Allergic rhinitis anticholinergics

Ipratropium bromide (Atrovent) nasal spray is an anticholinergic agent useful in perennial allergic rhinitis. 

Respiratory disease In general, antihistamines are not recommended to treat lower respiratory tract symptoms, because their anticholinergic effects may cause thickening of secretions and impair expectoration. However, several reports indicate antihistamines can be safely used in asthmatic patients with severe perennial allergic rhinitis. 

Cromolyn sodium and ipratropium bromide offer two additional approaches for treating allergic rhinitis. Cromolyn sodium is a mast cell stabilizer. Increased interest in this product has resulted from it becoming available without a prescription. Ipratropium bromide is an anticholinergic agent useful in pereimial allergic rhinitis. 

The combination possesses antihistamine/deconges-tant/anticholinergic properties. Chorpheniramine competitively antagonizes histamine at Hj-receptor sites phenylephrine stimulates postsynaptic alpha-receptors, resulting in vasoconstriction, which reduces congestion methscopolamine competitively inhibits action of acetylcholine at muscarinic receptors. The combination is indicated for temporary relief of symptoms of allergic rhinitis, casomotor rhinitis, sinusitis, and the common cold. 

It has a prolonged duration of action. It may be used effectively in perennial and seasonal allergic rhinitis, vasomotor rhinitis, allergic conjunctivitis due to inhalant allergens and foods and certain milder type of skin manifestations of urticaria. It also possesses some anticholinergic, antiserotoninergic, and marked local anaesthetic properties. 

Diphenhydramine (Benadryl) Dimenhydrinate (Dramamine) Carbinoxamine (Clistin) H1 Receptor Antagonist Type I allergies (allergic rhinitis conjunctivitis, simple urticaria, pruritis, angioedema). To induce sleep. Sedative VARIABLE Anticholinergic HIGH Gl upset LOW... 

Older adults are at most risk for adverse effects associated with first-generation antihistamines (68). Because second- and third-generation antihistamines have fewer sedative and anticholinergic adverse effects than first-generation antihistamines, they are generally recommended for the treatment of allergic rhinitis in older patients (66). 

Intranasal anticholinergics effectively reduce rhinorrhea. Ipratropium bromide, oxitropium bromide, tiotpropium bromide, and glycopyrrolate are quaternary structured ammonium muscarinic receptor antagonists, which are poorly absorbed into the systemic circulation. They reduce nasal secretions by influence on submucosal glands innervated by parasympathetic nerves (74). Intranasal anticholinergics are ineffective for control of allergic rhinitis symptoms other than rhinorrhea (74). 

Drugs have been administered nasally for several years both for topical and systemic effect. Topical administration includes agents for the treatment of nasal congestion, rhinitis, sinusitis, and related allergic and other chronic conditions. Various medications include corticosteroids, antihistaminics, anticholinergics, and vasoconstrictors. The focus in recent years has been on the use of nasal route for systemic drug delivery. 

Ipratropium nasal spray is an anticholinergic agent that exhibits antisecretory properties when applied locally. It provides symptomatic relief of rhinorrhea associated with allergic and other forms of chronic rhinitis. The 0.03% solution is given as two sprays (42 meg) two to three times daily. The optimal dose should be determined based on the specific patient s symptoms and response. Adverse effects are mild, with the most common being headache, nosebleeds, and nasal dryness. 

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