Ah, cold and flu season. It’s that joyous time of year when our department is flooded with miserable people complaining of sinus headaches, rhinorrhea and feeling terrible. We all know that for most viruses, symptomatic care is the way to go. A nose spray would be helpful, but what about all of those warning labels that tell you it could be dangerous for patients with hypertension?
A randomized, double-blind, placebo-controlled trial at Mayo Clinic sought to investigate whether or not a locally applied vasoconstrictor could impact hemodynamics in a meaningful way. Investigators compared oxymetazoline 0.05%, phenylephrine 0.25%, lidocaine 1% with epinephrine 1:100,000, and 0.9% sodium chloride (placebo) applied to the anterior naris with a cotton pledget and a nose clip for 15 minutes, and found no significant increase in MAP, SBP, DBP or HR when measurements were made every 5 minutes for 30 minutes. Note that they did not sniff, it was just a topical application ala epistaxis treatment. The population was small (n=68) and the average age was young (mean age 33.5 years), but the data is reassuring.
So, next time you treat someone with either a cold or a nosebleed and want to recommend a nose spray, take comfort in the fact that you will probably not tip them into heart failure.
Effect of Intranasal Vasoconstrictors on Blood Pressure: A Randomized, Double-Blind, Placebo-Controlled Trial. J Emerg Med. 2018 Sep 5. pii: S0736-4679(18)30659-0. doi: 10.1016/j.jemermed.2018.07.004.