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Phenylephrine (systemic): Drug information

Phenylephrine (systemic): Drug information
(For additional information see "Phenylephrine (systemic): Patient drug information" and see "Phenylephrine (systemic): Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Biorphen;
  • Little Colds Decongestant [OTC] [DSC];
  • Medi-Phenyl [OTC];
  • Non-Pseudo Sinus Decongestant [OTC];
  • Sudafed PE Childrens [OTC];
  • Sudafed PE Sinus Congestion [OTC];
  • Sudogest PE [OTC] [DSC];
  • Vazculep
Brand Names: Canada
  • Neo-Synephrine [DSC]
Pharmacologic Category
  • Alpha-Adrenergic Agonist
Dosing: Adult
Hypotension or shock

Hypotension or shock: Note: Not recommended for septic shock except in the following circumstances: 1) when norepinephrine (preferred first-line agent) is associated with serious arrhythmias; 2) when cardiac output is known to be high and BP persistently low; or 3) used as salvage therapy when the combination of vasopressor/inotropic agents and low-dose vasopressin fail to achieve target mean arterial pressure (MAP) (SSC [Dellinger 2013]; SSC [Rhodes 2017]). In general, maintain goal MAP (eg, ~65 mm Hg); consider use if patient is in shock or has hypoperfusion during or after fluid resuscitation (SSC [Dellinger 2013]; SSC [Levy 2018]; SSC [Rhodes 2017]). Institutional protocols may vary with weight-based or non–weight-based dose regimens.

Septic shock and other vasodilatory shock states (alternative agent):

Weight-based dosing: Continuous infusion: IV: Initial dose: 0.5 to 2 mcg/kg/minute; titrate to desired MAP; usual dosage range: 0.25 to 5 mcg/kg/minute. Doses up to 9.1 mcg/kg/minute have been reported (Baloch 2019; Flancbaum 1997; Gregory 1991; Hollenberg 2004; Jain 2010; Manaker 2021; Morelli 2008).

Non–weight-based dosing (based on ~80 kg patient): Continuous infusion: IV: Initial dose: 40 to 160 mcg/minute; titrate to desired MAP; usual dosage range: 20 to 400 mcg/minute. Doses up to ~730 mcg/minute have been reported (doses calculated and rounded for an 80 kg patient according to weight-based dosing using the referenced sources [Baloch 2019; Flancbaum 1997; Gregory 1991; Hollenberg 2004; Jain 2010; Manaker 2021; Morelli 2008]).

Cardiogenic shock: Note: For initial vasoactive management of cardiogenic shock due to aortic stenosis, mitral stenosis, or hypertrophic cardiomyopathy with left ventricular outflow tract obstruction (AHA/ACC [Ommen 2020]; AHA [van Diepen 2017]).

Continuous infusion: IV: 0.1 to 10 mcg/kg/minute; titrate to clinical end point (AHA [van Diepen 2017]).

Hypotension during anesthesia

Hypotension during anesthesia:

IV bolus: Initial: 40 to 100 mcg/dose; may repeat every 1 to 2 minutes as needed; titrate to clinical end point; maximum total dose: 200 mcg.

Continuous infusion: IV: Initial dose: 10 to 35 mcg/minute; titrate to clinical end point; maximum dose: 200 mcg/minute.

Nasal congestion

Nasal congestion: Oral: OTC labeling: 10 mg every 4 hours as needed for ≤7 days (maximum: 60 mg/24 hours).

Priapism, acute ischemic

Priapism, acute ischemic (off-label use): Note: The optimal dosing, frequency, and method of administration has not been established.

Intracavernous (off-label route): 100 to 500 mcg every 5 minutes or greater as needed for up to 1 hour (using a concentration of 100 to 500 mcg/mL); if used with aspiration/irrigation, then aspiration should be performed before administration of phenylephrine (AUA/SMSNA [Bivalacqua 2021]).

Dosing: Kidney Impairment: Adult

Mild to severe impairment: There are no dosage adjustments provided in the manufacturer's labeling.

End-stage kidney disease: There are no dosage adjustments provided in the manufacturer's labeling; dose-response data indicate increased responsiveness; lower initial doses may be required.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling; dose-response data indicate decreased responsiveness; higher doses may be required.

Dosing: Obesity: Adult

The recommendations for dosing in patients with obesity are based upon the best available evidence and clinical expertise. Senior Editorial Team: Jeffrey F. Barletta, PharmD, FCCM; Manjunath P. Pai, PharmD, FCP; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC.

