Effect of Intranasal Vasoconstrictors on Blood Pressure: A Randomized, Double-Blind, Placebo-Controlled Trial

Abstract

Background: Treatment for epistaxis includes application of intranasal vasoconstrictors. These medications have a precaution against use in patients with hypertension. Given that many patients who present with epistaxis are hypertensive, these warnings are commonly overridden by clinical necessity. Objectives: To determine the effects of these medications on blood pressure. Methods: We conducted a single-center, randomized, double-blind, placebo-controlled trial from November 2014 through July 2016. Adult patients being discharged from the emergency department (ED) at Mayo Clinic (Rochester, Minnesota) were recruited. Patients were ineligible if they had a contraindication to study medications, had a history of hypertension, were currently taking antihypertensive or antiarrhythmic medications, or had nasal abnormalities such as epistaxis. Subjects were randomized to 1 of 4 study arms (phenylephrine 0.25%; oxymetazoline 0.05%; lidocaine 1% with epinephrine 1:100,000; or bacteriostatic 0.9% sodium chloride [saline]). Blood pressure and heart rate were measured every 5 minutes for 30 minutes. Results: Sixty-eight patients were enrolled in the study; of these, 63 patients completed the study (oxymetazoline, n=15; phenylephrine, n=20; lidocaine with epinephrine, n=11; saline, n=17). We did not observe any significant differences in mean arterial pressure over time between phenylephrine and saline, oxymetazoline and saline, or lidocaine with epinephrine and saline. The mean greatest increases from baseline in mean arterial pressure, systolic and diastolic blood pressure, and heart rate for each treatment group also were not significantly different from the saline group. Conclusion: Intranasal vasoconstrictors did not significantly increase blood pressure in patients without a history of hypertension. Our findings reinforce the practice of administering these medications to patients who present to the ED with epistaxis, regardless of high blood pressure.

Descongestionantes nasais tópicos por automedicação e a autopercepção da qualidade de vida por universitários de cursos de saúde / Topical nasal decongestants through self-medication and self-perception of quality of life by students of health occupations

“…O uso de descongestionantes nasais tópicos não é indicado para pessoas que possuem comorbidades como Diabetes Mellitus (tipo 1 ou 2), hipertensão arterial e doenças na tireoide 16,17 . Embora identificados, o número de participantes que possuem alguma dessas condições e se automedicaram é pequeno em relação à amostra.…”

Anesthetic management of acute nasal epistaxis occurring during general anesthesia

“…Continuous bleeding should prompt investigation by an otolaryngologist. Common first‐line interventions performed by the otolaryngologist may include hemostatic agents (oxymetazoline or dilute phenylephrine/epinephrine), anterior nasal packing, and/or chemical or electrical cautery . In rare cases, posterior nasal packing or arterial embolization may be required .…”

Conceptual Model for Using Imidazoline Derivative Solutions in Pulpal Management

“…Precaution should not be interpreted as contraindications given the safety of controlled dosing. For example, a single center, randomized, double-blind, placebo controlled trial from the Mayo clinic determined that adult patients with hypertension can be treated for epistaxis using standardized controlled dosing of 0.25% phenylephrine, 0.05% oxymetazoline, or 1% lidocaine with epinephrine 1:100,000 with no significant changes in heart rate and blood pressure (systolic and blood pressure) compared to a saline control [ 36 ].…”