AK-Dilate Ophthalmic, Alconefrin, Isopto Frin, Mydfrin, Neo-Synephrine, Nostril, Rhinall, Sinarest Nasal, Sinex
Classifications: eye and nose preparation; alpha-adrenergic agonist; mydriatic; decongestant; Therapeutic: decongestant; mydriatic; vasoconstrictor
Pregnancy Category: C
10 mg chewable tablet; 0.125%, 0.16%, 0.5%, 1% nasal solution; 0.12%, 2.5%, 10% ophthalmic solution; 10 mg/mL injection
Potent, synthetic, direct-acting sympathomimetic with strong alpha-adrenergic and weak beta-adrenergic cardiac stimulant
actions. Produces little or no CNS stimulation. Elevates systolic and diastolic pressures through arteriolar constriction.
Reduces intraocular pressure by increasing outflow and decreasing rate of aqueous humor secretion.
Topical applications to eye produce vasoconstriction and prompt mydriasis of short duration, usually without causing cycloplegia.
Nasal decongestant action qualitatively similar to that of epinephrine but more potent and has longer duration of action.
Parenterally to maintain BP during anesthesia, to treat vascular failure in shock, and to overcome paroxysmal supraventricular
tachycardia. Used topically for rhinitis of common cold, allergic rhinitis, and sinusitis; in selected patients with wide-angle
glaucoma; as mydriatic for ophthalmoscopic examination or surgery, and for relief of uveitis.
Severe coronary disease, severe hypertension, atrial fibrillation, atrial flutter, cardiac arrhythmias; cardiac disease,
cardiomyopathy; uncontrolled hypertension; ventricular fibrillation or tachycardia; acute MI, angina; cerebral arteriosclerosis,
MAOI; narrow-angle glaucoma (ophthalmic preparations); labor, delivery; pregnancy (category C).
Hyperthyroidism; diabetes mellitus; older adult patients; 21 d before or following termination of MAO inhibitor therapy;
lactation. Ophthalmic solution (10%): Cardiovascular disease; diabetes mellitus; hypertension; aneurysms; infants.
Route & Dosage
Adult: IM/SC 110 mg (initial dose not to exceed 5 mg) q1015min as needed IV 0.10.18 mg/min until BP stabilizes; then 0.040.06 mg/min for maintenance
See Appendix A
Adult: IV 0.250.5 mg bolus, then 0.10.2 mg doses (total max: 1 mg)
Adult: Ophthalmic See Appendix A1 Intranasal Small amount of nasal jelly placed into each nostril q34h as needed or 23 drops or sprays of 0.250.5%
solution q34h as needed
Child: Intranasal <6 y, 23 drops or sprays of 0.125% solution q34h as needed; 612 y, 23 drops or sprays of 0.25% solution q34h as needed
- Nasal preparations: Instruct patient to blow nose gently (with both nostrils open) to clear nasal passages before administration
- Instillation (drops): Tilt head back while sitting or standing up, or lie on bed and hang head over side. Stay in position
a few minutes to permit medication to spread through nose. (Spray): With head upright, squeeze bottle quickly and firmly
to produce 1 or 2 sprays into each nostril; wait 35 min, blow nose, and repeat dose. (Jelly): Place in each nostril
and sniff it well back into nose.
- Clean tips and droppers of nasal solution dispensers with hot water after use to prevent contamination of solution. Droppers
of ophthalmic solution bottles should not touch any surface including the eye.
- Ophthalmic preparations: To avoid excessive systemic absorption, apply pressure to lacrimal sac during and for 12 min
after instillation of drops.
- Note: Ensure patency of IV site prior to administration.
PREPARE: Direct: Dilute each 1 mg in 9 mL of sterile water. IV Infusion: Dilute each 10 mg in 500 mL D5W or NS (concentration: 0.02 mg/mL).
ADMINISTER: Direct: Give a single dose over 60 sec. IV Infusion: Titrate to maintain BP.
INCOMPATIBILITIES Solution/additive: Phenytoin Y-site: Propofol, thiopental.
- Protect from exposure to air, strong light, or heat, any of which can cause solutions to change color to brown, form a precipitate,
and lose potency.
Adverse Effects (≥1%)Special Senses: Transient stinging,
lacrimation, brow ache, headache, blurred vision, allergy (pigmentary deposits on lids, conjunctiva, and cornea with prolonged
use), increased sensitivity to light. Rebound nasal congestion
(hyperemia and edema of mucosa), nasal burning,
stinging, dryness, sneezing. CV:
Palpitation, tachycardia, bradycardia (overdosage), extrasystoles, hypertension. Body as a Whole:
Trembling, sweating, pallor, sense of fullness in head, tingling of extremities, sleeplessness, dizziness, light-headedness,
weakness, restlessness, anxiety, precordial pain, tremor, severe visceral or peripheral vasoconstriction,
necrosis if IV
InteractionsDrug: ergot alkaloids
, guanethidine, reserpine, tricyclic antidepressants
increase pressor effects of phenylephrine; halothane, digoxin
increase risk of arrhythmias; mao inhibitors
cause hypertensive crisis; oxytocin
causes persistent hypertension; alpha blockers
, beta blockers
antagonize effects of phenylephrine.
Immediate IV; 1015 min IM/SC. Duration:
1520 min IV; 30120 min IM/SC; 36 h topical. Metabolism:
In liver and tissues by monoamine oxidase.
Assessment & Drug Effects
- Monitor infusion site closely as extravasation may cause tissue necrosis and gangrene. If extravasation does occur, area
should be immediately injected with 510 mg of phentolamine (Regitine) diluted in 1015 mL of NS.
- Monitor pulse, BP, and central venous pressure (q25min) during IV administration.
- Control flow rate and dosage to prevent excessive dosage. IV overdoses can induce ventricular dysrhythmias.
- Observe for congestion or rebound miosis after topical administration to eye.
Patient & Family Education
- Be aware that instillation of 2.510% strength ophthalmic solution can cause burning and stinging.
- Do not exceed recommended dosage regardless of formulation.
- Inform the physician if no relief is experienced from preparation in 5 d.
- Be aware that systemic absorption from nasal and conjunctival membranes can occur, though infrequently (see ADVERSe EFFECTS). Discontinue drug and report to the physician if adverse effects occur.
- Wear sunglasses in bright light because after instillation of ophthalmic drops, pupils will be large and eyes may be more
sensitive to light than usual. Stop medication and notify physician if sensitivity persists beyond 12 h after drug has been
- Be aware that some ophthalmic solutions may stain contact lenses.