Phenylephrine eye drops analogues. Description of the substance phenylephrine in the treatment of inflammatory diseases of the nose. ■ Indications for use

In modern medicine, it is often necessary to use adrenomimetic drugs, as well as vasoconstrictors. And in such cases, doctors often prescribe medications that contain phenylephrine hydrochloride. What it is? What properties does the substance have? How does it affect the body? In what cases is it appropriate to take this medication? The answers to these questions are of interest to many patients.

Phenylephrine hydrochloride: what is it? Release form, trade names

In modern medicine, this remedy is often used. But what properties does phenylephrine hydrochloride have? What it is? To begin with, it is worth understanding the general information.

This tool is a crystalline powder of white, sometimes yellowish color. This substance is easily and quickly soluble in water and alcohol.

To date, a solution for intravenous or subcutaneous administration is widely used (available in ampoules called "Phenylephrine"). In addition, this substance is an active ingredient in eye drops. In particular, it is present in the composition of drugs such as Irifrin and Neosynephrine.

Components such as pheniramine maleate, phenylephrine hydrochloride are part of many cold remedies, in particular, "Grippocitron". There are also sprays / drops for the nose containing this component - they have vasoconstrictive properties. There are also rectal suppositories that are used for hemorrhoids (as part of complex therapy), though not so often.

Phenylephrine hydrochloride. Action and pharmacological properties

This tool belongs to the group of adrenomimetics. It acts on postsynaptic alpha-adrenergic receptors. Under the influence of the drug, a narrowing of the arterioles and an increase in blood pressure are observed. Compared with adrenaline and norepinephrine, this drug does not increase blood pressure so quickly and sharply. At the same time, the effect of it lasts much longer, since the drug is slowly metabolized.

It is also noticed that the agent stimulates the work of the central nervous system, however, to a small extent. After taking the medicine, there is a narrowing of the pulmonary vessels, which leads to an increase in pressure in the pulmonary artery. The drug stimulates blood circulation in the abdominal cavity, as well as the limbs.

The most effective is intravenous administration. The effect of the drug appears almost immediately. The metabolism of phenylephrine occurs in the liver. Metabolic products are excreted from the body along with urine.

Also, the solution is used externally, in the form of eye drops. This substance provides a rapid expansion of the pupil, as well as the outflow of intraocular fluid. One of the effects of the drug is vasoconstriction. Immediately after instillation, there is a contraction of the smooth muscles of the arterioles of the conjunctiva and the pupil dilator. The effect appears 10 minutes after the procedure and lasts about 4-6 hours.

When should you use nasal drops?

When is it advisable to use a nasal spray or drops that contain phenylephrine hydrochloride? The use of the drug is justified in the presence of mucosal edema.

Drops are prescribed to patients with colds, flu, hay fever and other allergic diseases of the upper respiratory tract in the event that the disease is accompanied by mucosal edema. This drug allows you to quickly ease breathing and significantly improve the patient's condition.

Solution. Indications for use

As already mentioned, this tool belongs to the group of adrenomimetics. Injections are carried out in the following cases:

acute arterial hypertension;
vascular insufficiency, including one that has developed as a result of taking too many vasodilators;
shock conditions, including traumatic and toxic;
the drug is also administered when using local anesthetics (as a vasoconstrictor).

Eye drops. Application features

Eye drops containing phenylephrine are also widely used in modern ophthalmology:

to dilate the pupil during diagnostic procedures;
for the prevention of iridocyclitis;
10% solution is used before eye surgery in order to maximize pupil dilation;
to eliminate the so-called red eye syndrome;
in the treatment of glaucoma cyclitis crises.

How and in what doses should the solution be used?

Of course, the dosage and schedule of admission is selected by the attending physician. As a rule, with a moderate decrease in blood pressure, the solution is administered intramuscularly or subcutaneously. No more than 2-5 mg of the active substance is administered at a time. To achieve a greater effect, the solution can be administered intravenously - in this case, a single dose is 0.2 mg of phenylephrine.

If we are talking about jet administration using a dropper, then 10 mg of the drug is diluted in 9 ml of purified water for injection. For infusion, the same amount of phenylephrine is diluted using 500 ml of 9% saline or 5% glucose solution.

As a rule, 1 or 2% eye drops are used for therapeutic and prophylactic purposes. A solution with a concentration of 10% is used only before the operation.

