Epistaxis Medication

Updated: Jan 15, 2017
  • Author: Quoc A Nguyen, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Medication

Medication Summary

Most patients with epistaxis who seek medical attention are likely to be treated with cauterization, anterior packing, or both. Those with severe or recalcitrant bleeding may need posterior packing, arterial ligation, or embolization. Pharmacotherapy plays only a supportive role in treating the patient with epistaxis.

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Topical vasoconstrictors

Class Summary

Topical vasoconstrictors act on alpha-adrenergic receptors in the nasal mucosa, causing vessels to constrict.

Oxymetazoline 0.05% (Afrin)

Oxymetazoline is applied directly to mucous membranes, where it stimulates alpha-adrenergic receptors and causes vasoconstriction. Decongestion occurs without drastic changes in blood pressure, vascular redistribution, or cardiac stimulation.

Oxymetazoline can be used in combination with lidocaine 4% to provide effective nasal anesthesia and vasoconstriction.

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Anesthetics

Class Summary

When anesthetics are used concomitantly with vasoconstrictors, their anesthetic effect is prolonged and the pain threshold increased.

Lidocaine 4% (Xylocaine)

Lidocaine decreases permeability to sodium ions in neuronal membranes. This results in the inhibition of depolarization, blocking the transmission of nerve impulses.

Lidocaine can be used in combination with oxymetazoline 0.05% to provide effective nasal anesthesia and vasoconstriction.

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Antibiotic ointments

Class Summary

Antibiotic ointments help prevent local infection and provide local moisturization.

Mupirocin ointment 2% (Bactroban nasal)

Mupirocin ointment inhibits bacterial growth by inhibiting RNA and protein synthesis. It is a compounded medication.

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Cauterizing agents

Class Summary

Cauterizing agents coagulate cellular proteins, which can in turn reduce bleeding.

Silver nitrate

Silver nitrate coagulates cellular protein and removes granulation tissue. It also has antibacterial effects.

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