From the Guidelines
For epistaxis (nosebleeds), oxymetazoline nasal spray (0.05%) is an effective first-line treatment, as it has been shown to resolve nasal bleeding in 65% to 75% of patients 1. When managing a patient with an identified anterior nasal bleeding site, initial therapy may consist of topical treatments, including application of vasoconstricting agents such as oxymetazoline, phenylephrine, epinephrine, or cocaine and/or use of nasal cautery 1. Some key points to consider when using oxymetazoline nasal spray for epistaxis include:
- Apply 1-2 sprays into the affected nostril while pinching the nose for 10-15 minutes to constrict blood vessels in the nasal mucosa and reduce blood flow 1
- For recurrent nosebleeds, saline nasal sprays can be used preventatively 2-3 times daily to keep nasal passages moist, as dry mucosa is prone to bleeding
- Petroleum jelly applied inside the nostrils with a cotton swab can also help maintain moisture
- If bleeding is severe or doesn't stop after 20 minutes of pressure, seek medical attention immediately
- Avoid picking the nose, forceful nose blowing, and hot showers immediately after a nosebleed as these can disrupt clot formation
- For patients on blood thinners or with hypertension, more aggressive management may be needed, and they should consult their healthcare provider if experiencing frequent nosebleeds 1.
From the Research
Nasal Spray for Epistaxis
- Nasal sprays, such as oxymetazoline, can be used as an adjunct to compressive therapy to control anterior epistaxis 2.
- Oxymetazoline nasal spray has been shown to be effective in managing epistaxis, with 65% of patients successfully managed with oxymetazoline as their sole therapy 3.
- Topical tranexamic acid (TXA) has been compared to topical oxymetazoline in the treatment of epistaxis, with TXA showing greater efficacy in achieving hemostasis 4.
- Oxymetazoline has also been used in the treatment of posterior epistaxis, with 75% of cases effectively treated with no recurrent bleeding 5.
- A systematic review and meta-analysis found that topical TXA is associated with better bleeding cessation rates after treatment compared to standard practices, including nasal sprays like oxymetazoline 6.
Types of Nasal Sprays
- Oxymetazoline nasal spray is a vasoconstrictor that can be used to control anterior epistaxis 2, 3.
- Tranexamic acid (TXA) nasal spray is an antifibrinolytic agent that can be used to achieve hemostasis in epistaxis 4, 6.
Efficacy of Nasal Sprays
- Oxymetazoline nasal spray has been shown to be effective in 65% of patients with epistaxis 3.
- Topical TXA has been shown to be more effective than topical oxymetazoline in achieving hemostasis in anterior epistaxis 4.
- A systematic review and meta-analysis found that topical TXA is associated with a 3.5 times greater likelihood of achieving bleeding cessation at the first assessment compared to standard practices 6.