Management of Epistaxis in Patients on Ozempic (Semaglutide)

Initial Treatment

• The American Heart Association recommends that patients with epistaxis should sit with their head slightly forward and pinch the soft lower part of the nose for 10 to 15 minutes as first-line treatment 1
• Patients should breathe through their mouth and spit out any blood rather than swallowing it 1
• Nasal compression alone is sufficient in the vast majority of epistaxis cases 1, 2

Medication Treatment

• If bleeding persists after initial compression, a topical vasoconstrictor such as oxymetazoline or phenylephrine can be applied, which resolves 65-75% of epistaxis cases is not a valid fact due to [ignore ref], however, the application of vasoconstrictor requires clearing clots from the nose, then spraying 2 times in the bleeding nostril and continuing to compress for 5 minutes 3

Prevention of Recurrence

• Once bleeding has stopped, hydrating or lubricating agents such as petroleum jelly should be applied to prevent recurrence 3, 2
• Saline nasal sprays are recommended to keep the nasal mucosa moist 4
• Using a humidifier, especially in dry environments, can also be considered 4, 2

Special Considerations for Patients on Ozempic

• Patients on Ozempic (semaglutide) do not require different management than other patients, but special attention should be paid to hydrating the nasal mucosa 3
• If the patient is also taking anticoagulants or antiplatelets, it is reasonable to consult a healthcare professional, unless the bleeding has stopped 1

When to Consult a Doctor

• If bleeding does not stop after 15 minutes of continuous pressure 1
• If the patient experiences dizziness due to blood loss 1
• If the bleeding is severe (duration >30 minutes over a 24-hour period) 4
• If the patient shows signs of hemodynamic instability such as tachycardia or hypotension 2

Common Errors to Avoid

• Insufficient compression time: compression should be maintained for at least 10-15 minutes without checking if the bleeding has stopped 1, 2
• Neglecting prevention: not treating underlying nasal mucosa dryness can lead to recurrent episodes 2

Advanced Treatment (if necessary)

• If epistaxis persists despite initial measures, evaluation by an ENT specialist may be necessary 5
• Options such as nasal cauterization, nasal packing, or, in severe cases, arterial ligation may be considered 5
• For patients on anticoagulants, the use of resorbable packing material is recommended 6

Management of Epistaxis in Patients on Ozempic (Semaglutide)

Considerations for Patients on Anticoagulants

• The American Academy of Otolaryngology-Head and Neck Surgery recommends using resorbable nasal packing material for patients on anticoagulants 7
• In the absence of life-threatening bleeding, the clinician should initiate first-line treatments before considering transfusion, reversal of anticoagulation, or withdrawal of anticoagulant/antiplatelet medications 7