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.
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.
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.
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.
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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Posterior epistaxis from the left sphenopalatine artery.
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Resolved posterior epistaxis after endoscopic cauterization of the left sphenopalatine artery.
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Nasal speculum.
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Vaseline gauze packing.
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Expandable (Merocel) packing (dry).
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Nasal vascular anatomy
Tables
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- Overview
- Presentation
- DDx
- Workup
- Treatment
- Approach Considerations
- Manual Hemostasis
- Humidification and Moisturization
- Cauterization
- Nasal Packing
- Arterial Ligation
- Embolization
- Palliative Therapy for Hereditary Hemorrhagic Telangiectasia
- Complications of Treatment
- Dietary Measures
- Activity Restriction
- Prevention of Epistaxis
- Consultations
- Long-Term Monitoring
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- Guidelines
- Medication
- Questions & Answers
- Media Gallery
- References