Thursday, July 12, 2012

TOPICAL NASAL CORTICOSTEROIDS

Pharmacological sinusitis treatments

In patients with acute sinusitis, topical corticosteroids have proved to be relatively ineffective, partly due to their inability to reach the mucosa. Nevertheless, in cases of recurring or chronic sinusitis, the addition of topical corticosteroids (fluticasone) to a regimen of decongestants and antibiotics may accelerate the resolution of symptoms. A Cochrane review of topical intranasal steroid studies showed an improvement in children and adult patients as opposed to those that did not use it. However, there is not sufficient scientific evidence to recommend them.
To obtain the maximum benefit from the topical application of corticosteroids, it is essential that they reach the mucosa, hence any obstacle in the course thereof (hypertrophy of the turbinates, serious septal deviation or large polyps) is likely to reduce their effectiveness.





How do they work?
Glucocorticoids act by reducing the synthesis and release of inflammation and allergy mediators such as histamine, prostaglandins and leukotrienes.

  • Beclomethasone.
  • Budesonide.
  • Fluticasone propionate.
  • Mometasone.
  • Triamcinolone.
What should be recommended for their proper use?:
  • Apply preferably in the morning.
  • Clean the nose before administration, shake the container, apply in an upright position and clean the nasal applicator.
  • The therapeutic effect is achieved after a few days of uninterrupted treatment.
What situations may give rise to problems related to these medicinal products?
  • Irritation of the nasal mucosa, sneezing, nasal congestion, nose bleeds, rhinorrhea (<3%), irritation of the pharynx and dryness of the nose. Caution should be used in patients with frequent nose bleeds.
  • Bewilderment and headache (<5%).
  • Tearing (<5%).
  • Pharyngitis, cough (3-9%), dyspnoea and hoarseness (<1%).
  • Myalgia and osteomuscular pain (<1%).
  • Dyspepsia, dryness of mouth and nausea.
  • If sufficient systemic absorption occurs, it may give rise to a hypertensive crisis.


Do these drugs interact with other medicinal products?
No interactions have been reported.

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