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Drug dosage identifier

Phenylephrine Hydrochloride

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Dose and administration

Instil one drop in each eye before eye examination as per the Retinopathy of Prematurity (ROP) guideline.

Indications

Is used in conjunction with tropicamide 1% and topical anaesthetic drops 1% Amethocaine (Tetracaine) to dilate the pupil in preparation for eye examination.The dose is one drop each eye then repeat after 10mins. This is done 30-60mins before the expected eye examination.

  • All babies at risk of severe ROP.
  • Intraocular surgery pre and postoperatively.

Contraindications and precautions

  1. Known hypersensitivity to phenylephrine.
  2. Severe hypertension, ventricular tachycardia.
  3. Caution in neonates with hyperthyroidism, hypertension, myocardial disease, heart block, bradycardia, bronchopulmonary dysplasia.

Clinical pharmacology

Phenylephrine is a sympathomimetic agent with mainly direct effects on adrenergic receptors. Produces mydriasis without cycloplegia. It also acts as a conjunctival decongestant. The effect lasts several hours.

Phenylephrine may lower intraocular pressure temporarily.

Systemic absorption from conjunctival membranes can occur.

Possible adverse effect

  1. Reflex bradycardia, ventricular dysrhythmias, tachycardia.
  2. Excitability, headache, lacrimation, conjunctival allergy.
  3. Increase in blood pressure.
  4. May cause local discomfort.

Special considerations

  1. Solutions stronger than 2.5% are NOT recommended in the newborn.
  2. Interactions - beta-blocker: may cause arrhythmias.
  3. See the Retinopathy of Prematurity (ROP) guideline

Management of Phenylephrine administration

Description

Clear colourless solution 2.5% - no preservative - in small plastic containers. Do not use brown solutions.

Prescription

Charted on stat page of prescription chart.

Administration

Eye Drops

  1. No further dilution necessary.
  2. Avoid touching the conjunctiva with the tip of the dispenser.
  3. Each baby must have own dispenser.
  4. Systemic absorption can be minimised by depressing lacrimal sac for 1-2 minutes after instillation of drug.
  5. Check pupil in 15 minutes.

Nursing considerations

  1. Observe for bradycardia during instillation.
  2. Monitor for adverse effects.
  3. Monitor oxygenation where appropriate.
  4. Do not exceed recommended dosage because systemic effects can occur.
  5. Avoid bright light (photophobia due to cycloplegic action).

Storage

  • Store in refrigerator 2-5°C.
  • Protect from light, heat, air.
  • Expires as per date on box.

References

  1. Greaney M, Saunders R (eds) NE Compendium: Detailed prescribing information. Auckland, Adis Press 1990; p1048.
  2. Mirmanesh SJ, Abbasi S, Bhutani VK. Alpha-adrenergic bronchoprovocation in neonates with bronchopulmonary dysplasia. J Pediatr 1992; 121:622-5.
  3. Nursing 97 Drug Handbook, Springhouse 1997 p1062-63.
  4. Children's Hospital and Regional Medical Center, Seattle, Washington. Formulary of Medications 1998-1999, Lexicomp p181-1.
  5. Knight DB. National Women's Hospital Retinopathy of Prematurity Doctors Protocol Book, January 1998.
  6. Screening Examination of Premature Infant for Retinopathy of Prematurity. A joint statement of the American Academy of Pediatrics. The American Association of Pediatric Ophthalmology and Strabismus and American Academy of Ophthalmology Pediatrics 1997; 100:273.
  7. Retinopathy of prematurity: Guidelines for screening and treatment. The report of joint working party of the Royal College of Ophthalmologists and British Association of Perinatal Medicine, Early Human Development 1996; 46:239-58.

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Document Control

  • Date last published: 21 March 2019
  • Document type: Drug Dosage Guideline
  • Services responsible: ADHB Pharmacy, Neonatology
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years