Class 1, 2, and 3 obesity (BMI ≥30 kg/m2):

Continuous infusion: IV: If institution uses weight-based dosing, use ideal body weight for initial weight-based dose calculations, then titrate to hemodynamic effect and clinical response (expert opinion). If institution uses nonweight-based dosing for vasoactive agents, continue with this approach. During therapy, clinicians should not change dosing weight from one weight metric to another (ie, ideal body weight to/from actual body weight or weight-based dosing to/from nonweight-based dosing) (Erstad 2021; expert opinion). Refer to adult dosing for indication specific doses.

Rationale for recommendations: There is a paucity of studies evaluating the influence of obesity on phenylephrine dosing or pharmacokinetics. Observational studies, including phenylephrine, epinephrine, and norepinephrine, suggest nonweight-based dosing strategies may result in lower overall cumulative dose requirements and increased drug exposure to second line agents in some patients and may not be advantageous in time to achieving hemodynamic stability (Adams 2017; Radosevich 2016; Vadiei 2017). However, it is difficult to show outcome differences between weight-based and nonweight-based dosing because of dose titration to target BP, particularly in the context of retrospective studies. Furthermore, there is substantial variability in response in critically ill patients, irrespective of weight. Due to the short onset of action and small Vd, rapid titration to clinical effect after initial dosing is possible (Erstad 2021).

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Phenylephrine (systemic): Pediatric drug information")

Note: Dosing presented in both mg (oral) and mcg (parenteral); use caution when ordering and dispensing.

Nasal congestion

Nasal congestion: Oral:

Children 4 to 5 years: 2.5 mg every 4 hours; maximum daily dose: 15 mg in 24 hours.

Children 6 to 11 years: 5 mg every 4 hours; maximum daily dose: 30 mg in 24 hours.

Children ≥12 years and Adolescents: 10 mg every 4 hours; maximum daily dose: 60 mg in 24 hours.

Hypotension, low cardiac output

Hypotension, low cardiac output: Limited data available: Infants, Children, and Adolescents:

IM, SubQ: 100 mcg/kg/dose every 1 to 2 hours as needed; maximum dose: 5,000 mcg/dose (Park 2014).

IV bolus: 5 to 20 mcg/kg/dose every 10 to 15 minutes as needed (AAP 1998; Shaddy 1989); initial dose should not exceed 500 mcg/dose.

Continuous IV infusion: Usual initial dose: 0.1 to 0.5 mcg/kg/minute; titrate to desired response (Di Gennaro 2010; Stewart 2002; Wessel 2001); in cases of shock or intraoperative hypotension, doses up to 2 mcg/kg/minute have been reported (Di Gennaro 2010; Kliegman 2020; Shaddy 1989; Stewart 2002); for management of infundibular spasm (tet spell), even higher doses up to 5 mcg/kg/minute may be required (AAP 1998; Shaddy 1989).

Hypotension during spinal anesthesia

Hypotension during spinal anesthesia: IM, SubQ: Infants, Children, and Adolescents: 44 to 88 mcg/kg/dose; maximum dose: 500 mcg.

Dosing: Kidney Impairment: Pediatric

Mild to severe impairment: There are no dosage adjustments provided in the manufacturer's labeling.

End-stage renal disease: There are no dosage adjustments provided in the manufacturer's labeling. Based on dose-response data, a lower initial dose is recommended.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not defined.

Injection:

Cardiovascular: Cardiac arrhythmia (rare), exacerbation of angina, hypertension, hypertensive crisis, ischemia, localized blanching, low cardiac output, peripheral vasoconstriction (severe), reflex bradycardia, visceral vasoconstriction (severe), worsening of heart failure

Central nervous system: Anxiety, dizziness, excitability, headache, insomnia, nervousness, paresthesia, precordial pain (or discomfort), restlessness

Dermatologic: Pallor, piloerection, pruritus

Endocrine & metabolic: Metabolic acidosis

Gastrointestinal: Epigastric pain, gastric irritation, nausea, vomiting

Genitourinary: Decreased renal blood flow, decreased urine output

Hypersensitivity: Hypersensitivity reaction (including skin rash, urticaria, leukopenia, agranulocytosis, thrombocytopenia)

Neuromuscular & skeletal: Neck pain, tremor, weakness

Ophthalmic: Blurred vision

Respiratory: Dyspnea, respiratory distress

Oral: Central nervous system: Anxiety, dizziness, excitability, headache, insomnia, nervousness, restlessness

Contraindications

There are no contraindications listed in the manufacturer's labeling.