The scheme of application is simple: 2-3 drops are instilled into the conjunctival sac. It is important to ensure that the tip of the vial does not touch the mucous membrane of the eye. The effect of the procedure lasts for several hours.

Spray/drops for the nose. Instructions for use

The dosage of nasal agents depends on the age of the patient. If we are talking about babies in the first year of life, then experts recommend instilling one drop into each nostril. The break between procedures should last at least six hours.

Children from 1 to 6 years old can instill 2 drops in each nasal passage. Single dosage for patients older than 6 years - 4 drops.

In modern otolaryngology, a nasal spray is also used, however, it can only be prescribed to patients older than 12 years. Experts recommend doing 2-3 injections into each nostril. You can use the drug no more than once every four hours. Therapy in most cases lasts three days, although the right to change the treatment schedule remains with the doctor.

Contraindications for therapy

Can drugs containing phenylephrine hydrochloride be used in all cases? Eye drops have some contraindications:

violation of the integrity of the eyeball;
narrow-angle and closed-angle glaucoma, regardless of the severity;
diseases of the cardiovascular and cerebrovascular system, especially when it comes to elderly patients;
disorders in the production of tears;
congenital forms of glucose-6-phosphate dehydrogenase deficiency;
hyperthyroidism at any stage of development;
hepatic form of porphyria.

There are also age restrictions - drops are not prescribed for children under 12 years of age, as well as adolescent patients with insufficient body weight. A 10% solution should not be instilled in the presence of arterial aneurysms.

In what other cases can not use such a tool as phenylephrine hydrochloride? Nose drops are not instilled in the following cases:

in the presence of sclerosis of the coronary vessels, angina pectoris and some other pathologies of the cardiovascular system;
during a severe hypertensive crisis;
with thyrotoxicosis and diabetes mellitus;

Drops should also not be used by children under the age of six.

It is also worth noting that there are restrictions on injections using a solution of phenylephrine hydrochloride. Instructions for use contain information that therapy can be dangerous in the following cases:

at elevated pressure;
with ventricular fibrillation;
with some forms of cardiomyopathy;
with decompensated forms of heart failure;
in severe forms of ischemic disease;
with damage to the cerebral arteries;
in the presence of pheochromocytoma.

There are also relative contraindications. For example, if a patient has hypoxia, hypercapnia, metabolic acidosis, hypovolemia, thyrotoxicosis, the drug can be used, but the patient must be constantly monitored and strictly adhere to the dose prescribed by the doctor. The list of restrictions can be supplemented with such pathologies as shock conditions after a heart attack, bradycardia, ventricular arrhythmia, arterial hypertension. Age also matters - the drug is prescribed with caution to the elderly, as well as to patients under 18 years of age.

Are complications possible? List of adverse reactions

Is it safe to use drugs containing phenylephrine hydrochloride? Instructions for use, as well as reviews of doctors, indicate that most often the body tolerates therapy well. However, the possibility of adverse reactions should not be ruled out. Their list includes:

increase or decrease in blood pressure;
chest pain;
migraine;
sleep problems, in particular insomnia;
tremor;
general weakness;
increased heart rate, increased heart rate;
cardiac arrhythmias, including arrhythmias, tachycardia, bradycardia;
frequent dizziness, unexplained restlessness, constant irritability;
occlusion of the coronary arteries;
nausea ending in vomiting;
myocardial infarction;
severe pallor of the skin;
violation of respiratory functions;
increased sweating;
increased intraocular pressure;
thromboembolism.

Some patients complain of pain and swelling at the injection site. Sometimes soft tissue necrosis can develop in this area.

What else can be dangerous drugs containing phenylephrine hydrochloride? Eye drops can cause burning and irritation of the mucous membrane. Sometimes there is increased lacrimation. Some patients complain of blurred vision, which, however, goes away on its own.

There are other side effects that occur with the use of phenylephrine hydrochloride. Drops/spray for the nose can sometimes cause irritation of the mucous membrane. Some patients complain of severe itching and burning in the nose, which occur immediately after instillation. If any deterioration occurs, you should immediately consult a doctor.

What can replace the medicine?

What to do if, for one reason or another, a medicine containing phenylephrine hydrochloride is not suitable for the patient? Analogues of medicines, of course, exist.

