Epistaxis (Nosebleed) Side Effect

Epistaxis means nasal bleeding. Epistaxis can be caused or exacerbated by anticoagulant and antiplatelet medications1, Nonsteroidal Anti-Inflammatory Drugs2.

The inside surface of the nose has many blood vessels, which lie close to the surface. So these blood vessels are easy to injure or irritate.

Often the cause of nosebleeds is not easily identifiable. However, nosebleed is rarely caused by serious health conditions.

List of drugs that can cause epistaxis

Drug Incidence
Abilify < 1%
Accutane
Aceon 0.3% to 1%
Aciphex
Actiq > 1%
Activase < 1%
Adalat < 3%
Advair Diskus 1% to 4%
AeroBid 1% to 3%
Aggrenox 2.4%
Agrylin 1% to 5%
Alferon N 1%
Alinia < 1%
Altace < 1%
AmBisome 8.6% to 14.9%
Ambien Rare
Amerge Rare
Amnesteem
Anzemet Rare
Arava 1% to 3%
Aricept Infrequent
Aspirin3
Astelin 2% to 3.2%
Atacand > 0.5%
Atrovent 7% to 9%
Avalide
Avapro < 1%
Axert Infrequent
Bactroban < 1%
Beconase < 3%
Bextra 0.1% to 1.9%
Busulfex 25%
Caduet 0.1% to 2%
Campath 1% to 7%
Campral Infrequent
Cardizem < 2%
Casodex 2% to 5%
Celebrex 0.1% to 1.9%
Celexa Infrequent
CellCept 3% to 20%
Cialis < 2%
Clinoril < 1%
Clopidogrel (Plavix®) 2.9%
Clozapine < 1%
Clozaril < 1%
Colazal
Copaxone Infrequent
Cosopt
Cozaar < 1%
Dabigatran (Pradaxa®)
Dipyridamole (Persantine®)4
DDAVP < 3%
Depacon 1% to 5%
Depakene 1% to 5%
Depakote 1% to 5%
Desmopressin Acetate < 3%
Diovan > 0.2%
Dostinex < 10%
Doxil < 1%
DynaCirc 0.5% to 1%
Effexor Infrequent
Elidel < 3.3%
Elmiron < 1%
Eloxatin 2% to 9%
Evoxac 1% to 3%
Exelon Frequent
FazaClo < 1%
Flolan 4% to 9%
Flonase 6% to 6.9%
Flovent Rotadisk 1% to 3%
Floxin < 1%
Fludara < 1%
Fortovase < 2%
Gabitril 1% to 10%
Gamunex 23%
Gengraf 1% to 3%
Geodon Infrequent
Gleevec 3% to 12%
HIVID < 1%
Hytrin > 1%
Hyzaar
Imitrex
Indocin < 1%
Infergen 6% to 8%
Intal Inhaler Rare
Intron A < 5%
Invanz for > 0.1%
Invirase < 2%
Klonopin Infrequent
Lamictal Infrequent
Leukine 17%
Leustatin 5%
Levaquin 0.1% to 1%
Levitra < 2%
Lexapro Infrequent
Lipitor < 2%
Lofibra < 1%
Lotensin > 0.3%
Lupron Depot < 5%
Matulane
Mavik 0.3% to 1%
Maxalt Infrequent
Meridia
Merrem 0.2%
Miacalcin 3.5%
Micardis > 0.3%
Motrin < 1%
Mylotarg 3% to 34%
Nasacort 2.7%
Nasarel 3% to 9%
Nasonex 8% to 11%
Neoral 1% to 3%
Neupogen 9% to 15%
Nexium < 1%
Norvasc 0.1% to 1%
Norvir < 2%
Oncaspar < 1%
OptiPranolol Metipranolol Rare
Paxil Infrequent
Permax 1.6%
Pletal < 2%
Prevacid < 1%
Prevpac < 1%
Prilosec < 1%
Prinivil 0.3% to 1%
Prinzide
ProSom Rare
Protonix < 1%
Provigil 1%
Prozac > 2%
Pulmicort Respules 2% to 4%
Rapamune 3% to 20%
Recombinate
Refludan 4.4%
Relenza < 1%
Relpax Rare
Reminyl Infrequent
ReoPro Vials
Requip Infrequent
Rescriptor
Retrovir
Rivaroxiban (Xarelto®)
Rhinocort Aqua 8%
Rilutek Infrequent
Risperdal Infrequent
Rocephin Rare
Roferon-A Rare
Rythmol SR
Salagen 1% to 2%
Sandostatin < 4%
Seroquel Infrequent
Sonata < 1%
Spiriva HandiHaler 1% to 4%
Sular < 1%
Symbyax Infrequent
TNKase I.V. 1.5%
Tamiflu 3.1%
Tarka Less frequent
Tasmar Infrequent
Tequin < 0.1%
Teveten < 1%
Thalomid
Tiazac < 2%
Ticlid 0.5% to 1%
Tobi 7%
Topamax 1% to 4%
Toradol < 1%
Trental < 1%
Tricor
Trileptal 2% to 4%
Trisenox 25%
Trusopt
Unasyn < 1%
Uniretic < 1%
VFEND < 1%
Vantin < 1%
Viagra
Vioxx 0.1% to 1.9%
Warfarin (Coumadin®, Jantoven®)
Xanax Infrequent
Xeloda < 5%
Zegerid < 1%
Zevalin 3%
Zoladex > 1%
Zoloft < 2%
Zomig Infrequent
Zosyn < 1%
Zyban 2%
Zyprexa Infrequent
Zyrtec 1.9% to 3.7%

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Risk factors

Risk factors that predispose a person to nosebleeds:

  • Exposure to dry air or heated air over a long period of time
  • Nose-picking
  • Nasal and sinus infections
  • Allergic rhinitis
  • High blood pressure may promote bleeding, but is rarely a direct cause of nosebleed
  • Acute facial and nasal trauma
  • History of migraines
  • Stressful events

References

  • 1. Smith J, Siddiq S, Dyer C, Rainsbury J, Kim D. Epistaxis in patients taking oral anticoagulant and antiplatelet medication: prospective cohort study. J Laryngol Otol. 2011 Jan;125(1):38-42. PubMed
  • 2. Levy DM, Imundo LF. Nonsteroidal Anti-Inflammatory Drugs: A survey of practices and concerns of pediatric medical and surgical specialists and a summary of available safety data. Pediatr Rheumatol Online J. 2010 Feb 4;8:7. PubMed
  • 3. Tay HL, Evans JM, McMahon AD, MacDonald TM. Aspirin, nonsteroidal anti-inflammatory drugs, and epistaxis. A regional record linkage case control study. Ann Otol Rhinol Laryngol. 1998 Aug;107(8):671-4. PubMed
  • 4. Mittelman M, Ogarten U, Lewinski U, Djaldetti M. Dipyridamole-induced epistaxis. Ann Otol Rhinol Laryngol. 1986 May-Jun;95(3 Pt 1):302-3.

Published: August 03, 2016
Last updated: December 12, 2017

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