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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