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Phenylephrine is a selective α1-adrenergic receptor agonist used primarily as a decongestant, as an agent to dilate the pupil, and to increase blood pressure. Phenylephrine is marketed as a substitute for the decongestant pseudoephedrine, though clinical studies differ regarding its effectiveness in this role.
Decongestant
Phenylephrine is used as a decongestant sold as an oral medicine, as a nasal spray, or as eye drops. It is now the most common over-the-counter decongestant in the United States; oxymetazoline is a more common nasal spray.
Oral phenylephrine is extensively metabolised by monoamine oxidase, an enzyme that is present in the intestinal wall and in the liver. Compared to intravenous pseudoephedrine, it has a reduced and variable bioavailability; only up to 38%. Because phenylephrine is a selective α-adrenergic receptor agonist it does not cause the release of endogenous noradrenaline. Nor does it increase the rate (chronotropy) and strength (inotropy) of heart contractions, as pseudoephedrine does.Phenylephrine may cause side effects such as headache, reflex bradycardia, excitability, restlessness and cardiac arrhythmias.
Hemorrhoid discomfort
This medication is used to temporarily relieve swelling, burning, pain, and itching caused by hemorrhoids. It works by temporarily narrowing the blood vessels in the area. This effect decreases swelling and discomfort. Some products may also contain substances (e.g., cocoa butter, hard fat, mineral oil, shark liver oil) that form a protective barrier to prevent too much irritating contact with stool.
Mydriatic
Phenylephrine is used as an eye drop to dilate the pupil to facilitate visualization of the retina. It is often used in combination with tropicamide as a synergist when tropicamide alone is not sufficient. Narrow-angle glaucoma is a contraindication to phenylephrine use. As a mydriatic, it is available in 2.5% and 10% minims.
Vasopressor
Phenylephrine is commonly used as a vasopressor to increase the blood pressure in unstable patients with hypotension, especially resulting from septic shock. Such use is common in anesthesia or critical-care practices; it is especially useful in counteracting the hypotensive effect of epidural and subarachnoid anesthetics, as well as the vasodilating effect of bacterial toxins and the inflammatory response in sepsis and systemic inflammatory response syndrome.
Substitute for pseudoephedrine
Pseudoephedrine and phenylephrine are both used as decongestants; and, until recently, pseudoephedrine was much more commonly available in the United States. This has changed because provisions of the Combat Methamphetamine Epidemic Act of 2005 placed restrictions on the sale of pseudoephedrine products to prevent the clandestine manufacture of methamphetamine. Since 2004, phenylephrine has been increasingly marketed as a substitute for pseudoephedrine; some manufacturers have changed the active ingredients of products to avoid the restrictions on sales. Phenylephrine has been off patent for some time, and many generic brands are available.
Questions about effectiveness
Pharmacists Leslie Hendeles and Randy Hatton of the University of Florida suggested in 2006 that oral phenylephrine is ineffective as a decongestant at the 10-mg dose used, arguing that the studies used for the regulatory approval of the drug in the United States in 1976 were inadequate to prove effectiveness at the 10-mg dose, and safety at higher doses.Other pharmacists have expressed concerns over phenylephrine's effectiveness as a nasal decongestant, and other clinicians have indicated concern for regulatory actions that reduced the availability of pseudoephedrine. A subsequent meta-analysis by the same researchers concluded that the evidence for its effectiveness is insufficient, though another meta-analysis published shortly thereafter by researchers from GlaxoSmithKline found the standard 10-mg dose to be significantly more effective than a placebo.
You should not use this medication if you are allergic to chlorpheniramine or phenylephrine.
Do not use this medicine if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine.
Ask a doctor or pharmacist if it is safe for you to take this medicine if you have:
asthma or COPD, cough with mucus, or cough caused by smoking, emphysema, or chronic bronchitis;
a blockage in your stomach or intestines;
kidney or liver disease;
high blood pressure, heart disease, coronary artery disease, or recent heart attack;
enlarged prostate or urination problems;
glaucoma;
diabetes;
epilepsy or other seizure disorder;
pheochromocytoma (an adrenal gland tumor);
overactive thyroid; or
if you take potassium (Cytra, Epiklor, K-Lyte, K-Phos, Kaon, Klor-Con, Polycitra, Urocit-K).
FDA pregnancy category C. It is not known whether chlorpheniramine and phenylephrine will harm an unborn baby. Do not use this medicine without your doctor's advice if you are pregnant.
It is not known whether chlorpheniramine and phenylephrine passes into breast milk or if it could harm a nursing baby. Antihistamines and decongestants may also slow breast milk production. Do not use this medicine without your doctor's advice if you are breast-feeding a baby.
Older adults may be more likely to have side effects from this medicine.
