From the Guidelines
Topical epinephrine is a recommended treatment for epistaxis, particularly for anterior nasal bleeding sites, as it provides effective vasoconstriction to achieve hemostasis. According to the clinical practice guideline on nosebleed (epistaxis) published in 2020 1, topical treatments such as epinephrine can be used as initial therapy for patients with an identified anterior nasal bleeding site. The guideline suggests that vasoconstricting agents like oxymetazoline, phenylephrine, epinephrine, or cocaine can be applied topically to control bleeding.
Some key points to consider when using topical epinephrine for epistaxis include:
- Applying cotton pledgets or strips soaked in 1:1000 epinephrine solution (1 mg/mL) to the bleeding site for 5-10 minutes
- Using commercially available epinephrine-soaked nasal packs or sprays containing 1:1000 or 1:10,000 concentrations
- Directly applying the medication to the bleeding source, typically in the anterior nasal cavity, particularly Kiesselbach's plexus
- Exercising caution in patients with hypertension, cardiovascular disease, or those taking certain medications like beta-blockers, as systemic absorption may occur
It is essential to note that while topical epinephrine is effective, it may be associated with an increased risk of cardiac or other systemic complications, as reported in studies on oxymetazoline and phenylephrine 1. Therefore, clinicians should carefully evaluate the patient's medical history and current medications before administering topical epinephrine for epistaxis. After bleeding stops, patients should avoid nose-picking, strenuous activity, and hot showers for 24-48 hours to prevent recurrence.
From the Research
Topical Epinephrine for Epistaxis
- Topical epinephrine can be used as an adjunct to compressive therapy for the management of epistaxis, specifically for anterior epistaxis 2.
- The application of cotton soaked in epinephrine 1:1,000 may be useful in controlling bleeding 2.
- Topical vasoconstriction is a treatment option for epistaxis, and epinephrine is a commonly used vasoconstrictor 3.
- While there is no specific study on the effectiveness of topical epinephrine for epistaxis, the use of vasoconstrictors like epinephrine is a widely accepted practice in the management of nasal bleeding 3, 4, 5.
- The choice of treatment for epistaxis depends on the severity and location of the bleeding, as well as the patient's overall health status 3, 4, 5.