Table 3. Principal Medication Options for Rhinitis (continued)1
Allergic rhinitis: Seasonal allergic rhinitis and perennial allergic rhinitis
Combination therapy
Antihistamine, oral with decongestant, oral
Antihistamine, oral with LTRA, oral
Antihistamine, oral with intranasal antihistamine
Antihistamine, oral with intranasal corticosteroids
Intranasal anticholinergic with intranasal corticosteroid
Intranasal antihistamine with intranasal corticosteroid
Therapeutic considerations
> More effective relief of nasal congestion than antihistamines alone
> May be more effective than monotherapy with antihistamine or LTRA
> Less effective than INS > An alternative treatment for patients unresponsive to or not compliant with INS
> Combination may be considered, although controlled studies of additive benefit lacking
> Combination may be considered, although supporting studies limited and many studies unsupportive of additive benefit of adding an antihistamine to an intranasal steroid
> Concomitant use of ipratropium bromide nasal spray and an intranasal corticosteroid is more effective for rhinorrhea than administration of either drug alone
> Combination may be considered based on limited data > Inadequate data about optimal interval between administration of the 2 sprays
> For mixed rhinitis, there may be significant added benefit to the combination of an intranasal antihistamine with an intranasal corticosteroid
LTRA, oral with intranasal corticosteroid
Oral agents
Antihistamines, oral (H1
Decongestants, oral
Intranasal agents Intranasal antihistamines
Intranasal anticholinergic (ipratropium)
Intranasal corticosteroids Combination therapy > Generally ineffective for nonallergic rhinitis receptor antagonists) > Pseudoephedrine reduces nasal congestion > Effective for vasomotor rhinitis
> Effective only for rhinorrhea of nonallergic rhinitis syndromes
> Special role for preventing rhinorrhea of gustatory rhinitis
> Effective for some forms of nonallergic rhinitis, including vasomotor rhinitis and NARES
Inadequate data to provide firm recommendations in nonallergic rhinitis
Note: abbreviations are defined on the back cover.
> Subjective additive relief in limited studies, data inadequate
Nonallergic (idiopathic) rhinitis Monotherapy
Therapeutic considerations
Y
FOR INTERNAL USE ONLY
