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Drug-induced epistaxis
Other Resources UpToDate PubMed

Drug-induced epistaxis

Contributors: Joon B. Kim MD, Abhijeet Waghray MD
Other Resources UpToDate PubMed


A patient's medication history will be helpful in determining if nosebleeds are due to medications, drug interactions, or other substances. Anti-inflammatory drugs (eg, aspirin, ibuprofen, naproxen), anticoagulants (eg, warfarin [Coumadin], rivaroxaban), antiplatelet agents (eg, clopidogrel), and antiepileptics (eg, valproic acid) have been found to cause nosebleeds. Other classes of medications that can cause epistaxis are antidepressants, statins, antibiotics, antifungals, antihypertensives, and antihistamines. Exposure to rodenticides may be responsible for nosebleed, bruising, and other hemorrhage.

A minor anterior nosebleed may resolve on its own with conservative treatment. Monitoring medications and adjusting dosage may minimize bleeding episodes.

Management of bloody nose can include use of a cold compress, pinching the alae against the septum for 15 minutes, and nasal application of antibiotic. For recurrent, heavy bleeding, packing may be used (eg, Merocel tampon) to achieve hemostasis. Other methods include cautery or nasal balloon catheters. Treatment of recurring posterior epistaxis is more complex and may require hospitalization.

Heparin-induced thrombocytopenia (HIT) is a type of drug-induced thrombocytopenia that typically occurs 5-10 days after the initiation of heparin therapy and is diagnosed using the 4 Ts score (thrombocytopenia, timing, thrombosis, and other causes of thrombocytopenia).


R04.0 – Epistaxis

249366005 – Bleeding from nose

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Incidental finding
  • Infections – Human immunodeficiency virus primary infection (HIV), Hepatitis C virus infection, Epstein-Barr virus infection, Helicobacter pylori infection, Bacterial sepsis with disseminated intravascular coagulation
  • Alcohol use disorder
  • Nutrient deficiencies – Vitamin B12 deficiency, Folate deficiency, Copper deficiency
  • Immune thrombocytopenic purpura
  • Post-transfusion purpura
  • Myelodysplastic syndromes
  • Aplastic anemia

Best Tests

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Management Pearls

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Reviewed:03/27/2019
Last Updated:03/27/2019
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Drug-induced epistaxis
A medical illustration showing key findings of Drug-induced epistaxis : Antibiotic, NSAID, Anticonvulsant, Anticoagulant, Antihistamine, Epistaxis
Copyright © 2024 VisualDx®. All rights reserved.