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.
- 0.5% solution: Intranasal:
- 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.
- 0.125% solution: Intranasal:
- 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.
- 0.25% solution: Intranasal:
- 2 to <6 years:
- Adolescents:
- 0.25% to 1% solutions: Intranasal:
- Instill 1 to 3 drops or sprays every 4 hours as and when required.
- 0.25% to 1% solutions: Intranasal:
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
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Alpha1-Blockers |
May lessen Alpha1-Agonists' vasoconstricting effects. Similar to how Alpha1Blocker vasodilation may be resisted by Alpha1Agonists. |
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AtoMOXetine |
May enhance the hypertensive effect of Sympathomimetics. AtoMOXetine may enhance the tachycardic effect of Sympathomimetics. |
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Cannabinoid-Containing Products |
May enhance the tachycardic effect of Sympathomimetics. Exceptions: Cannabidiol. |
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Doxofylline |
Sympathomimetics may enhance the adverse/toxic effect of Doxofylline. |
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FentaNYL |
Alpha1-Agonists may lower the level of FentaNYL in the blood. The serum concentrations of fentanyl nasal spray may fall, and the effects may take longer to manifest. |
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Guanethidine |
Could make sympathomimetics more arrhythmogenic. Guanethidine might make sympathomimetic drugs more hypertensive. |
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Solriamfetol |
Sympathomimetics may intensify Solriamfetol's hypertensive effects. |
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Sympathomimetics |
Could intensify the hazardous or harmful effects of other sympathomimetics. |
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Tedizolid |
Could make sympathomimetics' hypertensive effects stronger. The tachycardic impact of sympathomimetics may be increased by tedizolid. |
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Tricyclic Antidepressants |
Alpha1-Agonists' potential therapeutic effects might be improved. The therapeutic benefit of Alpha1-Agonists may be diminished by Tricyclic Antidepressants. |
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Cocaine (Topical) |
May enhance the hypertensive effect of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. |
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Esketamine |
Esketamine's therapeutic impact may be diminished by nasally administered decongestant drugs. Treatment: Patients who need a nasal decongestant on the day of their esketamine dose should give them at least an hour before the esketamine. |
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Linezolid |
Could make sympathomimetics' hypertensive effects stronger. Reduce the first doses of sympathomimetic drugs and closely monitor individuals on linezolid for an augmented pressor response. There are currently no suggestions for specific dose adjustments. |
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Ergot Derivatives |
Alpha1-Agonists' hypertensive effects might be amplified. Alpha1-Agonists may have a greater vasoconstrictive impact when combined with ergot derivatives. Ergoloid Mesylates and Nicergoline are exceptions. |
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Iobenguane Radiopharmaceutical Products |
Iobenguane radiopharmaceutical products' therapeutic effects may be reduced by alpha1-agonists. Treatment: Before administering iobenguane, stop taking any medications that could impede or interfere with catecholamine transport or uptake for at least five biological half-lives. After each dose of iobenguane, wait at least 7 days before administering these medications. |
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Monoamine Oxidase Inhibitors |
May enhance the hypertensive effect of Alpha1-Agonists. While linezolid is expected to interact via this mechanism, management recommendations differ from other monoamine oxidase inhibitors. Refer to linezolid specific monographs for details. Exceptions: Linezolid; Tedizolid. |
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:
Phenylephrine (HCl) Nasal Drops 0.5 %w/v in Pakistan |
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Fenox |
Abbott Laboratories (Pakistan) Limited. |
 Injection.webp)