Yes

Alpha/Beta Agonist; Ophthalmic Agent, Antiglaucoma; Ophthalmic Agent, Mydriatic

Treatment of hypotension, vascular failure in shock; as a vasoconstrictor in regional analgesia; symptomatic relief of nasal and nasopharyngeal mucosal congestion; as a mydriatic in ophthalmic procedures and treatment of wide-angle glaucoma; supraventricular tachycardia

C

Hypersensitivity to phenylephrine, bisulfite (some products contain metabisulfite), or any component; hypertension; ventricular tachycardia

Use with caution in the elderly, patients with hyperthyroidism, bradycardia, partial heart block, myocardial disease, or severe CAD. Not a substitute for volume replacement. Avoid hypertension; monitor blood pressure closely and adjust infusion rate. Infuse into a large vein if possible. Watch I.V. site closely. Avoid extravasation. The elderly can be more sensitive to side effects from the nasal decongestant form. Rebound congestion can occur when the drug is discontinued after chronic use.

Incidence of adverse events is not reported.

Central nervous system: Headache, anxiety, weakness, dizziness, tremor, paresthesia

Endocrine and metabolic: Metabolic acidosis

Local: Extravasation which may lead to necrosis and sloughing of surrounding tissue, blanching of skin

Neuromuscular & skeletal: Pilomotor response

Renal: Decreased renal perfusion, reduced urine output, reduced urine output

Respiratory: Respiratory distress

Symptoms of overdose include vomiting, hypertension, palpitations, paresthesia, ventricular extrasystoles

Treatment is supportive; in extreme cases, I.V. phentolamine may be used

Beta-blockers (nonselective ones) may increase hypertensive effect; avoid concurrent use.

Cocaine may cause malignant arrhythmias; avoid concurrent use.

Guanethidine can increase the pressor response; be aware of the patient's drug regimen.

Methyldopa can increase the pressor response; be aware of patient's drug regimen.

Phenytoin administration during a dopamine infusion may result in hypotension and possibly cardiac arrest; use cautiously.

Reserpine increases the pressor response; be aware of patient's drug regimen.

TCAs increase the pressor response; be aware of patient's drug regimen.

MAO inhibitors potentiate hypertension and hypertensive crisis; avoid concurrent use.

Is stable for 48 hours in 5% dextrose in water at pH 3.5-7.5; do not use brown colored solutions

Potent, direct-acting alpha-adrenergic stimulator with weak beta-adrenergic activity; causes vasoconstriction of the arterioles of the nasal mucosa and conjunctiva; activates the dilator muscle of the pupil to cause contraction; produces vasoconstriction of arterioles in the body; produces systemic arterial vasoconstriction

Onset of effect: I.M., S.C.: Within 10-15 minutes; I.V.: Immediate

Duration: I.M.: 30 minutes to 2 hours; I.V.: 15-30 minutes; S.C.: 1 hour

Metabolism: To phenolic conjugates; metabolized in liver and intestine by monoamine oxidase

Half-life: 2.5 hours

Elimination: Urine (90%)

Ophthalmic procedures:

Infants <1 year: Instill 1 drop of 2.5% 15-30 minutes before procedures

Children and Adults: Instill 1 drop of 2.5% or 10% solution, may repeat in 10-60 minutes as needed

Nasal decongestant: (therapy should not exceed 5 continuous days)

Children:

2-6 years: Instill 1 drop every 2-4 hours of 0.125% solution as needed

6-12 years: Instill 1-2 sprays or instill 1-2 drops every 4 hours of 0.25% solution as needed

Children >12 years and Adults: Instill 1-2 sprays or instill 1-2 drops every 4 hours of 0.25% to 0.5% solution as needed; 1% solution may be used in adult in cases of extreme nasal congestion; do not use nasal solutions more than 3 days

Hypotension/shock:

Children:

I.M., S.C.: 0.1 mg/kg/dose every 1-2 hours as needed (maximum: 5 mg)