Artificially sweetened liquid cold medicine may contain phenylalanine. If you have phenylketonuria (PKU), check the medication label to see if the product contains phenylalanine.
This combination product is used for the temporary treatment of cough, stuffy nose, and sinus pain/pressure caused by infection (such as the common cold, flu) or other breathing illnesses (such as hay fever, bronchitis). Decongestants (such as pseudoephedrine, phenylephrine) work by narrowing the blood vessels to help relieve stuffy nose symptoms and sinus pressure. Expectorants (such as guaifenesin) work by thinning and loosening mucus in the airways, clearing congestion, and making breathing easier. Non-narcotic cough suppressants (such as dextromethorphan, chlophedianol) affect a certain part of the brain (cough center) to help you stop coughing.
Cough-and-cold products have not been shown to be safe or effective in children younger than 6 years. Therefore, do not use this product to treat cold symptoms in children younger than 6 years unless specifically directed by the doctor. Some products (such as long-acting tablets/capsules) are not recommended for use in children younger than 12 years. Ask your doctor or pharmacist for more details about using your product safely.
These products do not cure or shorten the length of the common cold and may cause serious side effects. To decrease the risk for serious side effects, carefully follow all dosage directions. Do not use this product to make a child sleepy. Do not give other cough-and-cold medication that might contain the same or similar ingredients (see also Drug Interactions section). Ask the doctor or pharmacist about other ways to relieve cough and cold symptoms (such as drinking enough fluids, using a humidifier or saline nose drops/spray).
How to use Vanacof Oral
If you are taking the over-the-counter product to self-treat, read all directions on the product package before taking this medication. If you have any questions, consult your pharmacist. If your doctor has prescribed this medication, take it as directed.
If you are using the liquid form of this medication, carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.
The dosage is based on your age, medical condition, and response to treatment. Do not increase your dose or take this drug more often than directed. Do not take more of this medication than recommended for your age. There are many brands and forms of this product available. Read the dosing instructions carefully for each product because the amount of cough suppressant and expectorant may be different between products.
If your symptoms do not improve after 7 days, if they worsen or return, if you develop fever, rash, or a persistent headache, or if you think you may have a serious medical problem, get medical help right away.
Nausea, vomiting, trouble sleeping, dizziness, headache, or nervousness may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.
If your doctor has directed you to use this medication, remember that he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this product do not have serious side effects.
Stop taking this medication and tell your doctor immediately if any of these unlikely but serious side effects occur: fast/irregular/pounding heartbeat, mental/mood changes (such as confusion, hallucinations, nervousness), seizures, shaking (tremors), trouble urinating.
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.
Before taking this medication, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.
If you have any of the following health problems, consult your doctor or pharmacist before using this product: cough with a lot of mucus, chronic cough (such as with asthma, emphysema, smoking), diabetes, a certain eye condition (glaucoma), heart problems (such as heart attack, chest pain, heart failure), fast/irregular heartbeat, high blood pressure, liver disease, overactive thyroid (hyperthyroidism), difficulty urinating (such as due to enlarged prostate).
This drug may make you dizzy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Limit alcoholic beverages.
This medicine may contain sugar, alcohol, or aspartame. Caution is advised if you have diabetes, alcohol dependence, liver disease, phenylketonuria (PKU), or any other condition that requires you to limit/avoid these substances in your diet. Ask your doctor or pharmacist about using this product safely.
Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).
Older adults may be more sensitive to the side effects of this medication, especially fast/irregular heartbeat, dizziness, problems urinating, trouble sleeping, or confusion.
Children may be more sensitive to the side effects of this medication, especially agitation.
During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.
Pseudoephedrine passes into breast milk. Consult your doctor before breast-feeding.
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.
Some products that may interact with this drug include: bronchodilators (such as albuterol, terbutaline), stimulants (such as caffeine, dextroamphetamine, methamphetamine).
Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before treatment with this medication. Ask your doctor when to start or stop taking this medication.
The decongestant in this medication may decrease the effectiveness of some blood pressure medications (such as beta blockers, calcium channel blockers, reserpine, guanethidine, methyldopa).
Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain similar ingredients (decongestants such as phenylephrine or cough suppressants). Ask your pharmacist about using those products safely.
If overdose is suspected, contact a poison control center or emergency room immediately. Symptoms of overdose may include: agitation, confusion, hallucinations, seizures.
Notes
This medication is for temporary use only. Do not use for more than 7 days without first consulting your doctor.
Missed Dose
If you are taking this product on a regular schedule and miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.
Storage
Different brands of this medication have different storage needs. Check the product package for instructions on how to store your brand, or ask your pharmacist. 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 October 2013. Copyright(c) 2013 First Databank, Inc.