For example, effective adrenomimetics are drugs such as Mezaton and Midodrin. As for nasal drops, such means as "Nazol", "Otrivin" will be effective. If we are talking about eye drops, then the doctor may prescribe the use of Atropine, Cycloptica, Tropicamide.

Overdose Information

What happens if too much of an agent such as phenylephrine hydrochloride enters the body? The instruction contains information that overdose is rarely recorded.

As a rule, patients in such cases complain of a feeling of heaviness in the head and limbs. Sometimes there is a sharp increase in blood pressure. Possible complications include ventricular tachycardia and extrasystole. In case of overdose, intravenous administration of beta and alpha-blockers is indicated.

Interaction with other drugs

You already know in which cases it is advisable to take phenylephrine hydrochloride, what it is and in what forms it is produced. But it is worth remembering that during a medical examination it is important to tell the specialist about all the drugs taken.

The simultaneous use of this drug with other blockers, as well as Furosemide and other diuretics, can lead to a weakening of the vasoconstrictor effect.

The combination of this drug with cyclopropane, halothane and other anesthetics sometimes leads to the development of ventricular fibrillation.

Phenylephrine is also not recommended to be taken together with MAO inhibitors - at least three weeks should elapse between courses. Do not combine this medicine with reserpine, as there is a risk of developing severe arterial hypertension.

Of course, this tool is widely used in modern medicine - sometimes its reception is simply vital. Nevertheless, improper use is dangerous, so self-medication is not worth it. Only the attending physician can draw up the correct treatment regimen.

Phenylephrine is essentially an adrenomimetic - it is a vasoconstrictor and is widely used in ENT practice and other fields of medicine.

Indications for use

The main indications for taking the medicine include:

the need to reduce swelling of the nasopharyngeal mucosa in respiratory diseases and allergic reactions;
reduction of swelling of the conjunctiva;
parenterally if it is necessary to increase blood pressure if hypotension is associated with a violation of vascular tone;
toxic shock;
traumatic shock;
local anesthesia.

In general, Phenylephrine has the greatest popularity and frequent use in solving upper respiratory diseases. Moreover, acute respiratory viral infections, sinusitis, sinusitis and other diseases of the ENT organs are far from a complete list of diseases in which it is successfully used.

It can also be used for pollinosis - an allergic reaction to spring flowering, when swelling of the nasal mucosa occurs and the eyes water.

Reviews about the effectiveness of taking the drug can be read at the end of the page.

Mode of application

Parenterally (as injections) Phenylephrine is used in cases of acute arterial hypotension, traumatic or toxic shock, as well as in vascular insufficiency or for local anesthesia as a vasoconstrictor - a substance that constricts blood vessels and reduces blood circulation in them.

In ENT practice, the drug is used in the form of nasal drops or spray to facilitate nasal breathing for colds and flu, as well as for allergic reactions that cause swelling of the nasal mucosa.

In the field of ophthalmology, the drug has uses as eye drops for pupil dilation in diagnostic procedures, as well as for preoperative preparation and for the treatment of "red eye syndrome". It reduces hyperemia of the membranes of the eye.

Release form, composition

The composition of the drug contains directly Phenylephrine. It is produced in the form of nasal drops (1 ml of the drug contains 1.25 g of the substance), eye drops (the composition is similar, there are also drops with a content of 100 g), as well as a solution for intramuscular and intravenous injections (in 1 ml of the drug 10 g active ingredient).

Interaction with other drugs

The use of Phenylephrine during general anesthesia caused by Halothane or Cyclopropane may cause ventricular fibrillation.

Simultaneous administration of Phenylephrine and MAO inhibitors results in potentiation of the effect of the drug, that is, an increase in the action of both drugs. This also applies to local application.

Most of the known diuretics (in other words, diuretics) reduce the medicinal effect of Phenylephrine, and Guanethidine, on the contrary, enhances its effect.

Some drugs enhance the effect of Phenylephrine regarding the increase in blood pressure. These include:

Oxytocin;
Ergot alkaloids;
Procarbazine;
Furazolidone;
Tricyclic antidepressants.

Beta-blockers, when taken simultaneously with a drug, significantly affect cardiostimulating activity, reducing it. Perhaps the development of arterial hypertension - increased pressure.

