phenylephrine ophthalmic (Rx, OTC)

Brand and Other Names:Altafrin, Neofrin, more...Refresh Redness Relief
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

ophthalmic solution

  • 0.12% (OTC; Refresh Redness Relief)
  • 2.5% (Rx; Altafrin, Neofrin)
  • 10% (Rx; Altafrin, Neofrin)

Mydriasis Production

Ophthalmoscopy: 1-2 gtt 2.5% solution or 10% solution, may repeat in 10-60 min, mydriasis persists >3 hr, no cycloplegia

Ocular Surgery: 1-2 gtt 2.5% or 10% solution administered 30-60 min preop

Irrigation: 1-2 gtt 0.12% solution into affected eye up to four times daily; not to exceed 72 hr of therapy

Posterior Synechiae Prevention

Anterior Uveitis: 1 gtt of 10% solution three times daily or more (with atropine);

Post-iridectomy: 1 gtt of 10% solution qDay or twice daily

Eye Redness

OTC strength (0.12%) may be used to decrease appearance of eye redness (bloodshot eyes)

Instill 1-2 gtt in affected eye(s) BID/TID

Dosage Forms & Strengths

ophthalmic solution

  • 2.5% (Rx; Altafrin, Neofrin)
  • 10% (Rx; Altafrin, Neofrin)

Ocular Procedures

Indicated to provide mydriasis (pupil dilation) needed for ophthalmic procedures

<1 year: 1 gtt of 2.5% solution 15-20 min before procedure

≥1 yr

  • Ophthalmoscopy: 1-2 gtt 2.5% solution or 10% solution, may repeat in 10-60 min, mydriasis persists >3 hr, no cycloplegia
  • Ocular Surgery: 1-2 gtt 2.5% or 10% solution administered 30-60 min pre-op
  • Irrigation: 1-2 gtt 0.12% solution into affected eye up to four times daily; not to exceed 72 hr of therapy
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Interactions

Interaction Checker

and phenylephrine ophthalmic

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      Serious - Use Alternative

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            Contraindicated (0)

              Serious - Use Alternative (0)

                Monitor Closely (17)

                • amitriptyline

                  amitriptyline, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

                • amoxapine

                  amoxapine, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

                • clomipramine

                  clomipramine, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

                • desipramine

                  desipramine, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

                • doxepin

                  doxepin, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

                • imipramine

                  imipramine, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

                • isocarboxazid

                  isocarboxazid increases effects of phenylephrine ophthalmic by pharmacodynamic synergism. Use Caution/Monitor. Some systemic absorption of ophthalmic phenylephrine; reduce dose within 21 days of MAO inhibitors.

                • linezolid

                  linezolid increases effects of phenylephrine ophthalmic by pharmacodynamic synergism. Use Caution/Monitor. Some systemic absorption of ophthalmic phenylephrine; reduce dose within 21 days of MAO inhibitors.

                • lofepramine

                  lofepramine, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

                • maprotiline

                  maprotiline, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

                • nortriptyline

                  nortriptyline, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

                • phenelzine

                  phenelzine increases effects of phenylephrine ophthalmic by pharmacodynamic synergism. Use Caution/Monitor. Some systemic absorption of ophthalmic phenylephrine; reduce dose within 21 days of MAO inhibitors.

                • procarbazine

                  procarbazine increases effects of phenylephrine ophthalmic by pharmacodynamic synergism. Use Caution/Monitor. Some systemic absorption of ophthalmic phenylephrine; reduce dose within 21 days of MAO inhibitors.

                • protriptyline

                  protriptyline, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

                • tranylcypromine

                  tranylcypromine increases effects of phenylephrine ophthalmic by pharmacodynamic synergism. Use Caution/Monitor. Some systemic absorption of ophthalmic phenylephrine; reduce dose within 21 days of MAO inhibitors.

