phenylephrine (Neo-Synephrine, Mydrifin, sudafed PE, PE)
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Introduction
Tradename: Neo-Synephrine, sudafed PE[6].
Indications
- systemic agent
- treatment of vascular failure in shock syndromes (hypotension) including hypertrophic cardiomyopathy[8]
- vasoconstriction to allow for regional spinal anesthesia
- paroxysmal supraventricular tachycardia (PSVT) uncontrolled by standard therapy
- decongestant for eustachian tube congestion
- topical agent
- nasal spray
- symptomatic relief from cold symptoms*
- allergic rhinitis*
- seasonal allergic rhinitis
- ophthalmic agent:
- mydriasis in ophthalmic procedures
- treatment of glaucoma (wide-angle) secondary to pupil block caused by aphakia or posterior synechiae
- prevention of echothiophosphate-induced iris cysts
- determination of refraction errors
- diagnosis of Horner's & Raeder's syndromes
- prevention & treatment of posterior synechiae in patients with anterior uveitis
- allergic conjunctivitis
* on list of medications to avoid for treatment of allergic rhinitis & viral rhinitis[11]
- cardiovascular risk cited
Contraindications
Dosage
- hypotension
- adults
- children
- 0.1 mg/kg SC every 1-2 hours PRN; max 5 mg/dose
- 5-20 ug/kg IV every 10-15 min PRN
- IV infusion:
- mix 10 mL in 250 mL of D5W or normal saline (40 ug/mL)
- start at 100-180 ug/min (2-5 mL/min)
- maintenance (after blood pressure has stabilized) 40-60 ug/min (0.8-1.2 mL/min)
- PSVT: 0.25-0.5 mg over 20-30 seconds
- nasal congestion: 2-3 sprays per nostril every 3-4 hours
- Oral decongestant: 10 mg every 4 hours PRN (Sudafed PE)[6]
- ophthalmic agent
- ophthalmoscopy & retinal photography:
- 1 drop
- may repeat as needed in 10-60 minutes
- refraction:
- instill 1 drop of 2.5% solution in between the administration of a cycloplegic drug
- diagnosis of Horner's & Raeder's syndromes
- use appropriate concentration to perform testing
- ocular surgery:
- glaucoma secondary to pupil block:
- 1 drop of 10% solution into the eye TID along with atropine for synergistic effect
- may be given QID if needed
- apply finger pressure to the lacrimal sac during & for 1-2 minutes following application to reduce frequency of systemic adverse effects
- mydriasis: 1 drop QD-TID for 5 days
- ophthalmoscopy & retinal photography:
Nasal spray: 0.125%, 0.25%, 0.5%, 1%. Ophthalmic agent: Tradenames: Neo-synephrine, Mydrifin. Ophthalmic agent: 2.5% (15 mL) 10% (5 mL).
Pharmacokinetics
- topical (intraocular, nasal) administration
- onset of action within minutes
- duration of action is 0.5 to 4 hours
- IV administration
- immediate onset of action
- duration of action is 20-50 minutes
- metabolized by monoamine oxidase (MAO)
elimination via plasma
Adverse effects
- Nasal
- Ophthalmic
- common (> 10%)
- transient stinging
- less common (1-10%)
- headache, blurred vision, photophobia, lacrimation, browache
- common (> 10%)
- Systemic
- common (> 10%)
- less common (1-10%)
- peripheral vasoconstriction, hypertension, angina, reflex bradycardia, arrhythmias, restlessness, excitability
- other[3][4]
- drug adverse effects of adrenergic receptor agonists
- drug adverse effects of alpha-adrenergic receptor agonists
- drug adverse effects of sympathomimetic(s)
Drug interactions
- alpha-adrenergic receptor antagonists antagonize effects of phenylephrine
- tricyclic antidepressants & MAO inhibitors increase the pressor effects of phenylephrine
- acetaminophen may increase plasma levels of phenylephrine
Mechanism of action
- alpha-1 adrenergic receptor agonist[8]
- potent vasoconstriction
- dose-related increase in peripheral vascular resistance
