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

No Results

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    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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             activity indicator 

            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
                  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
                  4 Way nasal
                  -
                  1 % liquid
                  Sinus PE Decongestant oral
                  -
                  10 mg tablet
                  Wal-Four nasal
                  -
                  1 % liquid
                  Wal-Four nasal
                  -
                  1 % liquid
                  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
                  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
                  Nasal Decongestant (phenylephrine) oral
                  -
                  10 mg tablet
                  Nasal Four nasal
                  -
                  1 % liquid
                  phenylephrine ophthalmic (eye)
                  -
                  10 % drops
                  phenylephrine ophthalmic (eye)
                  -
                  2.5 % drops
                  phenylephrine ophthalmic (eye)
                  -
                  10 % drops
                  phenylephrine ophthalmic (eye)
                  -
                  2.5 % drops
                  phenylephrine ophthalmic (eye)
                  -
                  2.5 % drops

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                  Patient Handout

                  A Patient Handout is not currently available for this monograph.
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                  Formulary

                  FormularyPatient Discounts

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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.