Side effects

From the side circulatory systems The most famous are the following:

heartache;
pressure increase or decrease;
reflex bradycardia;
arrhythmia;
tachycardia;
pulmonary embolism.

There are also cases of myocardial infarction among elderly patients with disorders in the work of the cardiovascular system.

From the side nervous system:

excitement, anxiety;
pain in the head;
dizziness;
sleep disturbance;
weakness;
paresthesia;
tremor.

Among the common side effects are nausea, respiratory depression, acidosis, sweating, pallor of the skin.

When using eye drops, lacrimation, burning in the eye area, and discomfort may develop.

Among the permanent contraindications are:

To use eye drops, the following diseases must be absent:

narrow-angle, angle-closure glaucoma;
advanced age combined with disorders of the heart and blood vessels;
additional expansion of the pupil during surgical operations;
hepatic porphyria;
hyperthyroidism;
arterial aneurysm.

Also, you can not use the drug under the age of 12 (relative to 10%) years and children with reduced body weight.

For taking nasal drops, there are such contraindications:

angina;
hypertensive crisis;
diabetes;
thyrotoxicosis.

Spray in addition to the above diseases is prohibited for children under the age of 6 years.

During pregnancy

Taking the drug during the period of bearing a child is advisable only when the intended benefit to the mother outweighs the potential risk to the child.

Terms and conditions of storage

Best before date the drug is 3 years, after which its use is prohibited. Storage conditions should include the presence of the product in a cool, dry place, the temperature regime should not exceed 25 degrees.

Price

average cost in Russia: The price of Phenylephrine depends on the city and manufacturer, the average is about 260 rubles.

average cost in Ukraine: The price of Phenylephrine in Ukraine averages about 100 hryvnia.

The main analogues of the drug, which have a similar effect, are:

Vizovifrin;
Irifrin;
Mezaton;
neosynephrine;
Phenylephrine hydrochloride.

Included in medications

ATH:

S.01.F.B.01 Ibopamine

Pharmacodynamics:

Action alpha-adrenomimetic, vasoconstrictor.

Stimulates postsynaptic alpha 1 -adrenergic receptors. Causes narrowing of arterioles, increased blood pressure (with possible reflex bradycardia), increased total peripheral vascular resistance. The action begins immediately after administration and lasts for 20 minutes after intravenous administration, 50 minutes with subcutaneous administration, 1-2 hours after intramuscular injection. It has a slight stimulating effect on the brain and spinal cord. Reduces blood flow - kidney, skin, in the abdominal organs and limbs. Constricts pulmonary vessels and increases pressure in the pulmonary artery.

As a vasoconstrictor, it has an anticongestive effect: it reduces swelling and hyperemia of the nasal mucosa, the severity of exudative manifestations, and restores free breathing; lowers pressure in the paranasal cavities and in the middle ear.

Causes contraction radial muscle of the iris, with by stimulating its alpha1-adrenergic receptors. When applied topically in ophthalmology, it causes pupil dilation, improves the outflow of intraocular fluid and constricts the vessels of the conjunctiva. After instillation into the eye, it easily penetrates into the tissues of the eye, causing a contraction of the pupillary dilator and smooth muscles of the conjunctival arterioles. Pupil dilation occurs within 10-60 minutes after a single instillation. Pupil size returns to its original state within 4-6 hours. Since it has little effect on the ciliary muscle, mydriasis occurs without cycloplegia. Due to a significant reduction in the pupil dilator, 30-45 minutes after instillation, particles of pigment from the pigment sheet of the iris can be detected in the moisture of the anterior chamber of the eye.

The use of phenylephrine in subdural and inhalation anesthesia (to maintain an adequate level of blood pressure and prolongation of subdural anesthesia), anaphylaxis, paroxysmal supraventricular tachycardia, reperfusion arrhythmia (Bertzold-Jarisch reflex), priapism, secretory prerenal anuria is described.

Pharmacokinetics:

After oral administration, it is poorly absorbed from the gastrointestinal tract, therefore it is metabolized with the participation of MAO in the intestinal wall and during the first passage through the liver. The bioavailability of phenylephrine is low.

After topical application, systemic absorption is low.

Indications:

For parenteral use: acute arterial hypotension, shock conditions (including traumatic shock, toxic shock), vascular insufficiency (including against the background of an overdose of vasodilators), local anesthesia (as a vasoconstrictor).