- elevation of blood pressure
- sinus bradycardia associated with vagal reflexes
- topical administration results in arteriole constriction
- reduction in blood flow & nasal congestion
NOT as effective of pseudoephedrine[7]
More general terms
Component of
- phenylephrine/thonzylamine
- phenylephrine/preparation h/witch hazel
- pheniramine/phenylephrine
- mineral oil/petrolatum/phenylephrine/shark liver oil
- mineral oil/petrolatum/phenylephrine/preparation h
- mineral oil/petrolatum/phenylephrine
- ketorolac/ophthalmic irrigation solution/phenylephrine
- glycerol/petrolatum/phenylephrine/shark liver oil
- glycerol/petrolatum/phenylephrine/pramoxine/preparation h
- glycerol/petrolatum/phenylephrine/pramoxine
- glycerol/hydroxypropyl methylcellulose/phenylephrine
- dextromethorphan/doxylamine/phenylephrine
- cocoa butter/phenylephrine/suppository
- cocoa butter/phenylephrine/shark liver oil/suppository
- cocoa butter/phenylephrine/preparation h/suppository
- choline salicylate/guaifenesin/phenylephrine
- choline salicylate/diphenhydramine/phenylephrine
- choline salicylate/dextromethorphan/guaifenesin/phenylephrine
- brompheniramine/dextromethorphan/diphenhydramine/phenylephrine
- acetaminophen/dextromethorphan/phenylephrine/triprolidine
- acetaminophen/dextromethorphan/guaifenesin/phenylephrine/triprolidine
- phenylephrine/pseudoephedrine
- phenylephrine/zinc sulfate
- phenylephrine/triprolidine
- phenylephrine/sulfacetamide
- phenylephrine/scopolamine
- phenylephrine/pramoxine
- phenylephrine/polyvinyl alcohol
- mineral oil/phenylephrine/shark liver oil/white petrolatum
- lidocaine/phenylephrine
- isoproterenol/phenylephrine
- ibuprofen/phenylephrine
- hyoscyamine/phenylephrine/pseudoephedrine/scopolamine
- hydrocodone/pheniramine/phenylephrine/phenylpropanolamine/pyrilamine
- guaifenesin/phenylephrine/zinc acetate
- guaifenesin/p21rho g/phenylephrine
- diphenhydramine/phenylephrine/pseudoephedrine
- diphenhydramine/guaifenesin/phenylephrine
- dextromethorphan/phenylephrine/thonzylamine
- dextromethorphan/pheniramine/phenylephrine
- dextromethorphan/guaiacolsulfonate/phenylephrine/pyrilamine
- dextromethorphan/guaiacolsulfonate/phenylephrine
- dexchlorpheniramine/dextromethorphan/guaifenesin/phenylephrine
- dexbrompheniramine/dextromethorphan/phenylephrine/pyrilamine
- dexbrompheniramine/dextromethorphan/guaifenesin/phenylephrine
- codeine/phenylephrine/phosphate/pyrilamine
- codeine/phenylephrine/phosphate/promethazine
- codeine/phenylephrine/phosphate
- codeine/guaifenesin/phenylephrine/phosphate
- codeine/diphenhydramine/phenylephrine/phosphate
- codeine/dexchlorpheniramine/phenylephrine/phosphate
- cocoa butter/phenylephrine
- chlorpheniramine/phenylephrine/scopolamine
- chlorpheniramine/methscopolamine/phenylephrine/zinc acetate
- chlorpheniramine/methscopolamine/phenylephrine/pseudoephedrine
- chlorpheniramine/methscopolamine/nitrate/phenylephrine
- chlorpheniramine/ibuprofen/phenylephrine
- chlorpheniramine/hyoscyamine/phenylephrine/scopolamine
- chlorpheniramine/hyoscyamine/phenylephrine/phenylpropanolamine/scopolamine
- chlorpheniramine/hydrocodone/phenylephrine/pyrilamine
- chlorpheniramine/guaifenesin/methscopolamine/phenylephrine
- chlorpheniramine/dextromethorphan/phenylephrine/phenylpropanolamine
- chlorpheniramine/dextromethorphan/guaifenesin/methscopolamine/phenylephrine
- chlorpheniramine/codeine/phenylephrine/potassium iodide
- chlorpheniramine/codeine/phenylephrine
- chlorpheniramine/citrate/phenylephrine/phenyltoloxamine
- chlorcyclizine/phenylephrine
- chlorcyclizine/nov protein/phenylephrine
- chlorcyclizine/codeine/phenylephrine
- chlophedianol/phenylephrine/triprolidine
