A Drug Study on

PHENYLEPHRINE

In Partial Fulfillment of the

Requirements in NCM-220
RLE
DISASTER NURSING ROTATION
Why phenylephrine is part on the first aid kit?
The use of First aid kits especially in traveling should be more comprehensive
because a drug store may or may not be accessible. In addition to personal medical
items, the kit should contain items to help alleviate the common symptoms of viral
respiratory infections such as these: Fever, cough, sore throat and Nasal congestion.
Hence, Phenylephrine is a decongestant that shrinks blood vessels in the nasal
passages. Dilated blood vessels can cause nasal congestion (stuffy nose).
Phenylephrine nasal is used to treat nasal congestion and sinus pressure caused by
allergies, the common cold, or the flu.

Generic Name Phenylephrine

Brand Name NeoSynephrine Nasal and Neo-Synephrine Cold & Sinus

Mild Strength Spray.
Drug Classification PHARMACOTHERAPEUTIC:
Alpha adrenergic agonist.

CLINICAL:
Nasal decongestant, mydriatic, vasopressor.
Mode of Action Phenylephrine is an alpha-1 adrenergic agonist that
mediates vasoconstriction1 and mydriasis7 depending on
the route and location of administration. Systemic exposure
to phenylephrine also leads to agonism of alpha-
1adrenergic receptors, raising systolic and diastolic
pressure as well as peripheral vascular resistance.6,8
Increased blood pressure stimulates the vagus nerve,
causing reflex bradycardia
Dose and Route AVAILABILITY (OTC)
Injection, Solution: 10 mg/mL. Solution, Nasal Drops
(Neo- Synephrine): 0.125%, 0.25%. Solution, Nasal
Spray (Neo- Synephrine): 0.25%,0.5%.Solution,Oral: 2.5
 mg/5mL.Tablets(SudafedPE): 10mg.

ADMINISTRATION/HANDLING
IV
Reconstitution
 For IV push, dilute with NS to a concentration of
0.1–1 mg/mL. For IV infusion, dilute 10–100
mg with 500 mL 0.9% NaCl or D5W.
Rate of administration
 For IV push, give over 20–30 sec. For IV
infusion, titrate dose to maintain systolic B/P
greater than 90 mm Hg.
Storage
 Store vials at room
temperature. Nasal Decongestant
 Intranasal: ADULTS, ELDERLY, CHIL- DREN
12 YRS AND OLDER: 2–3 drops or 2–3
sprays of 0.25%–0.5% solution into each
nostril q4h as needed.
 CHILDREN 6–11 YRS: 2–3 drops or 2–3 sprays
of 0.25% solution into each nostril q4h as
needed.
 CHILDREN 2–5 YRS: 1 drop of 0.125%
solution (dilute 0.5% solution with 0.9% NaCl
to achieve
0.125%) in each nostril. Repeat q2–4h as needed.
PO: ADULTS, ELDERLY, CHILDREN 13 YRS AND
OLDER: 10 mg q4h as needed for up to 7 days.
 Maximum: 60 mg/day. CHILDREN6–
11YRS: 5mgq4hasneeded for up to 7
days.
 Maximum: 30 mg/ day. CHILDREN 4–5 YRS:
2.5 mg q4h as neededforupto7days.
 Maximum: 15 mg/day.

Hypotension, Shock
IV infusion: ADULTS, ELDERLY: 0.5–6 mcg/kg/min.
Titrate to desired response. CHILDREN: Initially,0.1–
0.5mcg/kg/min. Titrate to desired effect.
Indications & Contraindications: Hypersensitivity to phenylephrine.
Contraindications Injection: Severe hypertension, ventricular
tachycardia.
Oral: Use within 14 days of MAOI therapy.