In otorhinolaryngology (nasal drops, spray): to facilitate breathing through the nose - colds, flu, hay fever or other allergic diseases of the upper respiratory tract, accompanied by acute rhinitis or sinusitis.

In ophthalmology (eye drops): iridocyclitis (to prevent the occurrence of posterior synechia and reduce exudation); pupil dilation during ophthalmoscopy and other diagnostic procedures necessary to monitor the condition of the posterior segment of the eye; conducting a provocative test in patients with a narrow anterior chamber angle profile and suspicion of angle-closure glaucoma; differential diagnosis of the type of injection of the eyeball; in ophthalmic surgery in preoperative preparation for pupil dilation (10% solution); during laser interventions on the fundus and vitreoretinal surgery; treatment of glaucoma cyclistic crises; treatment of "red eye syndrome" (2.5% solution) (to reduce hyperemia and irritation of the membranes of the eye).

I.A30-A49.A48.3 toxic shock syndrome

VII.H10-H13.H10.9 Conjunctivitis, unspecified

VII.H15-H22.H20 Iridocyclitis

VII.H40-H42.H40.8 Other glaucoma

XXI.Z00-Z13.Z13.5 Special screening examination to detect diseases of the eye and ear

IX.I95-I99.I95 Hypotension

IX.I95-I99.I99 Other and unspecified disorders of the circulatory system

X.J00-J06.J00 Acute nasopharyngitis (runny nose)

X.J00-J06.J01 Acute sinusitis

X.J00-J06.J06.8 Other acute upper respiratory tract infections of multiple sites

X.J10-J18.J11 Influenza, virus not identified

X.J30-J39.J30 Vasomotor and allergic rhinitis

XVIII.R50-R69.R57.9 Shock, unspecified

XIX.T79.T79.4 traumatic shock

Contraindications:

Hypersensitivity.

Solution for injection: arterial hypertension (monitoring of blood pressure and infusion rate is necessary), hypertrophic obstructive cardiomyopathy, atrial fibrillation, ventricular fibrillation, decompensated heart failure, severe atherosclerosis, severe coronary artery disease, cerebral artery disease, pheochromocytoma, metabolic acidosis, hypercapnia, hypoxia, hypovolemia, acute myocardial infarction, porphyria, congenital deficiency of glucose-6-phosphate dehydrogenase, age up to 18 years.

Eye drops: narrow-angle or angle-closure glaucoma, old age in the presence of serious disorders of the cardiovascular or cerebrovascular system; additional expansion of the pupil during surgical operations in patients with violation of the integrity of the eyeball, as well as in violation of tear production; hyperthyroidism, hepatic porphyria, congenital deficiency of glucose-6-phosphate dehydrogenase, children under 12 years of age and patients with arterial aneurysm (10% solution), children with reduced body weight (2.5% solution).

Nasal drops: diseases of the cardiovascular system (including coronary sclerosis, angina pectoris), hypertensive crisis, thyrotoxicosis, diabetes mellitus.

Nasal spray: diseases of the cardiovascular system (including severe atherosclerosis, angina pectoris, tachycardia), thyroid disease (thyrotoxicosis), diabetes mellitus, arterial hypertension, children under 6 years of age.

Carefully:Solution for injection: angle-closure glaucoma, hypertension in the pulmonary circulation, severe aortic stenosis, shock in myocardial infarction, tachyarrhythmia, ventricular arrhythmia, bradycardia, occlusive vascular disease (including history) - arterial thromboembolism, atherosclerosis, thromboangiitis obliterans (disease Buerger), Raynaud's disease, a tendency to vascular spasms (including frostbite), diabetic endarteritis, thyrotoxicosis, old age; nasal drops: children under 6 years of age. Pregnancy and lactation:

Use during pregnancy and lactation is possible only if the potential benefit to the mother outweighs the possible risk to the fetus and child.

Dosage and administration:

Subcutaneously, intramuscularly, intravenously bolus slowly or infusionally. The dosage regimen depends on the indications and the dosage form used.

For intravenous jet administration, 10 mg is dissolved in 9 ml of water; for intravenous infusion, 10 mg is added to 500 ml of 0.9% sodium chloride solution or 5% glucose.