- chlophedianol/phenylephrine/pyrilamine
- chlophedianol/phenylephrine
- chlophedianol/guaifenesin/phenylephrine
- chlophedianol/chlorpheniramine/phenylephrine
- chlophedianol/chlorcyclizine/phenylephrine
- carboxymethylcellulose/phenylephrine
- carbinoxamine/phenylephrine
- carbinoxamine/hydrocodone/phenylephrine
- carbinoxamine/dextromethorphan/phenylephrine
- carbetapentane/phenylephrine/pyrilamine
- carbetapentane/guaiacolsulfonate/phenylephrine
- carbetapentane/diphenhydramine/phenylephrine
- carbetapentane/diethylcarbamazine/guaifenesin/phenylephrine
- carbetapentane/dexchlorpheniramine/phenylephrine
- carbetapentane/citrate/guaifenesin/phenylephrine
- carbetapentane/citrate/dexchlorpheniramine/phenylephrine
- carbetapentane/carbinoxamine/phenylephrine
- caffeine/codeine/pheniramine/phenylephrine/salicylate
- brompheniramine/hydrocodone/phenylephrine
- brompheniramine/guaifenesin/phenylephrine
- brompheniramine/chlorpheniramine/methscopolamine/phenylephrine/pseudoephedrine
- brompheniramine/chlophedianol/phenylephrine
- aspirin/dextromethorphan/phenylephrine
- aspirin/dextromethorphan/doxylamine/phenylephrine
- acetaminophen/phenylephrine/pyrilamine
- acetaminophen/doxylamine/phenylephrine
- acetaminophen/diphenhydramine/phenylephrine/pseudoephedrine
- acetaminophen/diphenhydramine/guaifenesin/phenylephrine
- acetaminophen/dextromethorphan/doxylamine/guaifenesin/phenylephrine
- acetaminophen/dextromethorphan/diphenhydramine/guaifenesin/phenylephrine
- acetaminophen/dexbrompheniramine/phenylephrine
- acetaminophen/chlorpheniramine/phenylephrine/phenyltoloxamine
- acetaminophen/chlorpheniramine/guaifenesin/phenylephrine
- acetaminophen/chlorpheniramine/diphenhydramine/phenylephrine
- acetaminophen/chlorpheniramine/dextromethorphan/guaifenesin/phenylephrine
- acetaminophen/chlorpheniramine/codeine/phenylephrine
- acetaminophen/caffeine/chlorpheniramine/phenylephrine
- acetaminophen/caffeine/chlorpheniramine/hydrocodone/phenylephrine
- phenylephrine/shark liver oil
- methscopolamine/phenylephrine
- guaiacolsulfonate/phenylephrine
- dihydrocodeine/phenylephrine/pyrilamine
- dihydrocodeine/phenylephrine
- dihydrocodeine/guaifenesin/phenylephrine
- dexchlorpheniramine/methscopolamine/phenylephrine
- dexbrompheniramine/phenylephrine/pyrilamine
- dexbrompheniramine/phenylephrine
- dexbrompheniramine/hydrocodone/phenylephrine
- dexbrompheniramine/dextromethorphan/phenylephrine
- cocoa butter/phenylephrine/shark liver oil
- chlorpheniramine/phenylephrine/phenyltoloxamine
- chlorpheniramine/methscopolamine/phenylephrine
- chlorpheniramine/dihydrocodeine/phenylephrine
- carbetapentane/phenylephrine
- carbetapentane/guaifenesin/phenylephrine
- carbetapentane/chlorpheniramine/phenylephrine
- carbetapentane/chlorpheniramine/ephedrine/phenylephrine
- brompheniramine/dihydrocodeine/phenylephrine
- brompheniramine/carbetapentane/phenylephrine
- antipyrine/benzocaine/phenylephrine
- brompheniramine/chlorpheniramine/phenylephrine/pseudoephedrine
- phenylephrine/zinc oxide
- phenylephrine/witch hazel
- mineral oil/phenylephrine/white petrolatum
- hydrocodone/phenylephrine/pyrilamine
- diethylcarbamazine/guaifenesin/phenylephrine
- guaifenesin/phenylephrine/pyrilamine
- guaifenesin/hydrocodone/phenylephrine
- glycerol/phenylephrine/pramoxine/white petrolatum
- diphenhydramine/hydrocodone/phenylephrine
- diphenhydramine/huntingtin/hydrocodone/phenylephrine
- diphenhydramine/phenylephrine
- dextromethorphan/diphenhydramine/phenylephrine
- dextromethorphan/phenylephrine/pyrilamine
- dexchlorpheniramine/dextromethorphan/phenylephrine
- dexchlorpheniramine/dextromethorphan/phenylephrine/pyrilamine
