Version July 2025
Nasal congestion: Note: Therapy should not exceed 3 days:
Infants and Children <2 years: Limited data available: 0.5% solution: Intranasal: Instill 0.1 mL in each nostril as a single dose (Ralston 2008; Turner 1996). In a double-blind, placebo-controlled trial in 20 infants (mean age: 4 months) with bronchiolitis results showed, improved respiratory scores and oxygen saturation; however, statistical significance was not reached (Ralston 2008). In another randomized, double-blind, placebo-controlled trial, 23 pediatric patients (age range: 6 to 18 months) with the common cold showed improvement in nasal obstruction which was not considered significant; no effect on middle ear pressures was observed (Turner 1996).
Children ≥2 years:
2 to <6 years: 0.125% solution: Intranasal: Instill 1 drop in each nostril every 2-4 hours as needed. Note: Consult product specific information for further details.
Little Noses Decongestant: Instill 2 to 3 drops in each nostril every 4 hours as needed
6 to 12 years: 0.25% solution: Intranasal: Instill 1 to 3 sprays in each nostril every 4 hours as needed
Adolescents: 0.25% to 1% solutions: Intranasal: Instill 1 to 3 drops or sprays every 4 hours as needed
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in manufacturer's labeling.
There are no dosage adjustments provided in manufacturer's labeling.
(For additional information see "Phenylephrine (nasal): Drug information")
Nasal congestion: Intranasal: 0.25% to 1% solution: Instill 2 to 3 sprays in each nostril no more than every 4 hours.
Duration: Generally, limit to 3 to 5 days of consecutive use due to risk of rhinitis medicamentosa (Ref). In patients with persistent symptoms despite use of first-line therapies, some guidelines suggest intranasal decongestants may be offered in combination with an intranasal corticosteroid for up to 4 weeks with low risk of rhinitis medicamentosa (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in manufacturer’s labeling.
There are no dosage adjustments provided in manufacturer’s labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not defined.
Nasal: Burning, nasal discharge, sneezing, stinging
OTC labeling: When used for self-medication, do not use if hypersensitivity to phenylephrine or any components of the formulation has occurred; do not use for more than 3 days.
Concerns related to adverse effects:
• Local nasal effects: Temporary discomfort such as burning, stinging, sneezing, or an increase in nasal discharge may occur.
• Rebound nasal congestion: Frequent or prolonged use may cause nasal congestion to recur or worsen.
Other warnings/precautions:
• Self-medication (OTC use): When used for self-medication (OTC), notify health care provider prior to use if you have diabetes, heart disease, high BP, thyroid disease, or trouble urinating due to an enlarged prostate gland. Do not use >3 days; discontinue use and notify health care provider if symptoms do not improve; do not exceed recommended dosages. Use of this container by more than one person may spread infection.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, Nasal, as hydrochloride:
4-Way Fast Acting: 1% (29.6 mL) [contains benzalkonium chloride]
4-Way Menthol: 1% (14.8 mL [DSC], 29.6 mL [DSC]) [contains benzalkonium chloride, menthol, polysorbate 80]
Neo-Synephrine Cold/Allrg Mild: 0.25% (15 mL) [contains benzalkonium chloride]
Neo-Synephrine Cold/Allrgy Ext: 1% (15 mL) [contains benzalkonium chloride]
Neo-Synephrine Cold/Allrgy Reg: 0.5% (15 mL) [contains benzalkonium chloride]
No
Solution (4-Way Fast Acting Nasal)
1% (per mL): $0.32
Solution (Neo-Synephrine Cold/Allrg Mild Nasal)
0.25% (per mL): $0.28
Solution (Neo-Synephrine Cold/Allrgy Ext Nasal)
1% (per mL): $0.31
Solution (Neo-Synephrine Cold/Allrgy Reg Nasal)
0.5% (per mL): $0.28
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
For intranasal use only. Clear nostrils before use; squeeze bottle with firm, quick pressure while inhaling into each nostril and gently occluding the other. Wipe nozzle clean after each use.
For intranasal use only. Blow nose to clear nostrils before use; squeeze bottle with firm, quick pressure while inhaling into each nostril and gently occluding the other. Wipe nozzle clean after each use.
Store at room temperature. Store in a dry place.
