Contraindications: Known hypersensitivity to the product. Patients with trans-sphenoidal hypophysectomy or surgery exposing the dura mater.

Dose and Administration: Adults and elderly (all indications): 2 or 3 drops in each nostril 2 or 3 times daily. The drops are suitable for children over 12 years of age. Under 3 months, not recommended; over 3 months, 1 – 2 drops in each nostril once or twice daily.

DIMETHINDENE MALEATE-PHENYLEPHRINE:

Indications: common colds, acute and chronic rhinitis, seasonal and non­seasonal allergic rhinitis, acute and chronis sinusitis and adjuvant in cases of acute otitis media.

Contraindications: Known hypersensitivity to the product. Patients with trans-sphenoidal hypophysectomy or surgery exposing the dura mater.

Dose and Administration: apply 3-4 times a day in each nostril. Children from

1-6 years: 1 to 2 drops.