- dexchlorpheniramine/hydrocodone/phenylephrine
- dextromethorphan/phenylephrine
- hydrocodone/phenylephrine
- codeine/phenylephrine
- codeine/phenylephrine/pyrilamine
- codeine/dexchlorpheniramine/phenylephrine
- codeine/guaifenesin/phenylephrine
- codeine/diphenhydramine/phenylephrine
- chlorpheniramine/nitrate/phenylephrine
- chlorpheniramine/guaifenesin/phenylephrine
- chlorpheniramine/dextromethorphan/diethylcarbamazine/phenylephrine
- chlorpheniramine/dextromethorphan/guaifenesin/phenylephrine
- chlorpheniramine/hydrocodone/phenylephrine
- chlophedianol/dexbrompheniramine/phenylephrine
- phenylephrine/pyrilamine
- chlorpheniramine/ephedrine/phenylephrine
- caffeine/pheniramine/phenylephrine/salicylate
- brompheniramine/dextromethorphan/guaifenesin/phenylephrine
- brompheniramine/codeine/phenylephrine
- brompheniramine/diethylcarbamazine/phenylephrine
- brompheniramine/dextromethorphan/phenylephrine
- aspirin/chlorpheniramine/phenylephrine
- benzocaine/phenylephrine
- acetaminophen/codeine/guaifenesin/phenylephrine
- acetaminophen/dextromethorphan/diethylcarbamazine/doxylamine/phenylephrine
- acetaminophen/phenylephrine
- acetaminophen/dextromethorphan/guaifenesin/phenylephrine
- acetaminophen/chlorpheniramine/phenylephrine
- acetaminophen/chlorpheniramine/dextromethorphan/phenylephrine
- acetaminophen/caffeine/guaifenesin/phenylephrine
- acetaminophen/guaifenesin/phenylephrine
- acetaminophen/dextromethorphan/phenylephrine
- acetaminophen/dextromethorphan/doxylamine/phenylephrine
- acetaminophen/diphenhydramine/phenylephrine
- acetaminophen/chlorpheniramine/phenylephrine/salicylamide
- acetaminophen/pheniramine/phenylephrine
- guaifenesin/phenylephrine
- dextromethorphan/guaifenesin/phenylephrine
- dexchlorpheniramine/phenylephrine
- chlorpheniramine/dextromethorphan/phenylephrine
- citrate/guaifenesin/phenylephrine
- brompheniramine/diphenhydramine/phenylephrine
- brompheniramine/phenylephrine
- acetaminophen/dextromethorphan/diphenhydramine/phenylephrine
- cyclopentolate/phenylephrine (Cyclomydril)
- chlorpheniramine/phenylephrine (OMNIhist LA)
- chlorpheniramine/phenylephrine/pyrilamine (Triotann)
- chlorpheniramine/phenylephrine/phenylpropanolamine/phenyltoloxamine (Naldecon, Naldelate, Par Decon)
- guaifenesin/phenylephrine/phenylpropanolamine (Entex)
- phenylephrine/promethazine (Phenergan with phenylephrine)
- codeine/phenylephrine/promethazine (Phenergan with phenylephrine & codeine)
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Faga LJ, American Family Physician 58:1795-1802, 1998
- ↑ 3.0 3.1 Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ 4.0 4.1 Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Mangione CM, In: UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ 6.0 6.1 6.2 Prescriber's Letter 12(3): 2005 Sudafed PE Nasal Decongestant Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=210310&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 7.0 7.1 Prescriber's Letter 13(12): 2006 Changes to OTC cough and Cold products Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=221207&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 8.0 8.1 8.2 Medical Knowledge Self Assessment Program (MKSAP) 16, 17. American College of Physicians, Philadelphia 2012, 2015
- ↑ Deprecated Reference
- ↑ Atkinson HC et al Increased Phenylephrine Plasma Levels with Administration of Acetaminophen. N Engl J Med 2014; 370:1171-1172March 20, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24645960 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMc1313942
- ↑ 11.0 11.1 Therapeutics Letter #108. Therapeutics Initiative Drugs to Avoid. http://www.ti.ubc.ca/2018/01/04/108-drugs-avoid/