Intranasal Ipratropium Bromide to Control the Hypersecretion of Vasomotor Rhinitis: A Dose-Response Study

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Abstract
Twenty-six adults were enrolled in a randomized, double-blind trial of three conditions for treatment of the watery rhinorrhea of vasomotor rhinitis: ipratropium bromide (IB) 20 g (IB20) in each nasal cavity qid, IB, 40 g (IB40) in each nasal cavity qid, and placebo. The severity of nasal discharge in the treatment groups was low in comparison with placebo; for combined day/night data the difference was highly significant for the lB20 (p = 0.0002) and lB40 (p = 0.0014) phases. Local nasal side effects listed included nasal dryness, itch, stuffy nose, sneezing, mild nasal bleeding, and dry sore throat. Of 23 patients at least one such side effect was recorded by 13 patients receiving the IB20 treatment, 13 patients receiving the IB40 treatment, and 6 patients receiving the placebo treatment. Thus, the frequency of these reported side effects for the 2 IB dosages was equal and for both IB doses was significantly greater than for placebo. In contrast, the proportion of patients with a sense of nasal stuffiness was the same for the placebo and IB20 treatments but significantly higher for the IB40 treatment. Pulse and blood pressure were not affected. It was concluded that IB in both dosages was highly effective in controlling the watery rhinorrhea of vasomotor rhinitis. Side effects were entirely local, described as mild to severe, and claimed by about half the treated group. The recommended dose should not exceed 20 g in each nasal cavity qid.