OTC labeling (Oral): When used for self-medication: Use with or within 14 days of monoamine oxidase inhibitor therapy

Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Warnings/Precautions

Concerns related to adverse effects:

• Cardiovascular effects: IV use of phenylephrine may cause severe bradycardia (likely baroreflex mediated) and reduced cardiac output due to an increase in cardiac afterload especially in patients with preexisting cardiac dysfunction (Goertz 1993; Yamazaki 1982). May also precipitate angina in patients with severe coronary artery disease and increase pulmonary arterial pressure. Use with caution in patients with preexisting bradycardia, partial heart block, myocardial disease, or severe coronary artery disease. Avoid or use with extreme caution in patients with heart failure or cardiogenic shock; increased systemic vascular resistance may significantly reduce cardiac output. Avoid use in patients with hypertension (contraindicated in severe hypertension); monitor BP closely and adjust infusion rate. May also cause excessive peripheral and visceral vasoconstriction and ischemia to vital organs, particularly in patients with extensive peripheral vascular disease.

• Extravasation: IV administration: Vesicant; ensure proper needle or catheter placement prior to and during infusion. Avoid extravasation.

Disease-related concerns:

• Acidosis: Acidosis may reduce the efficacy of phenylephrine; correct acidosis during use of phenylephrine.

• Autonomic dysfunction: Patients with autonomic dysfunction (eg, spinal cord injury) may exhibit an exaggerated increase in BP response to phenylephrine.

Concurrent drug therapy issues:

• Monoamine oxidase inhibitors: Use with extreme caution in patients taking monoamine oxidase inhibitors; hypertension may result from concurrent use.

Dosage form specific issues:

• Benzyl alcohol and derivatives: Some dosage forms may contain sodium benzoate/benzoic acid; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggest that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol derivative with caution in neonates. See manufacturer's labeling.

• Oral: When used for self-medication (OTC), use with caution in patients with asthma, bowel obstruction/narrowing, hyperthyroidism, diabetes mellitus, cardiovascular disease, ischemic heart disease, hypertension, increased intraocular pressure, prostatic hyperplasia, or in older adults. Notify health care provider if symptoms do not improve within 7 days or are accompanied by fever. Discontinue and contact health care provider if nervousness, dizziness, or sleeplessness occur.

• Sulfites: Some products contain sulfites, which may cause allergic reactions in susceptible individuals.

Other warnings/precautions:

• Appropriate use: When used IV in patients who are hypotensive, assure adequate circulatory volume to minimize need for vasoconstrictors.

Warnings: Additional Pediatric Considerations

Safety and efficacy for the use of cough and cold products in pediatric patients <4 years of age is limited; the AAP warns against the use of these products for respiratory illnesses in young children. Serious adverse effects including death have been reported. Many of these products contain multiple active ingredients, increasing the risk of accidental overdose when used with other products. The FDA does not recommend OTC uses for these products in pediatric patients <2 years of age and recommends to use with caution in pediatric patients ≥2 years of age. Health care providers are reminded to ask caregivers about the use of OTC cough and cold products in order to avoid exposure to multiple medications containing the same ingredient (AAP 2018; CDC 2007; FDA 2017; FDA 2018).

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Liquid, Oral, as hydrochloride:

Little Colds Decongestant: 2.5 mg/mL (30 mL [DSC]) [alcohol free, dye free, saccharin free; contains sodium benzoate]

Solution, Intravenous, as hydrochloride:

Vazculep: 10 mg/mL (1 mL [DSC], 5 mL, 10 mL) [contains sodium metabisulfite]

Generic: 10 mg/mL (1 mL, 5 mL, 10 mL); 20 mg/250 mL in NaCl 0.9% (250 mL); 25 mg/250 mL in NaCl 0.9% (250 mL); 40 mg/250 mL in NaCl 0.9% (250 mL); 50 mg/250 mL in NaCl 0.9% (250 mL)

Solution, Intravenous, as hydrochloride [preservative free]:

Biorphen: 0.5 mg/5 mL (5 mL)

Biorphen: 0.5 mg/5 mL (5 mL [DSC]) [sulfate free]

