Medications for Stopping a Nosebleed
For an active nosebleed, use topical vasoconstrictor nasal sprays—specifically oxymetazoline or phenylephrine—which stop bleeding in 65-75% of cases when combined with nasal compression. 1, 2
First-Line Medication Approach
Topical vasoconstrictors are the primary medications for epistaxis management:
- Oxymetazoline (Afrin) or phenylephrine nasal sprays are the recommended over-the-counter medications 1, 2, 3
- After clearing blood clots from the nose, spray 2 sprays into the bleeding nostril 1, 2
- Continue firm compression of the soft lower nose for 5 minutes after application 1
- May repeat once if bleeding persists 1
- These vasoconstrictors resolve 65-75% of nosebleeds that don't stop with compression alone 2, 4
Important Caveats About Vasoconstrictors
- Cardiac risk warning: Vasoconstrictors may cause cardiac or systemic complications in susceptible patients (those with heart disease, hypertension, or taking certain medications) 2
- These are adjuncts to—not replacements for—proper nasal compression technique 1, 2
Alternative Topical Hemostatic Agents (Require Medical Setting)
For bleeding that doesn't respond to over-the-counter vasoconstrictors, medical providers can use:
- Tranexamic acid (topical): Promotes hemostasis in 78% of patients, superior to oxymetazoline (35%) and nasal packing (31%) 4
- Thrombin matrix (Floseal), hemostatic gauze (Surgicel), gelatin sponge (Spongostan), or fibrin glue for packing materials with hemostatic properties 4
What NOT to Use
Do not routinely reverse anticoagulation or withhold blood thinners unless there is life-threatening bleeding—first-line treatments (compression, vasoconstrictors, packing) should be attempted first 1, 2
Prevention Medications (After Bleeding Stops)
- Petroleum jelly (Vaseline) or nasal saline gel applied to the anterior septum prevents recurrence 1, 2
- Saline nasal sprays used regularly (1-3 times daily) keep nasal mucosa moist and prevent rebleeding 1, 2
Critical Pitfall to Avoid
The most common error is using vasoconstrictors without adequate compression time—you must maintain firm pressure on the soft lower nose for the full 10-15 minutes, not checking prematurely to see if bleeding has stopped 2, 5