Cautions:
Injection: Elderly, hyper- thyroidism, bradycardia,
partial heart block, cardiac disease, HF, cardiogenic
shock, hypertension.
Oral: Asthma, bowel obstruction, cardiac disease,
ischemic heart disease, hypertension, increased
intraocular pressure, elderly, prostatic hyperplasia.
Side Effects/ Adverse Frequent:
Effects Nasal: Rebound nasal con- gestion due to overuse,
esp. when used longer than 3 days.
Occasional: Mild CNS stimulation (restlessness, nervous-
ness, tremors, headache, insomnia, particularly in those
hypersensitive to sympathomimetics, such as elderly
pts). Nasal: Stinging, burning, drying of nasal mucosa.

Adverse effects/Toxic reactions

Large doses may produce tachycardia, palpitations
(particularly in pts with cardiac disease), dizziness, nausea,
vomiting. Overdose in pts older than 60 yrs may result in
hallucinations, CNS depression, seizures. Prolonged nasal
use may produce chronic swelling of nasal mucosa,
rhinitis. If phenyleph- rine 10% ophthalmic is instilled into
denuded/damaged corneal epithelium, corneal clouding
may result.
Drug Interactions DRUG:
Linezolid, MAOIs (e.g., phenelzine, selegiline) may
increase vasopressor effects. Tricyclic anti- depressants
(e.g., amitriptyline, doxepin) may increase vasopressor
ef- fect. Ergot derivatives (e.g., ergota- mine) may
increase hypertensive effect.
HERBAL: None significant.
FOOD: None known.
LAB VALUES: None significant.
Nursing 1. Advise to do a consultation with a health care provider
Responsibilities before attempting to use phenylephrine to treat nasal
stuffiness or eye irritation.
Rationale: To know the side effects and contraindications
regarding with the drug

2. Monitor patient's eyes for redness, excessive

lacrimation, or other signs of a local reaction.
Rationale: Phenylephrine can lower intraocular pressure,
affecting open (wide) angle glaucoma

3. Advise to never use more of this medicine than directed

on the label or prescribed by the physician.
Rationale: Using phenylephrine nasal too long can
damage the lining of the nasal passages and lead to
chronic nasal congestion.

4. Assess heart rate, ECG, and heart sounds, especially

during exercise
Rationale: This drug is intended to treat certain
arrhythmias, but it can unmask or precipitate new
arrhythmias (proar- rhythmic effect).

5. Use with extreme caution in patients with coronary

artery disease, heart disease, especially heart block and
hypertension.
Rationale: Drug stimulates alpha1 receptors, causing an
increase in blood pressure.

6. Assess symptoms of respiratory distress including

dyspnea, shortness of breath, cyanosis and monitor
pulse oximetry and perform pulmonary function tests
Rationale: To quantify suspected changes in ventilation
and respiratory function because excessive respiratory
depression requires emergency care.

7. Instruct patient to report immediately if there is change

in heart rate and rhythm, or chest pain.
Rationale: Phenylephrine is an α-receptor agonist without
β- agonist activity. Its administration causes
vasoconstriction and an increase in arterial blood
pressure, and a decrease in heart rate.

8. Monitor breathing patterns and observe for shortness of

breath and/or audible wheezing.
 Rationale: This medicine can slow or stop the breathing,
and death may occur. Must seek emergency medical
attention immediately if a person is experiencing slow
breathing with long pauses and blue colored lips.

9. Observe the patient’s responsiveness to light

Rationale: Phenylephrine causes photosensitivity by
affecting the pupillary light accommodation/response.

10. Discontinue drug if adverse reactions occur.

References:
Jones & Bartlett Learning (2021). Phenylephrine. Nurse’s Drug Handbook
(Fourteenth Edition). Ismail Aw-abdi

Kizior, R.J., Hodgson, K.J., & EBSCO Publishing. (2020). Phenylephrine. Saunders
nursing drug handbook 2019. St. Louis, Missouri: Elsevier

RxList (2021). Phenylephrine nasal. Retrieved from

https://www.rxlist.com/consumer_phenylephrine_nasal/drugs-condition.htm