Skip to Content

Phenylephrine (Ophthalmic)

Medically reviewed by Drugs.com. Last updated on May 22, 2020.

Pronunciation

(fen il EF rin)

Index Terms

  • Phenylephrine HCl
  • Phenylephrine Hydrochloride

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution, Ophthalmic, as hydrochloride:

Altafrin: 2.5% (15 mL); 10% (5 mL) [contains benzalkonium chloride]

Generic: 2.5% (2 mL, 3 mL [DSC], 5 mL [DSC], 15 mL); 10% (5 mL)

Solution, Ophthalmic, as hydrochloride [preservative free]:

Generic: 2.5% (1 ea [DSC])

Brand Names: U.S.

  • Altafrin

Pharmacologic Category

  • Alpha-Adrenergic Agonist
  • Ophthalmic Agent, Mydriatic

Pharmacology

Potent, direct-acting alpha-adrenergic agonist with virtually no beta-adrenergic activity; produces local vasoconstriction. When applied topically to the eye, phenylephrine stimulates the dilator muscle of the iris, resulting in mydriasis.

Absorption

Minimal systemic absorption (Kumar 1986)

Onset of Action

Mydriasis: 15 minutes; maximal mydriasis: 20 to 90 minutes; time to recovery: 3 to 8 hours

Time to Peak

Plasma: ≤20 minutes (Kumar 1986)

Use: Labeled Indications

Mydriasis: Pharmacologic dilation of pupils.

Contraindications

2.5% solution: There are no contraindications listed in the manufacturer's labeling.

10% solution: Hypertension; thyrotoxicosis; infants younger than 1 year.

Dosing: Adult

Mydriasis: Ophthalmic: 2.5% or 10% solution: Instill 1 drop every 3 to 5 minutes as needed (maximum dose: 3 drops per eye). If necessary, dose may be repeated.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Mydriasis: Ophthalmic:

2.5% Solution: Infants, Children, and Adolescents: Instill 1 drop 15 to 30 minutes prior to procedure; administer every 3 to 5 minutes; maximum total dose: 3 drops per eye (AAP 2008)

10% Solution: Children and Adolescents: Instill 1 drop 15 to 30 minutes prior to procedure; administer every 3 to 5 minutes as needed; maximum total dose: 3 drops per eye

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Administration

Ophthalmic: Wash hands before and after application. For topical ophthalmic use only; to avoid contamination, do not touch dropper tip to eyelids or other surfaces when placing drops in eyes. Solution should be applied to the conjunctival fornix unless otherwise directed. Protect eyes from bright illumination while pupils are dilated. Use of finger to occlude tear duct following instillation reduces systemic exposure. Topical ophthalmic phenylephrine may contain a preservative that can discolor soft contact lenses. Patients should remove contacts prior to drop instillation and wait at least 15 minutes before reinsertion.

Storage

Ophthalmic solution: 2.5% and 10%: Refer to product labeling. Some products are labeled to store at room temperature; others should be stored under refrigeration at 2°C to 8°C (36°F to 46°F). Do not use solution if brown or contains a precipitate.

Drug Interactions

Alpha1-Blockers: May diminish the vasoconstricting effect of Alpha1-Agonists. Similarly, Alpha1-Agonists may antagonize Alpha1-Blocker vasodilation. Monitor therapy

AtoMOXetine: May enhance the hypertensive effect of Sympathomimetics. AtoMOXetine may enhance the tachycardic effect of Sympathomimetics. Monitor therapy

Cannabinoid-Containing Products: May enhance the tachycardic effect of Sympathomimetics. Monitor therapy

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. Consider therapy modification

Doxofylline: Sympathomimetics may enhance the adverse/toxic effect of Doxofylline. Monitor therapy

Ergot Derivatives: May enhance the hypertensive effect of Alpha1-Agonists. Ergot Derivatives may enhance the vasoconstricting effect of Alpha1-Agonists. Avoid combination

Guanethidine: May enhance the arrhythmogenic effect of Sympathomimetics. Guanethidine may enhance the hypertensive effect of Sympathomimetics. Monitor therapy

