Six Ways to Get Rid of Cough from Post-Nasal Drip

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Post-nasal drip has a new name: upper airway cough syndrome  or UACS. If you have a cough that won’t go away, along with nasal congestion, “dripping” mucus down the back of your throat, the sensation that you need to clear your throat, a hoarse voice, or if you wake up in the morning with “gunk” in the back of your throat . . . this may be you.

This very common cause of a cough that won’t go away, upper airway cough syndrome, can be allergic or nonallergic and may be related to a sinusitis. Here are six things that work to treat it:

1.  Nasal steroid sprays aka “intranasal steroids.” Two of these are over the counter now—Flonase Allergy Relief (fluticasone propionate) and Nasacort Allergy (triamcinolone acetonide)—so you can buy them and try them on your own. Intranasal steroids are more effective than oral antihistamines and should be first line treatment here. Onset of action is a few hours but they may take a few days to get rid of your cough. If it works for you, continue therapy for 3 months. For comparisons of the nasal sprays see my previous blog.

2.  Oral antihistamines. The sedating ones. Sadly, the ones that make you sleepy work a little better for the cough. Over the counter examples are Chlor-tabs (chlorpheniramine) and Tavist (clemastine) or the combination drugs like Bromfed and Lodrane-D (brompheniramine and pseudoephedrine) or Dimetapp (brompheniramine and phenylephrine). At night they may be fine, but during the day it may be hard to function with how sleepy they make you.

3.  Oral antihistamines, the non-sedating ones. To avoid feeling sleepy with your meds, go for the non-sedating options. Three are available over the counter: Claritin (loratadine), Allegra (fexofenadine), Zyrtec (cetirizine), and then there is the expensive prescription-only Xyzal.

4.  Antihistamine nasal sprays. These are another good option for cough due to post nasal drip. Azelastine (Astelin or Astepro) works to reduce the runny nose and cough as does Atrovent (ipratropium bromide) nasal spray. Azelastine may cause sleepiness while ipratropium does not.

5.  Oral decongestants. Sudafed (pseudoephedrine) is the obvious choice here, and you can take an antihistamine (Claritin, Zyrtec, Allegra) mixed with Sudafed as well. Any medication with -D behind it is mixed with sudafed already, e.g. Claritin-D or Allegra-D. Warning here: Sudafed may make you jittery and can raise blood pressure.

6.  Oral leukotriene receptor antagonists. Singulair (montelukast) and Accolate (zafirlukast) are the two commonly used in this class. Both now come in a generic so you won’t have the same sticker shock you used to, but they are still pricey.

Know this: If your cough does not improve after one to two weeks using the therapies listed above, upper airway cough syndrome (post-nasal drip) may not be the cause of your cough. See your doctor.

Dr O.

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