Moderate hypotension: subcutaneously or intramuscularly, adults - 2-5 mg, then, if necessary, 1-10 mg; intravenously - 0.2 mg (0.1-0.5 mg), the interval between injections is at least 10-15 minutes. Severe hypotension and shock - intravenous drip; the initial infusion rate is 0.18 mg / min, as blood pressure stabilizes, the rate is reduced to 0.04-0.06 mg / min.

As a vasoconstrictor for regional analgesia, it is added to the anesthetic solution.

Higher doses for adults: subcutaneously or intramuscularly a single dose - 10 mg, daily - 50 mg, with intravenous administration a single dose of 5 g, daily - 25 mg.

Eye drops: used in the form of instillations.

Intranasally, children under the age of 1 year - 1 drop in each nasal passage no more than every 6 hours, from 1 year to 6 years - 1-2 drops, older than 6 years and adults - 3-4 drops. The duration of treatment is no more than 3 days. For spray: children 6-12 years old - 2-3 injections no more than every 4 hours.

Side effects:

From the side cardiovascular system and blood(hematopoiesis, hemostasis): increase or decrease in blood pressure, pain in the heart area, palpitations, tachycardia, cardiac arrhythmias, including ventricular ones, arterial hypertension, reflex bradycardia, coronary artery occlusion, pulmonary embolism, myocardial infarction (in some cases with use of 10% solution of eye drops in elderly people who had diseases of the cardiovascular system).

From the side nervous system and sense organs: headache, dizziness, agitation, anxiety, irritability, weakness, sleep disturbance, tremor, paresthesia; eye drops - an increase in intraocular pressure, reactive miosis (the next day after application; at this time, repeated instillations of the drug may give less pronounced mydriasis than the day before; the effect is more often seen in elderly patients).

Others: nausea or vomiting, respiratory depression, oliguria, acidosis, pale skin, sweating.

Local reactions: solution for injection - local ischemia of the skin at the injection site, necrosis and the formation of a scab when it enters the tissue or subcutaneous injection; eye drops - burning sensation (at the beginning of application), blurred vision, irritation, discomfort, lacrimation; nasal dosage forms: burning, stinging or stinging in the nose.

Overdose:

Manifested by ventricular extrasystole and short paroxysms of ventricular tachycardia, a feeling of heaviness in the head and limbs, a significant increase in blood pressure.

Treatment: intravenous administration of alpha-blockers (for example, phentolamine) and beta-blockers (for heart rhythm disturbances).

Interaction:

α-Adrenergic blockers, other drugs with α-adrenergic blocking activity (, phenothiazines, thioxanthenes), and other diuretics - a decrease in the vasoconstrictor effect.

β-blockers, including drugs used in ophthalmology - mutual weakening of therapeutic effects, the risk of hypertension and severe bradycardia with the possible development of heart block.

Rauwolfia alkaloids - a decrease in the hypotensive effect, a prolongation of the effects of adrenergic agonists.

Antianginal agents - a decrease in the antianginal effect.

Antihypertensive drugs - antagonistic effects on blood pressure.

Diatrizoates, yothalamate, yoxaglat - increased neurological effects of these drugs.

Other sympathomimetic agents - increased likelihood of side effects.

MAO inhibitors, tricyclic antidepressants, adrenomimetics increase the pressor effect and the risk of severe ventricular arrhythmias (use at intervals of 2-3 weeks).

Cocaine for topical use - increased stimulation of the central nervous system, the likelihood of developing a hypertensive crisis and rhythm disturbances.

Methyldopa - an increase in the pressor effect of sympathomimetics.

Cardiac glycosides - risk of cardiac arrhythmias; if necessary, simultaneous use to conduct careful monitoring of the ECG.

Means for inhalation anesthesia (derivatives of hydrocarbons) - the risk of severe ventricular arrhythmias.

Thyroid hormones - potentiation of side effects of adrenomimetics, risk of coronary insufficiency.

Tricyclic antidepressants and - cardiac arrhythmias, tachycardia, severe arterial hypertension or hyperthermia.

Ergotamine (ergot derivatives) - risk of severe hypertension, ischemia and gangrene (vasoconstriction).