Iobenguane Radiopharmaceutical Products: Alpha1-Agonists may diminish the therapeutic effect of Iobenguane Radiopharmaceutical Products. Management: Discontinue all drugs that may inhibit or interfere with catecholamine transport or uptake for at least 5 biological half-lives before iobenguane administration. Do not administer these drugs until at least 7 days after each iobenguane dose. Avoid combination

Linezolid: May enhance the hypertensive effect of Sympathomimetics. Management: Reduce initial doses of sympathomimetic agents, and closely monitor for enhanced pressor response, in patients receiving linezolid. Specific dose adjustment recommendations are not presently available. Consider therapy modification

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. Avoid combination

Ozanimod: May enhance the hypertensive effect of Sympathomimetics. Management: Concomitant use of ozanimod with sympathomimetic agents is not recommended. If combined, monitor patients closely for the development of hypertension, including hypertensive crises. Consider therapy modification

Solriamfetol: Sympathomimetics may enhance the hypertensive effect of Solriamfetol. Sympathomimetics may enhance the tachycardic effect of Solriamfetol. Monitor therapy

Sympathomimetics: May enhance the adverse/toxic effect of other Sympathomimetics. Monitor therapy

Tedizolid: May enhance the hypertensive effect of Sympathomimetics. Tedizolid may enhance the tachycardic effect of Sympathomimetics. Monitor therapy

Tricyclic Antidepressants: May enhance the therapeutic effect of Alpha1-Agonists. Tricyclic Antidepressants may diminish the therapeutic effect of Alpha1-Agonists. Monitor therapy

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Frequency not defined. Systemic effects are rare at normal dosages.

Ophthalmic: Burning sensation of eyes, eye irritation, miosis (rebound), visual disturbance, vitreous opacity (transient)

<1%, postmarketing, and/or case reports: Cardiac arrhythmia, hypertension, myocardial infarction, subarachnoid hemorrhage, syncope

Warnings/Precautions

Concerns related to adverse effects:

• Cardiovascular events: Although rare, ventricular arrhythmias and myocardial infarction (including fatalities) have been reported with use of the 10% solution. Patients with preexisting cardiovascular disease may be at increased risk; consider use of 2.5% solution in these patients.

• Hypertension: Significant blood pressure elevation has been reported with the 10% solution; risk is less with 2.5% solution. Use caution when using 10% solution in children <5 years of age, patients with hyperthyroidism or patients with cardiovascular disease. Carefully monitor posttreatment blood pressure in patients with endocrine or cardiac diseases, or any patient who develops symptoms during treatment.

• Rebound miosis: Has been reported 1 day after treatment; reinstallation of the drug produced a lesser mydriatic effect.

Special populations:

• Pediatrics: The 10% should NOT be used in infants <1 year of age (2.5% solution should be used). Use caution when using 10% solution in children <5 years of age.

Other warnings/precautions:

• Appropriate use: For ophthalmic use only; not for injection.

• Driving: Topical ophthalmic phenylephrine may cause blurring of vision. Patients should be cautioned about driving or operating machinery following dosing.

• Sulfites: Some products contain sulfites which may cause allergic reactions in susceptible individuals.

Pregnancy Risk Factor

C

Pregnancy Considerations

Animal reproduction studies have not been conducted. When administered intravenously, phenylephrine crosses the placenta (refer to the Phenylephrine (Systemic) monograph for details). The amount of phenylephrine available systemically following ophthalmic application is generally less in comparison to oral or IV doses.

Patient Education

What is this drug used for?

• It makes the eye pupils larger.

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

• Stinging

• Eye pain

• Eye irritation

• Blurred vision

• Sensitivity to light

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Severe headache

• Dizziness

• Passing out

• Vision changes

• Chest pain

• Fast heartbeat

• Abnormal heartbeat

• Weakness on 1 side of the body, trouble speaking or thinking, change in balance, drooping on one side of the face, or blurred eyesight

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine's uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.