# Epistaxis (anterior nosebleed, primary care) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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) ## Treatment metadata - Oxymetazoline — nasal ## Complete treatment card ```text EPISTAXIS (ANTERIOR NOSEBLEED, PRIMARY CARE) 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 Review status: REVIEWED against 3 sources listed above (2026-08) 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 Source StatPearls "Epistaxis" - disease-level clinical article Status traced to the source above 1. OXYMETAZOLINE [1st line] Adult Instill 1-2 sprays into bleeding nostril after blowing out clots - single application for acute bleeding Peds Age restriction: minimum 72 months 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. (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.) 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. Caution 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. Egypt NASOPHARM 0.05% SPRAY MUP > EGYPTIA... 2.50 EGP ILIADIN 0.05 % ADULT NASAL SPRAY AMOUN > MERCK... 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. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)