Phenylephrine Nasal Spray (NeoSynephrine) is an alpha-adrenergic stimulating agent that causes topical vasoconstriction when applied locally as a nasal spray or drops.

Phenylephrine Nasal Spray (NeoSynephrine) Uses:

• Nasal congestion:
  • It is prescribed to temporarily relieve nasal congestion brought on by hay fever, the common cold, allergic rhinitis, or other upper respiratory allergens.
• Off Label Use of Phenylephrine in Adults:
  • It may be used for topical vasoconstriction in nasal procedures

Phenylephrine Nasal Spray (NeoSynephrine) Dose in Adults

Nasal congestion:

• Intranasal: 0.25% to 1% solution
  • Spray each nostril 2 to 3 times, no more frequently than every 4 hours, for no longer than 3 days.

Phenylephrine Nasal Spray (NeoSynephrine) Dose in Children

Phenylephrine Nasal Spray (NeoSynephrine) Dose for the treatment of Nasal congestion:

Note: Therapy should not exceed 3 days:

• Infants and Children <2 years: Limited data available:
  • 0.5% solution: Intranasal:
    • Instill 0.1 ml in each nostril as a single dose.
• Children ≥2 years:
  • 2 to <6 years:
    • 0.125% solution: Intranasal:
      • Instill 1 drop in each nostril every 2-4 hours as required.
      • Note: Consult product specific information for further details.
  • Little Noses Decongestant:
    • Instill 2 to 3 drops in each nostril every 4 hours as required.
  • 6 to 12 years:
    • 0.25% solution: Intranasal:
      • Each nostril should get 1 to 3 sprays every 4 hours, as needed.
• Adolescents:
  • 0.25% to 1% solutions: Intranasal:
    • Instill 1 to 3 drops or sprays every 4 hours as and when required.

Phenylephrine nasal spray Pregnancy Category: C

• Placental barrier is crossed when phenylephrine is intravenously administered.
• For the treatment of rhinitis, it is best to avoid decongestants during pregnancy. The use of phenylephrine nasal drops for a short time (3 days or less) may prove to be beneficial.

Use of phenylephrine during breastfeeding

• It is unknown if phenylephrine can be excreted into breastmilk.

Dose in Kidney Disease:

There are no dosage adjustments provided in manufacturer’s labeling.   

Dose in Liver disease:

There are no dosage adjustments provided in manufacturer’s labeling.   

Side effects of Phenylephrine Nasal Spray:

• Nasal:
  • Burning
  • Nasal discharge
  • Sneezing
  • Stinging

Contraindications to Phenylephrine Nasal Spray:

OTC labeling

• If self-medication is being used, it is best to avoid any allergic reactions or if the person has a history of hypersensitivity to phenylephrine and any component.

Warnings and precautions

• Local nasal effects:
  • Temporary local pain such as burning, stinging, or an increase in nasal discharge may occur.
• Recover your nasal congestion
  • Nasal congestion can recur, or get worse if it is prolonged or repeated.
• Cardiovascular disease
  • Patients with heart disease or hypertension should be cautious as it can cause vasoconstriction, which could lead to angina.
• Diabetes mellitus:
  • Patients with diabetes mellitus should be cautious. Some patients may experience a decrease in their diabetes control.
• Thyroid disease:
  • Patients with thyroid disease should be cautious. It can aggravate hyperthyroidism symptoms.
• Prostatic hyperplasia, Urinary obstruction
  • Patients suffering from prostatic hyperplasia or GU obstruction should be careful to not make the condition worse.

Phenylephrine (nasal): Drug Interaction

Monitoring Parameters:

Monitor the response to therapy.   

How to administer Phenylephrine Nasal Spray?

• It is indicated for intranasal use only.
• Ask the patient to blow the nose to clear the nostrils before using the spray.
• Gently occlude one nostril and use the spray or drop solution in one nostril.
• After that, do the opposite nostril. After each usage, clean the nozzle.

Mechanism of action of Phenylephrine:

• It is an alpha-adrenergic receptor antagonist that acts directly and without beta-adrenergic activation. 
• When it is applied locally, it causes nasal decongestion and vasoconstriction.

Onset of action:

• Intranasal: 2 minutes or less.

Duration:

• Intranasal: 2.5 to 4 hours (the duration of effects is dose-dependent).

International Brand Names of Phenylephrine Nasal Spray:

• 4-Way Fast Acting
• 4-Way Menthol
• Afrin Childrens
• Nasal Four
• Neo-Synephrine Cold & Sinus
• Neo-Synephrine
• Rhinall
• Ada Spray
• Denason
• Humex Nosni
• Humoxal
• Nasenspray
• Nazol
• Neo-Sinifrina
• Neo-Synephrine
• Phenepirin
• Quranasal
• Rhinofrin
• Vibrocil

Phenylephrine Nasal Spray Brand Names in Pakistan: