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.
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 (Prednisone Intensol)
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.
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 Allergy Relief, Xhance)
Potent vasoconstrictive and anti-inflammatory activity; weak inhibitory potency on HPA when applied topically. Nasal drying, epistaxis, and, in long-term use, septal perforation have been reported. 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 Allergy)
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.
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.
Interleukin inhibitors
Class Summary
Inhibition of interleukins 4 and 13 with dupilumab in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) has shown to decrease polyp burden and improve symptoms.
Dupilumab (Dupixent)
Monoclonal antibody that inhibits IL-4 and IL-13 signaling by specifically binding to the IL-4 receptor-alpha subunit shared by the IL-4 and IL-13 receptor complexes. Blocking the IL-4 receptor-alpha subunit inhibits IL-4 and IL-13 cytokine-induced responses, including the release of proinflammatory cytokines, chemokines, and IgE. It is indicated for adults with inadequately controlled, severe CRSwNP.
-
Nasal polyposis, right nasal passage.
-
Nasal polyposis, right nasal passage.
