The aim of the present study was to test the efficacy of the topically active
cholinoceptor antagonist,
ipratropium, in the treatment of
rhinorrhea in perennial nonallergic
rhinitis, with special reference to identification of subgroups of responders and increased efficacy from high-dose
therapy. Thirty-six adult patients with watery
rhinorrhea as a dominant symptom completed the study, which consisted of a 2-week run-in period followed by two 3-week treatment periods with placebo and
ipratropium in an ordinary dosage (80 micrograms four times a day) in a double-blind, crossover design, and, finally, an open 2-week period with high-dose
therapy (400 micrograms four times a day). The number of nose blowings was 47% lower during treatment with
ipratropium in the ordinary dosage than during the placebo period (p less than 0.001). There was an additional reduction during high-dose
therapy that was slight but statistically significant (p less than 0.05).
Ipratropium had no effect on the number of sneezes or on
nasal blockage index. During ordinary-dose
therapy, side effects were slight and confined to the nose, whereas the high-dose
therapy caused unpleasant nasal dryness and, in a few cases, systemic side effects. It was not possible to separate responders from nonresponders by case history, physical examination, or nasal
methacholine testing. It is concluded that intranasal
ipratropium is effective in the treatment of watery
rhinorrhea in perennial nonallergic
rhinitis and that 320 micrograms a day is sufficient in most patients.