Generic: 10 mg/mL (1 mL, 5 mL, 10 mL)

Solution, Oral, as hydrochloride:

Sudafed PE Childrens: 2.5 mg/5 mL (118 mL) [alcohol free, sugar free; contains edetate (edta) disodium, fd&c red #40 (allura red ac dye), sodium benzoate; berry flavor]

Solution Prefilled Syringe, Intravenous, as hydrochloride:

Generic: 1 mg/10 mL (10 mL)

Tablet, Oral, as hydrochloride:

Medi-Phenyl: 5 mg [pseudoephedrine free; contains fd&c red #40 (allura red ac dye), fd&c yellow #6 (sunset yellow)]

Non-Pseudo Sinus Decongestant: 10 mg [contains fd&c red #40(allura red ac)aluminum lake, fd&c yellow #6(sunset yellow)alumin lake]

Sudafed PE Sinus Congestion: 10 mg [contains fd&c red #40(allura red ac)aluminum lake, fd&c yellow #6(sunset yellow)alumin lake, quinoline (d&c yellow #10) aluminum lake]

Sudogest PE: 10 mg [DSC] [contains fd&c red #40 (allura red ac dye)]

Sudogest PE: 10 mg [DSC] [gluten free; contains fd&c red #40(allura red ac)aluminum lake]

Generic: 10 mg

Generic Equivalent Available: US

May be product dependent

Pricing: US

Solution (Biorphen Intravenous)

0.5 mg/5 mL (per mL): $1.20

Solution (Phenylephrine HCl (Pressors) Intravenous)

10 mg/mL (per mL): $1.41 - $4.80

Solution (Sudafed PE Childrens Oral)

2.5 mg/5 mL (per mL): $0.05

Solution (Vazculep Intravenous)

10 mg/mL (per mL): $5.30

Tablets (Phenylephrine HCl Oral)

10 mg (per each): $0.04

Tablets (Sudafed PE Sinus Congestion Oral)

10 mg (per each): $0.41

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.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution, Injection, as hydrochloride:

Neo-Synephrine: 10 mg/mL ([DSC]) [contains sodium metabisulfite]

Generic: 10 mg/mL (1 mL, 2 mL, 5 mL, 10 mL)

Solution Prefilled Syringe, Intravenous, as hydrochloride:

Generic: 0.5 mg/10 mL (10 mL)

Administration: Adult

IV:

Hypotension/shock: May be administered via continuous infusion (after diluting); IV infusions require an infusion pump. When administering as a continuous infusion, central line administration is preferred; extravasation may cause severe ischemic necrosis. If central line is not available, may administer for a short duration (<72 hours) through a peripheral IV catheter placed in a large vein at a proximal site (eg, in or proximal to antecubital fossa). Frequent monitoring of the IV catheter site is recommended to rapidly identify extravasation (Cardenas-Garcia 2015; Evans 2021; Lewis 2019; Stolz 2022; Tian 2020; Tran 2020). Refer to institutional policies and procedures; catheter placement/size and vasopressor concentration may vary depending on institution. Administration through midline catheters may also be an option (Prasanna 2021).

Hypotension during anesthesia: Using 100 mcg/mL concentration, administer as an IV bolus over 20 to 30 seconds.

Intracavernous (off-label route): Using a 100 to 500 mcg/mL concentration, administer laterally (3 or 9 o'clock position) near the base of the penile shaft with small needles (eg, 27-gauge). May consider penile block with local anesthetic prior to administration (AUA/SMSNA [Bivalacqua 2021]).

Vesicant; ensure proper needle or catheter placement prior to and during infusion; avoid extravasation.

Extravasation management: If extravasation occurs, stop infusion immediately; leave cannula/needle in place temporarily but do NOT flush the line; gently aspirate extravasated solution, then remove needle/cannula; elevate extremity; apply dry warm compresses; initiate phentolamine (or alternative antidote) (Stefanos 2023).

Phentolamine: SUBQ: Dilute 5 to 10 mg in 10 mL NS and administer into extravasation site as soon as possible after extravasation; if IV catheter remains in place, administer initial dose IV through the infiltrated catheter; may repeat in 60 minutes if patient remains symptomatic (Stefanos 2023).

Alternative to phentolamine: Nitroglycerin topical 2% ointment: Apply a 1-inch strip to the site of ischemia to cover the affected area; may repeat every 8 hours as necessary (Stefanos 2023).