Special instructions:

During the period of treatment, ECG, blood pressure, wedge pressure in the pulmonary artery, cardiac output, blood circulation in the extremities and at the injection site should be monitored. With arterial hypertension, it is necessary to maintain systolic blood pressure at a level of 30-40 mm Hg. below usual. Before or during the treatment of shock states, correction of hypovolemia, hypoxia, acidosis, hypercapnia is mandatory. A sharp increase in blood pressure, severe bradycardia or tachycardia, persistent cardiac arrhythmias require discontinuation of treatment. To prevent re-lowering blood pressure after discontinuation of the drug, the dose should be reduced gradually, especially after prolonged infusion. The infusion is resumed if systolic blood pressure drops to 70-80 mm Hg.

During therapy, potentially hazardous activities that require speed of motor and mental reactions are excluded.

When applied topically after absorption through the mucous membrane, it can cause systemic effects. In this regard, the use of phenylephrine in the form of 10% eye drops should be avoided in infants and elderly patients. The use of a 2.5% or 10% solution of phenylephrine with MAO inhibitors, as well as within 21 days after their cancellation, should be carried out with caution, since systemic adrenergic effects may develop.

Instructions

Recipe (international)

Rp.: Solutionis Phenylephrini 1% 1ml
D.t. d. N. 10 in ampullis
S. Assign intravenous drip of 1 ml in 500 ml of 5% glucose solution to increase blood pressure during collapse and arterial hypotension due to a decrease in vascular tone

pharmachologic effect

Stimulates postsynaptic alpha-adrenergic receptors. Causes narrowing of arterioles, increased blood pressure (with possible reflex bradycardia), increased peripheral vascular resistance.

It has a slight stimulating effect on the brain and spinal cord. Reduces blood flow - kidney, skin, in the abdominal organs and limbs.

Constricts pulmonary vessels and increases pressure in the pulmonary artery. As a vasoconstrictor, it has an anticongestive effect: it reduces swelling and hyperemia of the nasal mucosa, the severity of exudative manifestations, and restores free breathing; lowers pressure in the paranasal cavities and in the middle ear.

When applied topically in ophthalmology, it causes pupil dilation, improves the outflow of intraocular fluid and constricts the vessels of the conjunctiva. After instillation, phenylephrine contracts the pupillary dilator, thereby causing pupillary dilation, and smooth muscle of the conjunctival arterioles. Pupil size returns to baseline within 4 to 6 hours. Since phenylephrine has little effect on the ciliary muscle, mydriasis occurs without cycloplegia. Phenylephrine easily penetrates into the tissues of the eye, pupil dilation occurs within 10-60 minutes after a single instillation. Mydriasis persists for 4–6 hours. Due to a significant contraction of the pupil dilator, 30–45 minutes after instillation, particles of pigment from the pigment sheet of the iris can be detected in the moisture of the anterior chamber of the eye.

Biotransformed in the liver and gastrointestinal tract (without the participation of catechol-O-methyltransferase). Excreted by the kidneys as metabolites. The action begins immediately after administration and lasts for 20 (after i / v administration) - 50 minutes (with s / c injection) - 1-2 hours (after i / m injection). When applied topically, it is subjected to systemic absorption.

Mode of application

For adults: Phenylephrine is administered subcutaneously, intramuscularly, intravenously by slow stream or infusion. The dosage regimen depends on the indications and the dosage form used.

For jet intravenous administration, 10 mg of the drug is dissolved in 9 ml of water; for intravenous infusion, 10 mg of the drug is added to 500 ml of 5% glucose or 0.9% sodium chloride solution.
- With moderate hypotension: intramuscularly or subcutaneously, adults - 2-5 mg, then, if necessary, 1-10 mg; intravenously - 0.2 mg (0.1–0.5 mg), the interval between injections is at least 10–15 minutes.

In severe hypotension and shock - intravenous drip, the initial infusion rate is 0.18 mg / min, as blood pressure stabilizes, the rate is reduced to 0.04-0.06 mg / min.
- As a vasoconstrictor during regional analgesia, the drug is added to the anesthetic solution.

The maximum doses for adults are intramuscularly or subcutaneously - a single dose - 10 mg, daily - 50 mg, when administered intravenously, a single dose of 5 mg, daily - 25 mg.

Intranasally: children under 1 year old - 1 drop in each nasal passage no more than every 6 hours, 1-6 years old - 1-2 drops, over 6 years old and adults - 3-4 drops; duration of therapy - no more than 3 days; spray: children 6-12 years old - 2-3 injections no more than every 4 hours. Eye drops: used in the form of instillations.

