Heart Drug Helps Nasal Problem

The drug Verapamil, which is currently used to treat cardiovascular disease and cluster headache, can ease the symptoms of chronic rhinosinusitis (CRS), according to a study published in the Journal of Allergy and Clinical Immunology.

CRS, which is also called chronic sinusitis, is one of the most common sinus conditions. It can significantly decrease the quality of life in patients, who often cannot breathe or sleep easily due to obstructed nasal and sinus passages. Nasal polyps represent a particularly severe form of the disease.

According to the Centers for Disease Control and Prevention, 29.4 million — or 12.3 percent of American adults — have been diagnosed with chronic sinusitis. Current treatment strategies, which commonly include long-term steroid use, do not target the cause of the disease and can also cause serious side effects.

Verapamil works by inhibiting P-glycoprotein, a protein pump inside the nasal lining that appears to be a factor in severe cases of CRS that include the presence of nasal polyps.

“Recently, we became aware that some of the inflammation in CRS with nasal polyps is generated by the nasal lining itself, when a particular protein pump (P-glycoprotein) is overexpressed and leads to the hyper-secretion of inflammatory cytokines,” said senior author Dr. Benjamin S. Bleier.

“Verapamil is a first-generation inhibitor that is well-established in blocking P-glycoprotein,” said Bleier, a sinus surgeon at Massachusetts Eye and Ear, and an assistant professor of otolaryngology at Harvard Medical School. “In some patients with CRS with nasal polyps, we saw dramatic improvement in their symptom scores.”

The researchers conducted a randomized, double-blind, placebo-controlled clinical trial studying the use of low-dose Verapamil in 18 patients with CRS with nasal polyps.

Researchers found that the symptoms of patients taking Verapamil improved, but improvements were significantly limited in patients who were overweight. They plan future studies to determine if a higher dose may be needed in some patients.

“Chronic rhinosinusitis with nasal polyps is among our most challenging diagnoses to treat, because these patients essentially have chronic, lifelong inflammation that needs chronic, lifelong treatment,” said Dr. Bleier. “We observed no significant side effects at the doses we used, and we are very encouraged by the results of this first step toward a more targeted therapy for our patients.”