Administration: Pediatric

Oral: OTC products: Administer without regard to food. Administer liquid formulation using an accurate measuring device; do not use household tablespoon.

Parenteral:

IV bolus: 10 mg/mL solution must be diluted prior to administration; a 100 mcg/mL (0.1 mg/mL) ready-to-use formulation requiring no further dilution is also available for IV bolus administration. Administer dose over 20 to 30 seconds (Klaus 1989).

Continuous IV infusion: 10 mg/mL solution must be diluted prior to administration. Administer as a continuous infusion via an infusion pump. Central line administration is preferred; extravasation may cause severe ischemic necrosis. If central line is not available, may consider administering for a short duration through a peripheral IV catheter placed in a large vein or via intraosseous access using a more dilute solution or with a second carrier fluid (ACCM [Davis 2017]. Administration into an umbilical arterial catheter is not recommended. Frequent monitoring of the IV catheter site is recommended to rapidly identify extravasation. Refer to institutional policies and procedures; catheter placement/size and vasopressor concentration may vary depending on institution.

Vesicant; ensure proper needle or catheter placement prior to and during infusion; avoid extravasation. If extravasation occurs, stop infusion immediately and disconnect (leave cannula/needle in place); gently aspirate extravasated solution (do not flush the line); remove needle/cannula; elevate extremity. Initiate phentolamine (or alternative antidote). (See Management of Drug Extravasations for more details.) Apply dry warm compresses (Hurst 2004; Reynolds 2014).

Usual Infusion Concentrations: Adult

IV infusion: 10 mg in 500 mL (concentration: 20 mcg/mL) of D5W or NS, 50 mg in 500 mL (concentration: 100 mcg/mL) of NS, 100 mg in 500 mL (concentration: 200 mcg/mL) of NS, or 100 mg in 250 mL (concentration: 400 mcg/mL) of NS.

Other institutions may use concentrations of 40 mcg/mL or 160 mcg/mL; however, stability information is not available for these concentrations.

Usual Infusion Concentrations: Pediatric

IV infusion: 20 mcg/mL, 40 mcg/mL, 60 mcg/mL, 80 mcg/mL, or 400 mcg/mL.

Use: Labeled Indications

Hypotension or shock: Treatment of severe hypotension or shock that persists during and after adequate fluid volume replacement.

Hypotension during anesthesia: Treatment of vasodilation and hypotension during anesthesia.

Nasal congestion [OTC]: For the temporary relief of nasal congestion due to the common cold, sinusitis, hay fever, or upper respiratory allergies.

Use: Off-Label: Adult

Priapism, acute ischemic

Medication Safety Issues
Sound-alike/look-alike issues:

Sudafed PE may be confused with Sudafed.

Vazculep may be confused with Bloxiverz (neostigmine) due to similar packaging.

High alert medication:

The Institute for Safe Medication Practices (ISMP) includes this medication (IV formulation) among its list of drugs which have a heightened risk of causing significant patient harm when used in error.

International issues:

Biorphen: Brand name for phenylephrine systemic [US] but is also the brand name for orphenadrine [Great Britain]

Metabolism/Transport Effects

None known.

Drug Interactions

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 Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Acetaminophen: May increase the serum concentration of Phenylephrine (Systemic). Risk C: Monitor therapy

Alpha1-Blockers: May diminish the vasoconstricting effect of Alpha1-Agonists. Similarly, Alpha1-Agonists may antagonize Alpha1-Blocker vasodilation. Risk C: Monitor therapy

Atomoxetine: May enhance the hypertensive effect of Sympathomimetics. Atomoxetine may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy

Atropine (Systemic): May enhance the hypertensive effect of Alpha1-Agonists. Risk C: Monitor therapy

Benzylpenicilloyl Polylysine: Alpha1-Agonists may diminish the diagnostic effect of Benzylpenicilloyl Polylysine. Management: Consider delaying skin testing until alpha1-agonists are no longer required, or use of a histamine skin test as a positive control to assess a patient's ability to mount a wheal and flare response. Risk D: Consider therapy modification

Bromocriptine: May enhance the hypertensive effect 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 enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy

Chloroprocaine (Systemic): May enhance the hypotensive effect of Phenylephrine (Systemic). Risk C: Monitor therapy

