Intranasal anticholinergics

Intranasal anticholinergic agents (e.g., ipratropium) reduce the severity and duration of rhinorrhea but have no effect on other nasal symptoms.11,12,21 Ipratropium reduces cholinergic hyperreactivity and cholinergically mediated histamine- and antigen-induced secretion. Intranasal ipratropium acts locally, with only minimal systemic absorption. Clinical trials demonstrated that ipratropium bromide 0.3% reduced rhinorrhea in adults and children with PAR.11,12 Intranasal ipratropium is an option for patients in whom rhinorrhea is refractory to topical intranasal corticosteroids and/or antihistamines.8,12 Intranasal ipratropium is available only by prescription, and the dose is two sprays nasally two to three times daily.15 Adverse effects are minimal, but dry nasal membranes have been reported.11,12... 

Weiner AL, Bayer MJ, McKay CA Jr, DeMeo M, Starr E. Anticholinergic poisoning with adulterated intranasal cocaine. Am J Emerg Med 1998 16(5) 517-20. 

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). 

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