chronic

Epistaxis (anterior nosebleed, primary care)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources5 sources

AAO-HNS Clinical Practice Guideline: Epistaxis 2020 · Afrin 0.5 mg/ml nasal spray SmPC sections 4.1-4.3 - Dutch Medicines Evaluation Board (CBG-MEB), procedure NL/H/1971/001-004, Aug 2022 (afrin-oxymetazoline-smpc-cbg-nl-2022.txt): "Afrin 0,5 mg/ml neusspray, oplossing" and "Elke ml oplossing bevat 0,5 mg oxymetazolinehydrochloride", which is the 0.05% strength. · Epistaxis - disease-level clinical article (StatPearls, NCBI Bookshelf NBK435997) · Iliadin Nose Drops / Nose Spray 0.05% Professional Information - South African Health Products Regulatory Authority (English cross-check) · NICE CKS Epistaxis 2021

Verified against3 documents

Afrin 0.5 mg/ml nasal spray SmPC sections 4.1-4.3 - Dutch Medicines Evaluation Board (CBG-MEB), procedure NL/H/1971/001-004, Aug 2022 (afrin-oxymetazoline-smpc-cbg-nl-2022.txt): "Afrin 0,5 mg/ml neusspray, oplossing" and "Elke ml oplossing bevat 0,5 mg oxymetazolinehydrochloride", which is the 0.05% strength.
Epistaxis - disease-level clinical article (StatPearls, NCBI Bookshelf NBK435997)
Iliadin Nose Drops / Nose Spray 0.05% Professional Information - South African Health Products Regulatory Authority (English cross-check)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (3)

Patients report how long the bleed has lasted, how severe it is, how often it recurs, and which side is affected
Use of blood thinners, aspirin, NSAIDs, or nasal steroid sprays is a relevant history point
There are two kinds: anterior, which is the common one, and posterior, which is rarer and more likely to need help

Signs — what you find (4)

Active bleeding seen in the back of the throat without a visible nasal vessel suggests a posterior bleed [bleeding]
Bleeding from both nostrils at once suggests a high-flow posterior source [nosebleed]
Nine in ten of the common kind come from Kiesselbach plexus, also called Little's area, on the front of the septum
That spot sits right at the entrance, takes the extremes of heat, cold and dryness, and is easily injured

Tests (2)

Blood count, type and crossmatch, and clotting studies may be drawn if needed, without delaying treatment
X-rays or CT scanning play no part in the emergency management of an active nosebleed

If not this — what else fits (5)

Nasal tumor is part of the differential for a nosebleed
Bleeding disorders such as DIC, hemophilia, and von Willebrand disease are on the differential
Rhinitis or a foreign body lodged in the nose can also cause bleeding
Bleeding from warfarin or NSAID toxicity is also on the list
The posterior kind is commoner on blood thinners, in high blood pressure, and where a blood or vessel disorder lies underneath

SourceStatPearls "Epistaxis" - disease-level clinical article

Presentation findings are traced to the source above.

OXYMETAZOLINE

1st line

Formnasal

Adult dose and duration

Instill 1-2 sprays into bleeding nostril after blowing out clots - single application for acute bleeding

Paediatric dose

Age restriction: minimum 72 months

(Licensed from 6 years at this 0.05% strength - not from 12. The old 12-year line came from a UK patient leaflet, which is a general-sales restriction and not a fact about the drug; both regulator SmPCs license the strength from 6. Children 6-10 years: 1 spray, not 2. Under 6 years the 0.05% strength is contraindicated - Egypt registers separate 0.025% paediatric preparations (Iliadin paediatric, Afrin pediatric, Oxymet paed); dose those from their own carton. Compression remains the first step at every age.)

Dose by age
6 to 10 years:	1 spray of the 0.05% strength, not 2. Under 6 years this strength is contraindicated. Compression remains the first step at every age.

Dose source

Afrin 0.5 mg/ml nasal spray SmPC sections 4.1-4.3 - Dutch Medicines Evaluation Board (CBG-MEB), procedure NL/H/1971/001-004, Aug 2022 (afrin-oxymetazoline-smpc-cbg-nl-2022.txt): "Afrin 0,5 mg/ml neusspray, oplossing" and "Elke ml oplossing bevat 0,5 mg oxymetazolinehydrochloride", which is the 0.05% strength.

Why

Topical nasal decongestant that constricts the nasal mucosal blood vessels, helping control an ongoing anterior nosebleed; used alongside, not instead of, firm nasal compression, which remains the first step. The indication is the condition's own disease article - "Vasoconstrictors such as oxymetazoline or thrombogenic foams or gels can be employed if that is ineffective" - while the spray quantity and the age floor are the regulator SmPC's; neither SmPC licenses the drug for epistaxis, so the two claims are cited separately.

Cautions

The first-line step is firm bilateral nasal alar compression for 10-15 minutes leaning forward.
Avoid prolonged use (>3-5 days) to prevent rhinitis medicamentosa.
Refer urgently to ENT if bleeding persists >20 minutes despite compression.
Licensed from 6 years at the 0.05% strength. Afrin SmPC 4.1 verbatim: "Afrin is geïndiceerd voor volwassenen en kinderen van 6 jaar en ouder." (indicated for adults and children of 6 years and older), and 4.3: "Afrin mag niet worden gebruikt bij kinderen jonger dan 6 jaar." Under 6, use a 0.025% paediatric preparation instead.
Not with coronary heart disease, not in angle-closure glaucoma, and not within two weeks of an MAOI.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
NASOPHARM 0.05% SPRAY	MUP > EGYPTIAN PHARMACISTS COMPANY	2.50 EGP
ILIADIN 0.05 % ADULT NASAL SPRAY	AMOUN > MERCK KGAA F.R.GERMANY	4.30 EGP
NORMIFRIN 0.5MG/ML NASAL SPRAY 20 ML	MUP	26.00 EGP
ILIADIN 0.025 % PAED. NASAL SOL. 10 ML	AMOUN > MERCK KGAA F.R.GERMANY	3.20 EGP
ILIADIN 0.05 % ADULT NASAL SOLUTION 10 ML	AMOUN > MERCK KGAA F.R.GERMANY	3.35 EGP
OXYMET 0.025% PAED.NASAL DROPS 15 ML	PHAROPHARMA	15.00 EGP
OXYMET 0.05% ADULT NASAL DROPS 15 ML	PHAROPHARMA	15.00 EGP
ADOFRINAZ 0.05% NASAL DROPS 20 ML	KAHIRA > ARAB DRUG COMPANY (ADCO)	24.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.