phenylephrine (Rx)

Brand and Other Names:Vazculep
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 10mg/mL
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Mild to Moderate Hypotension

0.1-0.5 mg IV q10-15min; not to exceed 0.5 mg/dose IV

Initial: 2-5 mg SC/IM q1-2hr PRN; maintenance 1-10 mg

Severe Hypotension/Shock

IV bolus: 100 to 500 mcg/dose q5-10min PRN; not to exceed 500 mcg

IV infusion: 100-180 mcg/min; titrate to desired response; alternatively, 0.5 mcg/kg/min; itrate to desired response

Dosing range between 0.4 to 9.1 mcg/kg/min reported when treating septic shock  

Dosing considerations

  • Drug not recommended by The Society of Critical Care Medicine, to treat septic shock, except when fist line agent epinephrine associated with causing serious arrhythmia, when cardiac output is high and blood pressure persistently low, or when combination of inotrope/vasopressore and low dose vasopressin failed to achieve desired mean arterial pressure and phenylephrine used as salvage therapy

Dosage Forms & Strengths

injectable solution

  • 10mg/mL
more...

Mild to Moderate Hypotension

<2 years

  • Safety and efficacy not established

≥2 years

  • 0.1 mg/kg SC/IM q1-2hr PRN; not to exceed 5 mg/dose 

Severe Hypotension/Shock

<2 years

  • Safety and efficacy not established

≥2 years

  • 5-20 mcg/kg IV once; THEN 0.1-0.5 mcg/kg/min IV; not to exceed 3-5 mcg/kg/min IV 
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Interactions

Interaction Checker

and phenylephrine

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            Adverse Effects

            Frequency Not Defined

            Extravasation

            Hypertension

            Reflex bradycardia

            Anxiety

            Headache

            Burning

            Rebound congestion

            Sneezing

            Pulmonary edema

            Metabolic acidosis

            Decreased renal perfusion

            Reduced urine output

            Nausea

            Gastric irritation

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            Warnings

            Black Box Warnings

            Physicians should completely familiarize themselves with complete contents of package insert prior to prescribing phenylephrine hydrochloride injection

            Contraindications

            Hypersensitivity to phenylephrine or sulfites

            Severe hypertension

            Ventricular tachycardia

            Closed-angle glaucoma

            Cautions

            Avoid extravasation; ensure proper needle or catheter placement prior to and during infusion

            IV administration may cause severe bradycardia and reduced cardiac output, resulting from increase in cardiac afterload especially in patients with preexisting cardiac dysfunction; use with caution in patients with preexisting bradycardia, partial heart block, nyocardial disease, or severe coronary artery disease; may also increase pulmonary arterial pressure and precipitate angina in patients with severe coronary artery disease

            Avoid or use with extreme caution in patients with heart failure or cardiogenic shock; cardiac output may decrease with increased systemic vascular resistance

            Avoid use in patients with hypertension; monitor blood pressure closely and adjust infusion rate; use is contraindicated in severe hypertension

            May cause excessive peripheral and visceral vasoconstriction and ischemia to vital organs, especially in patients with peripheral vascular disease

            Patients with spinal cord injury or other autonomic dysfunction may experience exaggerated increase in blood pressure response to therapy

            Use with caution in hyperthyroidism

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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Safe

            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

            Strong alpha effects resulting in increased peripheral vascular resistance and blood pressure; decreases cardiac output and renal perfusion

            Absorption

            Bioavailability: <38%

            Onset: 10-15 min

            Duration: 15 min

            Peak plasma time: 0.75-2 hr

            Distribution

            Vdss: 184-543 L

            Metabolism

            Extensively metabolized in intestinal wall; moderately metabolized in liver

            Metabolites: M-hydroxymandelic acid (inactive)

            Elimination

            Half-life: 2-3 hr (terminal phase)

            Excretion: Urine (80-90%)

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            Administration

            IV Compatibilities

            Additive: Chloramphenicol, dobutamine, lidocaine, KCl, Na bicarb

            Y-site: Amiodarone, amrinone, famotidine, haloperidol

            IV Preparation

            10 mg in 250 mL D5W (40 mcg/mL); at 2-5 mL/min (80-200 mcg/min)

            100-500 mg in 250 mL have been used

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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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            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            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.