Symptomatic relief of nasal and nasopharyngeal mucosal congestion (OTC products: FDA approved in adults; refer to product specific information regarding FDA approval in pediatric patients)
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program
Atomoxetine: May increase hypertensive effects of Sympathomimetics. Atomoxetine may increase tachycardic effects of Sympathomimetics. Risk C: Monitor
Atropine (Systemic): May increase hypertensive effects of Alpha1-Agonists. Risk C: Monitor
Bornaprine: Sympathomimetics may increase anticholinergic effects of Bornaprine. Risk C: Monitor
Bromocriptine: May increase hypertensive effects of Alpha1-Agonists. Management: Consider alternatives to this combination when possible. If combined, monitor for hypertension and tachycardia, and do not coadminister these agents for more than 10 days. Risk D: Consider Therapy Modification
Cannabinoid-Containing Products: May increase tachycardic effects of Sympathomimetics. Risk C: Monitor
Cocaine (Topical): May increase hypertensive effects of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. Risk D: Consider Therapy Modification
Dihydralazine: Sympathomimetics may decrease therapeutic effects of Dihydralazine. Risk C: Monitor
Doxofylline: Sympathomimetics may increase adverse/toxic effects of Doxofylline. Risk C: Monitor
Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates): May increase vasoconstricting effects of Alpha1-Agonists. Risk X: Avoid
Esketamine (Injection): May increase adverse/toxic effects of Sympathomimetics. Specifically, the risk for elevated heart rate, hypertension, and arrhythmias may be increased. Risk C: Monitor
Esketamine (Nasal): Decongestants (Nasally Administered) may decrease therapeutic effects of Esketamine (Nasal). Management: Patients who require a nasal decongestant on an esketamine dosing day should administer the nasal decongestant at least 1 hour before esketamine. Risk D: Consider Therapy Modification
FentaNYL: Decongestants may decrease serum concentration of FentaNYL. Risk C: Monitor
Guanethidine: May increase hypertensive effects of Sympathomimetics. Guanethidine may increase arrhythmogenic effects of Sympathomimetics. Risk C: Monitor
Iobenguane Radiopharmaceutical Products: Alpha1-Agonists may decrease therapeutic effects of Iobenguane Radiopharmaceutical Products. Management: Discontinue all drugs that may inhibit or interfere with catecholamine transport or uptake for at least 5 biological half-lives before iobenguane administration. Do not administer these drugs until at least 7 days after each iobenguane dose. Risk X: Avoid
Kratom: May increase adverse/toxic effects of Sympathomimetics. Risk X: Avoid
Levothyroxine: May increase therapeutic effects of Sympathomimetics. Sympathomimetics may increase therapeutic effects of Levothyroxine. Levothyroxine may increase adverse/toxic effects of Sympathomimetics. Specifically, the risk of coronary insufficiency may be increased in patients with coronary artery disease. Risk C: Monitor
Linezolid: May increase hypertensive effects of Sympathomimetics. Management: Consider initial dose reductions of sympathomimetic agents, and closely monitor for enhanced blood pressure elevations, in patients receiving linezolid. Risk D: Consider Therapy Modification
Lisuride: May increase hypertensive effects of Alpha1-Agonists. Risk X: Avoid
Metergoline: May increase adverse/toxic effects of Alpha1-Agonists. Risk C: Monitor
Monoamine Oxidase Inhibitors: May increase hypertensive effects of Alpha1-Agonists. While linezolid is expected to interact via this mechanism, management recommendations differ from other monoamine oxidase inhibitors. Refer to linezolid specific monographs for details. Risk X: Avoid
Pergolide: May increase hypertensive effects of Alpha1-Agonists. Risk C: Monitor
Solriamfetol: Sympathomimetics may increase hypertensive effects of Solriamfetol. Sympathomimetics may increase tachycardic effects of Solriamfetol. Risk C: Monitor
Sympathomimetics: May increase adverse/toxic effects of Sympathomimetics. Risk C: Monitor
Tedizolid: May increase adverse/toxic effects of Sympathomimetics. Specifically, the risk for increased blood pressure and heart rate may be increased. Risk C: Monitor
Tricyclic Antidepressants: May increase therapeutic effects of Alpha1-Agonists. Tricyclic Antidepressants may decrease therapeutic effects of Alpha1-Agonists. Risk C: Monitor
Zavegepant: Decongestants (Nasally Administered) may decrease serum concentration of Zavegepant. Management: Avoid the concurrent administration of intranasal decongestants with zavegepant. If combined use is unavoidable, intranasal decongestants should be administered at least 1 hour after zavegepant administration. Risk D: Consider Therapy Modification
When administered intravenously, phenylephrine crosses the placenta.
Decongestants are not recommended for the treatment of rhinitis during pregnancy (BSACI [Scadding 2017]). Use of phenylephrine nasal spray can be considered if acute relief is needed (Mazzotta 1999).
Potent, direct-acting alpha-adrenergic agonist with virtually no beta-adrenergic activity; produces local vasoconstriction resulting in nasal decongestion.
Onset of action: Intranasal: ≤2 minutes (Chua 1989)
Duration: Intranasal: 2.5 to 4 hours (dose dependent) (Chua 1989)