CloZAPine: May diminish the therapeutic effect of Phenylephrine (Systemic). Risk C: Monitor therapy

Cocaine (Topical): May enhance the hypertensive effect 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

Doxofylline: Sympathomimetics may enhance the adverse/toxic effect of Doxofylline. Risk C: Monitor therapy

Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates): May enhance the vasoconstricting effect of Alpha1-Agonists. Risk X: Avoid combination

FentaNYL: Decongestants may decrease the serum concentration of FentaNYL. Risk C: Monitor therapy

Guanethidine: May enhance the arrhythmogenic effect of Sympathomimetics. Guanethidine may enhance the hypertensive effect of Sympathomimetics. Risk C: Monitor therapy

Hyaluronidase: May enhance the vasoconstricting effect of Phenylephrine (Systemic). Management: Avoid the use of hyaluronidase to enhance dispersion or absorption of phenylephrine. Use of hyaluronidase for other purposes in patients receiving phenylephrine may be considered as clinically indicated. Risk X: Avoid combination

Iobenguane Radiopharmaceutical Products: Alpha1-Agonists may diminish the therapeutic effect 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 combination

Kratom: May enhance the adverse/toxic effect of Sympathomimetics. Risk X: Avoid combination

Levothyroxine: May enhance the adverse/toxic effect of Sympathomimetics. Specifically, the risk of coronary insufficiency may be increased in patients with coronary artery disease. Levothyroxine may enhance the therapeutic effect of Sympathomimetics. Sympathomimetics may enhance the therapeutic effect of Levothyroxine. Risk C: Monitor therapy

Linezolid: May enhance the hypertensive effect 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 enhance the hypertensive effect of Alpha1-Agonists. Risk X: Avoid combination

Monoamine Oxidase Inhibitors: May enhance the hypertensive effect 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 combination

Ozanimod: May enhance the hypertensive effect of Sympathomimetics. Risk C: Monitor therapy

Pergolide: May enhance the hypertensive effect of Alpha1-Agonists. Risk C: Monitor therapy

Propacetamol: May increase the serum concentration of Phenylephrine (Systemic). Management: Monitor patients closely for increased side effects of phenylephrine if propacetamol is used concomitantly. Patients with underlying blood pressure issues or arrhythmias may need closer monitoring and may warrant consideration of alternative therapies. Risk C: Monitor therapy

Solriamfetol: Sympathomimetics may enhance the hypertensive effect of Solriamfetol. Sympathomimetics may enhance the tachycardic effect of Solriamfetol. Risk C: Monitor therapy

Sympathomimetics: May enhance the adverse/toxic effect of other Sympathomimetics. Risk C: Monitor therapy

Tedizolid: May enhance the hypertensive effect of Sympathomimetics. Tedizolid may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy

Tricyclic Antidepressants: May enhance the therapeutic effect of Alpha1-Agonists. Tricyclic Antidepressants may diminish the therapeutic effect of Alpha1-Agonists. Risk C: Monitor therapy

Pregnancy Considerations

Phenylephrine crosses the placenta at term.

Maternal use of phenylephrine during the first trimester of pregnancy is not strongly associated with an increased risk of fetal malformations; maternal dose and duration of therapy were not reported in available publications. Phenylephrine is available over-the-counter for the symptomatic relief of nasal congestion. Decongestants are not the preferred agents for the treatment of rhinitis during pregnancy. Oral phenylephrine should be avoided during the first trimester of pregnancy; short-term use (<3 days) of intranasal phenylephrine may be beneficial to some patients although its safety during pregnancy has not been studied. Phenylephrine injection is used at delivery for the prevention and/or treatment of maternal hypotension associated with spinal anesthesia in women undergoing cesarean section. Phenylephrine may be associated with a more favorable fetal acid base status than ephedrine; however, overall fetal outcomes appear to be similar. Nausea or vomiting may be less with phenylephrine than ephedrine but is also dependent upon blood pressure control. Phenylephrine may be preferred in the absence of maternal bradycardia.

Breastfeeding Considerations

It is not known if phenylephrine is present in breast milk.

According to the manufacturer, the decision to continue or discontinue breastfeeding during therapy should take into account the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the breastfeeding person; the manufacturer recommends that caution be exercised when administering phenylephrine to people who are breastfeeding a child.

Dietary Considerations

Some products may contain phenylalanine and/or sodium.