                • trazodone

                  trazodone, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

                • trimipramine

                  trimipramine, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

                Minor (0)

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                  Adverse Effects

                  Frequency Not Defined

                  Frequent: transient burning or stinging

                  Arrhythmia

                  Myocardial infarction

                  Subarachnoid hemorrhage

                  Headache or browache

                  Blurred vision

                  Syncope

                  Rebound myosis

                  Reactive hyperemia

                  Transient keratitis

                  Hypersensitivity reactions such as allergic conjunctivitis or dermatitis

                  Sensitivity to light

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                  Warnings

                  Contraindications

                  Hypersensitivity, narrow-angle glaucoma, ventricular tachycardia, hypertension

                  Cautions

                  Reduce dose if used within 21 d of MAO inhibitors or TCAs

                  Wait 5 min between multiple drops (no >3 drops needed)

                  Rebound miosis may occur in elderly people 1 day after treatmentwith phenylephrine

                  Notify healthcare provider if vision changes, worsening of symptoms, or continued redness occur

                  Caution with marked hypertension, cardiac disorders, advanced arteriosclerotic changes, type 1 diabetes mellitus, hyperthyroidism; in children of low body weight; elderly

                  May cause false-normal tonometry readings, tonometry should be performed before phenylephrine is administered

                  Presence of sulfites in some products may cause allergic reactions in susceptible patients

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                  Pregnancy & Lactation

                  Pregnancy

                  Not known whether drug can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity; administer to a pregnant woman only if clearly needed

                  Animal data

                  • Animal reproduction studies have not been conducted with topical phenylephrine

                  Lactation

                  It is not known whether this drug is excreted in human breast milk; because many drugs are excreted in human milk, caution should be exercised when therapy is administered to a nursing woman

                  Pregnancy Categories

                  A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

                  B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

                  C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

                  D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

                  X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

                  NA: Information not available.

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                  Pharmacology

                  Mechanism of Action

                  Acts directly on alpha-adrenergic receptors in eye producing contraction of dilator muscle of pupil & constriction of arterioles in conjunctiva

                  Pharmacokinetics

                  Onset of action: 15-30 min (mydriasis)

                  Duration: 1-3 hr (mydriasis)

                  Peak plasma time: <20 min

                  Absorption: Minimal (systemic)

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                  Images

                  BRAND FORM. UNIT PRICE PILL IMAGE
                  phenylephrine ophthalmic (eye)
                  -
                  2.5 % drops
                  phenylephrine ophthalmic (eye)
                  -
                  10 % drops
                  phenylephrine ophthalmic (eye)
                  -
                  10 % drops
                  phenylephrine ophthalmic (eye)
                  -
                  2.5 % drops
                  phenylephrine ophthalmic (eye)
                  -
                  2.5 % drops
                  Sinus PE Decongestant oral
                  -
                  10 mg tablet
                  Vazculep injection
                  -
                  10 mg/mL vial
                  Vazculep injection
                  -
                  10 mg/mL vial
                  Vazculep injection
                  -
                  10 mg/mL vial
                  Vazculep injection
                  -
                  10 mg/mL vial
                  Vazculep injection
                  -
                  10 mg/mL vial
                  4 Way nasal
                  -
                  1 % liquid
                  Nasal Four nasal
                  -
                  1 % liquid
                  Ephrine nasal
                  -
                  1 % drops
                  phenylephrine injection
                  -
                  10 mg/mL vial
                  phenylephrine injection
                  -
                  10 mg/mL vial
                  phenylephrine injection
                  -
                  10 mg/mL vial
                  phenylephrine injection
                  -
                  10 mg/mL vial
                  phenylephrine injection
                  -
                  10 mg/mL vial
                  phenylephrine injection
                  -
                  10 mg/mL vial
                  phenylephrine injection
                  -
                  10 mg/mL vial
                  phenylephrine injection
                  -
                  10 mg/mL vial
                  phenylephrine injection
                  -
                  10 mg/mL vial
                  phenylephrine injection
                  -
                  10 mg/mL vial
                  phenylephrine injection
                  -
                  10 mg/mL vial
                  phenylephrine injection
                  -
                  10 mg/mL vial
                  phenylephrine injection
                  -
                  10 mg/mL vial
                  phenylephrine injection
                  -
                  10 mg/mL vial
                  phenylephrine injection
                  -
                  10 mg/mL vial
                  phenylephrine injection
                  -
                  10 mg/mL vial
                  phenylephrine injection
                  -
                  10 mg/mL vial
                  phenylephrine injection
                  -
                  10 mg/mL vial
                  phenylephrine injection
                  -
                  10 mg/mL vial
                  phenylephrine injection
                  -
                  10 mg/mL vial
                  phenylephrine injection
                  -
                  10 mg/mL vial
                  phenylephrine injection
                  -
                  10 mg/mL vial
                  phenylephrine injection
                  -
                  10 mg/mL vial
                  phenylephrine injection
                  -
                  10 mg/mL vial
                  phenylephrine injection
                  -
                  10 mg/mL vial
                  phenylephrine injection
                  -
                  10 mg/mL vial
                  phenylephrine injection
                  -
                  10 mg/mL vial
                  phenylephrine injection
                  -
                  10 mg/mL vial
                  phenylephrine injection
                  -
                  10 mg/mL vial
                  Neo-Synephrine (phenylephrine) nasal
                  -
                  1 % liquid
                  Neo-Synephrine (phenylephrine) nasal
                  -
                  0.5 % liquid
                  Neo-Synephrine (phenylephrine) nasal
                  -
                  0.25 % liquid
                  Neo-Synephrine (phenylephrine) nasal
                  -
                  1 % liquid
                  Nasal Decongestant (phenylephrine) oral
                  -
                  10 mg tablet
                  Nasal Decongestant (phenylephrine) oral
                  -
                  10 mg tablet
                  Sinus Decongestant (PE) oral
                  -
                  10 mg tablet
                  Sinus Decongestant (PE) oral
                  -
                  10 mg tablet
                  Sinus Decongestant (PE) oral
                  -
                  10 mg tablet
                  Wal-phed PE oral
                  -
                  10 mg tablet
                  Wal-Four nasal
                  -
                  1 % liquid
                  Wal-Four nasal
                  -
                  1 % liquid

