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RESPIRATORY SYSTEM › NASAL PREPARATIONS › NASAL DECONGESTANTS FOR SYSTEMIC USE › Sympathomimetics
phenylephrine
R01BA03
Forms & Strengths
- Nasal spray: 0.125%, 0.25%, 0.5%, 1%
- Nasal drops: 0.125%, 0.25%, 0.4%, 0.5%
- Ophthalmic solution: 2.5%, 10%
- Injection: 10 mg/mL
Adult Dosing
- Nasal decongestant: 2-3 sprays of 0.25%-0.5% solution into each nostril every 4 hours PRN
- Ophthalmic (mydriasis): 1 drop of 2.5% or 10% solution prior to procedure
- Hypotension (IV bolus): 40-100 mcg every 1-2 minutes PRN
- Hypotension (IV infusion): 0.5-9 mcg/kg/min titrated to response
Pediatric Dosing
- Nasal decongestant (Children >12 years): 2-3 sprays of 0.25%-0.5% every 4 hours PRN
- Nasal decongestant (Children 6-12 years): 2-3 sprays of 0.25% every 4 hours PRN
- Ophthalmic (Infants): 1 drop of 2.5% solution
- Hypotension: Safety and efficacy not well established in pediatric patients for systemic use
Indications
- Temporary relief of nasal congestion associated with rhinitis, sinusitis, and common cold
- Mydriasis induction for ophthalmic examinations and procedures
- Treatment of clinically significant hypotension, particularly during anesthesia
Mechanism of Action
- Direct-acting alpha-1 adrenergic receptor agonist
- Causes vasoconstriction of arterioles in nasal mucosa, reducing edema and exudation
- Causes contraction of the dilator pupillae muscle resulting in mydriasis
- Increases systemic vascular resistance and raises blood pressure via systemic vasoconstriction
Contraindications
- Hypersensitivity to phenylephrine or any component
- Severe hypertension
- Ventricular tachycardia
- Angle-closure glaucoma (ophthalmic use)
Adverse Reactions
- Transient stinging or burning of the nasal mucosa
- Rebound congestion (rhinitis medicamentosa) with prolonged use (>3-5 days)
- Hypertension, reflex bradycardia, headache, and palpitations (systemic)
- Transient blurred vision and increased intraocular pressure (ophthalmic)
Drug Interactions
- Monoamine oxidase inhibitors (MAOIs): May cause severe hypertensive crisis; avoid concurrent use
- Vasopressor agents and ergot alkaloids: Potentiation of vasopressor effects and severe hypertension
- Beta-blockers: May antagonize cardiac effects and lead to severe peripheral vasoconstriction
- Tricyclic antidepressants: May potentiate pressor response
Curated Content: Needs Vetting Before Put to Clinical Use