I.V. bolus: 5-20 mcg/kg/dose every 10-15 minutes as needed

I.V. infusion: 0.1-0.5 mcg/kg/minute

Adults:

I.M., S.C.: 2-5 mg/dose every 1-2 hours as needed (initial dose should not exceed 5 mg)

I.V. bolus: 0.1-0.5 mg/dose every 10-15 minutes as needed (initial dose should not exceed 0.5 mg)

I.V. infusion: 10 mg in 250 mL D₅W or NS (1:25,000 dilution) (40 mcg/mL); start at 100-180 mcg/minute (2-5 mL/minute; 50-90 drops/minute) initially; when blood pressure is stabilized, maintenance rate: 40-60 mcg/minute (20-30 drops/minute)

Paroxysmal supraventricular tachycardia: I.V.:

Children: 5-10 mcg/kg/dose over 20-30 seconds

Adults: 0.25-0.5 mg/dose over 20-30 seconds

Blood pressure, heart rate, arterial blood gases, central venous pressure

Phenylephrine allows for close titration of blood pressure and should be used in patients with hypotension or shock due to peripheral vasodilation. Phenylephrine should not constitute sole therapy in patients with hypotension due to aortic dysfunction or hypovolemia. An important benefit of this drug is the short half-life, allowing rapid changes in dosage with prompt appropriate blood pressure responses. When administered intravenously, it should be used in intensive care settings or under very close monitoring.

May cause anxiety or restlessness

Concurrent use with MAOIs may result in hypertensive crisis; avoid combination

Use with caution since phenylephrine is a sympathomimetic amine which could interact with epinephrine to cause a pressor response

Up to 10% of patients could experience tachycardia, palpitations, and dry mouth; use vasoconstrictor with caution

Nasal decongestant: Do not use for more than 5 days in a row. Clear nose as much as possible before use. Tilt head back and instill recommended dose of drops or spray. Do not blow nose for 5-10 minutes. You may experience transient stinging or burning.

Ophthalmic: Open eye, look at ceiling, and instill prescribed amount of solution. Close eye and roll eye in all directions, and apply gentle pressure to inner corner of eye for 1-2 minutes after instillation. Do not let tip of applicator touch eye or contaminate tip of applicator. Temporary stinging or blurred vision may occur. Report persistent pain, burning, double vision, severe headache, or if condition worsens.

Pregnancy/breast-feeding precautions: Inform prescriber if you are pregnant. Consult prescriber if breast-feeding.

May cause necrosis or sloughing tissue if extravasation occurs during I.V. administration or S.C. administration

Injection, as hydrochloride (Neo-Synephrine®): 1% [10 mg/mL] (1 mL)

Nasal solution, as hydrochloride:

Drops:

Neo-Synephrine®: 0.125% (15 mL)

Alconefrin® 12: 0.16% (30 mL)

Alconefrin® 25, Neo-Synephrine®, Children's Nostril®, Rhinall®: 0.25% (15 mL, 30 mL, 40 mL)

Alconefrin®, Neo-Synephrine®: 0.5% (15 mL, 30 mL)

Spray:

Alconefrin® 25, Neo-Synephrine®, Rhinall®: 0.25% (15 mL, 30 mL, 40 mL)

Neo-Synephrine®, Nostril®, Sinex®: 0.5% (15 mL, 30 mL)

Neo-Synephrine®: 1% (15 mL)

Ophthalmic solution, as hydrochloride:

AK-Nefrin®, Prefrin™ Liquifilm®, Relief®: 0.12% (0.3 mL, 15 mL, 20 mL)

AK-Dilate®, Mydfrin®, Neo-Synephrine®, Phenoptic®: 2.5% (2 mL, 3 mL, 5 mL, 15 mL)

AK-Dilate®, Neo-Synephrine®, Neo-Synephrine® Viscous: 10% (1 mL, 2 mL, 5 mL, 15 mL)