Monitoring Parameters

BP (or mean arterial pressure), heart rate, cardiac output (as appropriate); intravascular volume status; creatinine and urine output; peripheral perfusion; monitor site of infusion for blanching/extravasation.

Consult individual institutional policies and procedures.

Mechanism of Action

Potent, direct-acting alpha-adrenergic agonist with virtually no beta-adrenergic activity; produces systemic arterial vasoconstriction. Such increases in systemic vascular resistance may result in dose-dependent increases in systolic and diastolic blood pressure and reductions in heart rate and cardiac output (most noticeable in patients with preexisting cardiac dysfunction).

Pharmacokinetics (Adult Data Unless Noted)

Onset of action:

Blood pressure increase/vasoconstriction: IM, SubQ: 10 to 15 minutes; IV: Immediate

Nasal decongestant: Oral: 15 to 30 minutes (Kollar 2007)

Duration:

Blood pressure increase/vasoconstriction: IM: 1 to 2 hours; IV: ~15 to 20 minutes; SubQ: 50 minutes

Nasal decongestant: Oral: ≤4 hours (Kollar 2007)

Absorption: Oral: Erratic and incomplete (Kanfer 1993)

Distribution: Vd: Initial: 26 to 61 L; Vdss: 184 to 543 L (mean: 340 L) (Hengstmann 1982)

Metabolism: Hepatic via oxidative deamination (Oral: 24%; IV: 50%); Undergoes sulfation (Oral [mostly within gut wall]: 46%; IV: 8%) and some glucuronidation; forms inactive metabolites (Kanfer 1993)

Bioavailability: Oral: ≤38% (Hengstmann 1982; Kanfer 1993)

Half-life elimination: Alpha phase: ~5 minutes; Terminal phase: 2 to 3 hours (Hengstmann 1982; Kanfer 1993)

Time to peak: Oral: 0.75 to 2 hours (Kanfer 1993)

Excretion: Urine (mostly as inactive metabolites)

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AR) Argentina: Fenilefrina phoroneus;
  • (AT) Austria: Neosynephrine | Phenylephrin aguettant;
  • (AU) Australia: Amcal nasal decongestant pe | Chemists Own Sinus Relief PE | Codral relief | Decongestant PE | Maxiclear sinus relief | Neo synephrine | Nyal nasal decongestant pe | Nyal sinus relief pe | Pharmacy care nasal decongestant pe | Phenylephrine bnm | Sinutab pe sinus & pain relief | Sudafed pe | Sudafed pe nasal decongestant | Terry white chemists sinus decongestant pe | Vicks action cold nasal relief;
  • (BE) Belgium: Fenylefrine Unimedic | Phenylephrine aguettant;
  • (CH) Switzerland: Phenylephrin labatec;
  • (CO) Colombia: Fenilefrina hcl;
  • (CZ) Czech Republic: Phenylephrine | Phenylephrine aguettant;
  • (DE) Germany: Biorphen | Phenylephrin aguettant | Phenylephrin sintetica;
  • (EE) Estonia: Biorphen;
  • (ES) Spain: Fenilefrina Altan;
  • (FI) Finland: Fenylefrin abcur | Fenylefrin aguettant | Fenylefrin stragen | Fenylefrin unimedic;
  • (FR) France: Phenylephrine aguettant | Phenylephrine medac | Phenylephrine renaudin;
  • (GB) United Kingdom: Phenylephrine;
  • (IE) Ireland: Phenylephrine;
  • (IT) Italy: Fenilefrina aguettant;
  • (KW) Kuwait: Phenylephrine aguettant;
  • (NL) Netherlands: Biorphen | Fenylefrin altan | Fenylefrine Aguettant;
  • (NO) Norway: Fenylefrin | Fenylefrin aguettant | Fenylefrin stragen | Fenylefrin unimedic;
  • (NZ) New Zealand: Sudafed pe;
  • (PH) Philippines: Sinudrin;
  • (PR) Puerto Rico: Biorphen | Medi-phenyl | Phenylephrine HCL | Sudafed pe sinus congestion | Sudogest pe;
  • (RO) Romania: Biorphen;
  • (SE) Sweden: Fenylefrin abcur | Fenylefrin aguettant | Fenylefrin stragen | Fenylefrin unimedic;
  • (SG) Singapore: Phenylalpha;
  • (TH) Thailand: Phenylephrine;
  • (TN) Tunisia: Phenylephrine
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