Hypotension/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]).
Post cardiac arrest (off-label dose): Note: For vasoactive management of severe hypotension ([eg, systolic BP <70 mm Hg] and low total peripheral resistance) during/after cardiac arrest.
Continuous infusion: IV: Initial dose: 0.5 to 2 mcg/kg/minute; titrate to effect (AHA [Peberdy 2010]).
Cardiogenic shock (off-label dose): Note: For initial vasoactive management of cardiogenic shock due to aortic stenosis, mitral stenosis, or dynamic left ventricular outflow tract obstruction.
Continuous infusion: IV: 0.1 to 10 mcg/kg/minute (AHA [van Diepen 2017]).
Hypotension during anesthesia:
IV bolus: Initial: 40 to 100 mcg/dose; may repeat every 1 to 2 minutes as needed (total dose should not exceed 200 mcg) or 50 to 100 mcg (usual range: 50 to 250 mcg); titrate to achieve BP goal.
Continuous infusion: IV: Initial dose: 10 to 35 mcg/minute (not to exceed 200 mcg/minute) or 0.5 to 1.4 mcg/kg/minute; titrate to BP goal.
Nasal congestion: Oral: OTC labeling: 10 mg every 4 hours as needed for ≤7 days (maximum: 60 mg/24 hours).
Priapism (ischemic) (off-label use): Intracavernous (off-label route): 100 to 500 mcg every 3 to 5 minutes (using a concentration of 100 to 500 mcg/mL) over the course of ~1 hour; lower concentrations in smaller volumes should be used in patients with severe cardiovascular disease (AUA [Montague 2003]).
(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: 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: 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: IM, SubQ: Infants, Children, and Adolescents: 44 to 88 mcg/kg/dose; maximum dose: 500 mcg.
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.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
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).
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) [alcohol free, dye free, saccharin free; contains sodium benzoate; grape flavor]
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) [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 [DSC] [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
May be product dependent
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)
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; Tian 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: Administer as an IV bolus over 20 to 30 seconds.
Vesicant; ensure proper needle or catheter placement prior to and during infusion; avoid extravasation.
Extravasation management: 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). Apply dry warm compresses (Hurst 2004; Reynolds 2014).
Phentolamine: Dilute 5 to 10 mg in 10 to 20 mL NS and administer into extravasation site as soon as possible after extravasation; may readminister if patient remains symptomatic (Reynolds 2014).
Alternative to phentolamine: Nitroglycerin topical 2% ointment (based on limited data): Apply a 1-inch strip to the site of ischemia; may repeat every 8 hours as necessary (Reynolds 2014).
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).
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.
IV infusion: 20 mcg/mL, 40 mcg/mL, 60 mcg/mL, 80 mcg/mL, or 400 mcg/mL.
Hypotension/shock: Treatment of hypotension, vascular failure in shock.
Hypotension during anesthesia: As a vasoconstrictor in regional analgesia.
Nasal congestion: As a decongestant [OTC].
Hypotension in patients with hypertrophic cardiomyopathy with left ventricular outflow tract obstruction; Priapism (ischemic)
Sudafed PE may be confused with Sudafed.
Vazculep may be confused with Bloxiverz (neostigmine) due to similar packaging.
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.
Biorphen: Brand name for phenylephrine systemic [US] but is also the brand name for orphenadrine [Great Britain]
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
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
Concerns related to adverse effects:
• Cardiovascular effects: Intravenous 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 blood pressure 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 prior to or during use of phenylephrine.
• Autonomic dysfunction: Patients with autonomic dysfunction (eg, spinal cord injury) may exhibit an exaggerated increase in blood pressure 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 suggests 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 intravenously in patients who are hypotensive, assure adequate circulatory volume to minimize need for vasoconstrictors.
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).
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 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
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
Linezolid: May enhance the hypertensive effect of Sympathomimetics. Management: Reduce initial doses of sympathomimetic agents, and closely monitor for enhanced pressor response, in patients receiving linezolid. Specific dose adjustment recommendations are not presently available. 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
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.
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.
Some products may contain phenylalanine and/or sodium.
Blood pressure (or mean arterial pressure), heart rate; cardiac output (as appropriate), intravascular volume status, pulmonary capillary wedge pressure (as appropriate); monitor infusion site closely
Consult individual institutional policies and procedures.
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).
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)
Solution (Biorphen Intravenous)
0.5 mg/5 mL (per mL): $1.20
Solution (Phenylephrine HCl Intravenous)
10 mg/mL (per mL): $1.92 - $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): $0.38
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