Verapamil improves symptoms of CRS with nasal polyps

The calcium-channel blocker verapamil may have a role in the treatment of chronic rhinosinusitis (CRS) with nasal polyps, according to a first-of-its-kind study published in the Journal of Allergy and Clinical Immunology: In Practice.

Researchers at Massachusetts Eye and Ear investigated treatment of CRS through the inhibition of P-glycoprotein, a protein pump within the nasal lining that had been previously identified as a mechanism for severe cases of CRS with nasal polyps.

“We recently became aware that some of the inflammation in CRS with nasal polyps is generated by the nasal lining itself, when P-glycoprotein is overexpressed and leads to the hyper-secretion of inflammatory cytokines,” said senior author Benjamin S. Bleier, MD, a sinus surgeon at Massachusetts Eye and Ear and an assistant professor of otolaryngology at Harvard Medical School, Boston, MA. “Verapamil is a first-generation inhibitor that is well-established in blocking P-glycoprotein. In some patients with CRS with nasal polyps, we saw dramatic improvement in their symptom scores.”

Building on the previous findings regarding P-glycoprotein, the study authors conducted a randomized, double-blind, placebo-controlled clinical trial involving the use of low-dose verapamil in 18 patients with CRS with nasal polyps.

Patients in the verapamil group showed improved outcomes when compared with those receiving placebo. However, the treatment effect was significantly limited among patients with higher BMI scores. Future studies are being planned to determine if a higher dose of verapamil may be more effective for some patients.

Verapamil is currently indicated for treatment hypertension, angina, and certain rhythm disorders. It also prescribed in an off-label manner for certain types of headaches.

CRS is one of the more prevalent chronic illnesses in the US. It has caused marked detriment to quality of life in patients who have difficulty breathing or sleeping due to obstructed nasal and sinus passages. The presence of nasal polyps often results in more severe issues for patients.

Current treatment strategies may fail to target an underlying cause, and they may cause bothersome adverse effects.