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                  Patient Handout

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                  Patient Education
                  phenylephrine ophthalmic (eye)

                  PHENYLEPHRINE - OPHTHALMIC

                  (FEN-il-EF-rin)

                  COMMON BRAND NAME(S): Mydfrin

                  USES: This medication is used to dilate the pupils for eye examinations or procedures, and to treat certain eye conditions. It belongs to a class of drugs known as decongestants. Phenylephrine works by narrowing blood vessels.

                  HOW TO USE: To apply eye drops, wash hands first. To avoid contamination, do not touch the dropper tip or let it touch your eye or any other surface.If you are wearing contact lenses, remove them before using eye drops. Wait at least 15 minutes before replacing your contact lenses. Tilt your head back, look upward, and pull down the lower eyelid to make a pouch. Hold the dropper directly over your eye and place one drop into the pouch. Use as often as directed by your doctor. Look downward, gently close your eyes, and place one finger at the corner of your eye (near the nose). Apply gentle pressure for 1 to 2 minutes before opening your eyes. This will prevent the medication from draining out. Try not to blink or rub your eye. Repeat these steps if your dose is for more than one drop. If directed to use this medication in both eyes, repeat these steps for your other eye. Wait several minutes for your vision to clear before driving or operating machinery. Do not rinse the dropper. Replace the dropper cap after each use.If you are using another kind of eye medication (such as drops or ointments), wait at least 10 minutes before applying other medications. Use eye drops before eye ointments to allow the drops to enter the eye.Use this medication as prescribed to get the most benefit from it.Tell your doctor if your condition lasts or gets worse.

                  SIDE EFFECTS: Burning or stinging, headache, sensitivity to light, or blurred vision may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: eye pain, irregular heartbeat.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

                  PRECAUTIONS: Before using phenylephrine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients (such as sulfites found in some brands), which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: glaucoma (angle-closure type), blood vessel disorders (such as aneurysm).This medication may cause blurred vision. Do not drive, use machinery, or do any activity that requires clear vision until you are sure you can perform such activities safely.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.

                  DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

                  OVERDOSE: This medicine may be harmful if swallowed. If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

                  NOTES: Do not share this medication with others.

                  MISSED DOSE: If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.

                  STORAGE: Store in the refrigerator or at room temperature away from light. Different brands of this medication have different storage needs. Check the product package for instructions on how to store your brand. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

                  Information last revised March 2022. Copyright(c) 2022 First Databank, Inc.

                  IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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                  Formulary

                  FormularyPatient Discounts

                  Adding plans allows you to compare formulary status to other drugs in the same class.

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                  The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

                  Tier Description
                  1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
                  2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
                  3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
                  4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                  5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                  6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                  NC NOT COVERED – Drugs that are not covered by the plan.
                  Code Definition
                  PA Prior Authorization
                  Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
                  QL Quantity Limits
                  Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
                  ST Step Therapy
                  Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
                  OR Other Restrictions
                  Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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                  Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.