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Nonsurgical Treatment of Nasal Polyps Medication

  • Author: Sanford M Archer, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
 
Updated: Mar 17, 2016
 

Medication Summary

The only medications effective in shrinking polyps are corticosteroids. Available both orally and topically, they provide a nonspecific anti-inflammatory response that reduces the size of the polyps and improves symptoms related to nasal obstruction. Other medications currently undergoing evaluation affect the nasal inflammatory pathway in different ways and specificity, but they have not shown great promise.

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Oral corticosteroids

Class Summary

The time-tested medical treatment for obstructing nasal polyps is oral corticosteroids. This nonspecific anti-inflammatory agent significantly reduces the size of the inflammatory polyps and improves symptoms quickly. Unfortunately, the effects are short lasting, and polyps frequently regrow and cause similar symptoms within weeks to months.

Prednisone (Deltasone, Orasone)

 

Immunosuppressant to treat autoimmune disorders; may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Potent anti-inflammatory, generically available, and cost effective.

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Topical nasal corticosteroids

Class Summary

These induce a nonspecific anti-inflammatory response that should theoretically reduce the size of polyps and prevent regrowth when used continuously. Available nasal steroid sprays appear to be similarly effective and relatively safe for both short- and long-term use.

Fluticasone (Flonase)

 

Potent vasoconstrictive and anti-inflammatory activity; weak inhibitory potency on HPA when applied topically. Advise patients to administer spray toward lateral nasal wall, avoiding irritation to septum or having drug run down back of pharynx.

Mometasone (Nasonex)

 

Nasal spray; elicits anti-inflammatory activity. Indicated for nasal polyposis treatment. Demonstrated no mineralocorticoid, androgenic, antiandrogenic, or estrogenic activity in preclinical trials. Decreases rhinovirus-induced up-regulation in respiratory epithelial cells and modulates pretranscriptional mechanisms. Reduces intraepithelial eosinophilia and inflammatory cell infiltration (eg, eosinophils, lymphocytes, monocytes, neutrophils, plasma cells). Before initial use, prime pump by actuating 10 times or until a fine spray appears; if stored unused for > 1 wk, reprime. Advise patients to administer spray toward lateral nasal wall, avoiding irritation to septum or having drug run down back of pharynx.

Budesonide inhaled (Rhinocort, Rhinocort Aqua)

 

Potent vasoconstrictive and anti-inflammatory activity. Budesonide is indicated for nasal polyposis management. Advise patients to administer spray toward lateral nasal wall, avoiding irritation to septum or having drug run down back of pharynx.

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Leukotriene receptor antagonists

Class Summary

These agents prevent or reverse some of the pathologic features associated with the inflammatory process mediated by leukotrienes.

Montelukast (Singulair)

 

Potent and selective antagonist of leukotriene D4 (LTD4) at the cysteinyl leukotriene receptor, CysLT1. Prevents or reverses some of the pathologic features associated with the inflammatory process mediated by leukotrienes C4, D4, and E4.

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Contributor Information and Disclosures
Author

Sanford M Archer, MD Professor, Department of Surgery and Pediatrics, Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center

Sanford M Archer, MD is a member of the following medical societies: American College of Surgeons, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, American Rhinologic Society, Kentucky Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Robert M Kellman, MD Professor and Chair, Department of Otolaryngology and Communication Sciences, State University of New York Upstate Medical University

Robert M Kellman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Head and Neck Society, American Rhinologic Society, Triological Society, American Neurotology Society, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, Medical Society of the State of New York

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

Additional Contributors

Eric J Moore, MD, FACS Residency Director, Associate Professor, Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Graduate School of Medicine

Eric J Moore, MD, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Head and Neck Society, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate-Craniofacial Association

Disclosure: Nothing to disclose.

References
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Nasal polyposis, right nasal passage.
Nasal polyposis, right nasal passage.
 
 
 
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