During therapy, monitoring of ECG, blood pressure, wedge pressure in the pulmonary artery, cardiac output, blood circulation in the extremities and in the injection area is necessary.

It is necessary to maintain systolic blood pressure at a level that is 30–40 mm Hg. less than usual, with arterial hypertension. Before or during the treatment of shock states, correction of hypoxia, hypovolemia, hypercapnia, and acidosis is mandatory. A sharp increase in blood pressure, persistent heart rhythm disturbances, severe tachycardia or bradycardia require discontinuation of therapy.
-To prevent a re-lowering of blood pressure after discontinuation of phenylephrine, the dose should be reduced gradually, especially with prolonged infusions. The infusion must be restarted if systolic blood pressure drops to 70–80 mmHg.
- During treatment, it is necessary to exclude potentially hazardous activities that require the speed of mental and motor reactions.

When used topically after absorption through the mucous membrane, phenylephrine can lead to the development of systemic effects. Therefore, the use of phenylephrine 10% eye drops should be avoided in elderly patients and infants.
- The use of a 10% or 2.5% solution of phenylephrine with MAO inhibitors, as well as within 21 days after their cancellation, must be carried out with caution due to the possibility of developing systemic adrenergic effects.

Indications

Phenylephrine is prescribed orally and topically to reduce swelling of the nasopharyngeal mucosa during allergies and during colds (rhinitis, sinusitis, influenza, hay fever).

The drug is administered subcutaneously, intravenously or intramuscularly:
with acute arterial hypotension;
patients with vascular insufficiency (may develop due to an overdose of vasodilators);
with toxic or traumatic shock;
as a vasoconstrictor in local anesthesia.

Phenylephrine eye drops are used:
as a prophylactic for iridocyclitis;
to expand the pupil for diagnostics in ophthalmology;
when conducting a provocative test in patients with suspected angle-closure glaucoma;
to dilate the pupil before surgery on the eyes and fundus (use 10% solution);
during differential diagnosis such as injection of the eyeball;
in vitreoretinal surgery;
for the treatment of glaucoma cyclistic crises;
with red eye syndrome.

Rectal suppositories are also used to treat hemorrhoids.

Contraindications

Hypersensitivity.

For injections: arterial hypertension (it is necessary to control blood pressure and infusion rate), ventricular fibrillation, hypertrophic obstructive cardiomyopathy, decompensated heart failure, severe forms of coronary heart disease, severe atherosclerosis, damage to the cerebral arteries, pheochromocytoma.

For eye drops: angle-closure or narrow-angle glaucoma, hepatic porphyria, hyperthyroidism, old age in the presence of serious violations of the cerebrovascular or cardiovascular system; congenital insufficiency of glucose-6-phosphate dehydrogenase, additional dilation of the pupil during surgical operations in patients with violation of the integrity of the eyeball, as well as in violation of tear production; children with reduced body weight (for 2.5% solution), patients with arterial aneurysm and age up to 12 years (for 10% solution). For nasal drops: diseases of the circulatory system (including angina pectoris, coronary sclerosis), thyrotoxicosis, hypertensive crisis, diabetes mellitus.

For nasal spray: diseases of the circulatory system (including severe atherosclerosis, tachycardia, angina pectoris), thyroid disease, arterial hypertension, diabetes mellitus, age up to 6 years.

Side effects

When using Phenylephrine, you may experience:

Arterial hypo- or hypertension;

Pain in the region of the heart;

headache, weakness, insomnia, tremor;

Increased heart rate and heartbeat;

Tachycardia, arrhythmia, bradycardia;

Dizziness, irritability and anxiety, paresthesia;

Myocardial infarction, occlusion of the coronary arteries;

Vomiting, oliguria, increased sweating, general pallor, acidosis;

Pulmonary embolism;

Respiratory depression, nausea;

Increased intraocular pressure, reactive miosis.

At the injection site, ischemia, soft tissue necrosis, and a scab may occur.

Release form

Phenylephrine release

Solution for injection (in 1 ml - 10 mg);

nasal drops (in 1 ml - 1.25 mg);

eye drops (in 1 ml - 25 mg, 100 mg).

ATTENTION!

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