Narivent – an effective, fast-acting non-vasoconstrictive nasal decongestant?
Reviewed by Christopher Burgess

The nasal obstruction associated with acute and chronic rhinitis is often considered one of the most unpleasant symptoms associated with these conditions. Whilst topical over-the-counter vasoconstrictors such as xylometazoline and oxymetazoline are highly effective at alleviating nasal obstruction, they are of course notorious for causing rebound congestion (rhinitis medicamentosa), limiting their use to the very short term only. Narivent is a non-vasoconstrictive nasal spray that contains mannitol and glycyrrhizin. The former compound acts osmotically to reduce mucosal oedema and the latter acts as a topical anti-inflammatory. According to the authors, the beneficial effects on symptom control have previously been reported, but what is less clear is the timing of clinical improvement after administration. This study used both subjective (VAS / I-NOSE questionnaires) and objective (anterior rhinomanometry) measures of nasal obstruction at baseline and 10 minutes after one spray of Narivent per nostril in patients complaining of nasal obstruction secondary to allergic rhinitis or inferior turbinate hypertrophy. A total of 83 patients were enrolled. Mean VAS score decreased from 8.8 to 4.8 (p < 0.0001), the I-NOSE score decreased from 18.4 to 10.3 (p < 0.0001) and total nasal airway resistance decreased from 0.70 to 0.37 Pa/cm3/s. No adverse effects were reported. These results certainly do suggest that Narivent produces a rapid improvement in both subjective and objective measures of nasal obstruction, and may represent a useful option for short-term, rapid relief of nasal obstruction. The authors acknowledge the absence of a control group as a limitation of the study. It would certainly be interesting to compare Narivent and xylometazoline head-to-head in a future prospective double-blind randomised control trial.

Rapid improvement of nasal obstruction after treatment with a non-vasoconstrictive osmotic nasal spray.
De Luca P, Di Stadio A, de Campora L, et al.
AM J OTOLARYNGOL
2026;47(4):104877.