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Dose and administration
Instil one drop in each eye before eye examination as per the Retinopathy of Prematurity (ROP) guideline.
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
- Known hypersensitivity to phenylephrine.
- Severe hypertension, ventricular tachycardia.
- Caution in neonates with hyperthyroidism, hypertension, myocardial disease, heart block, bradycardia, bronchopulmonary dysplasia.
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
- Reflex bradycardia, ventricular dysrhythmias, tachycardia.
- Excitability, headache, lacrimation, conjunctival allergy.
- Increase in blood pressure.
- May cause local discomfort.
- Solutions stronger than 2.5% are NOT recommended in the newborn.
- Interactions - beta-blocker: may cause arrhythmias.
- See the Retinopathy of Prematurity (ROP) guideline
Management of Phenylephrine administration
Clear colourless solution 2.5% - no preservative - in small plastic containers. Do not use brown solutions.
Charted on stat page of prescription chart.
- No further dilution necessary.
- Avoid touching the conjunctiva with the tip of the dispenser.
- Each baby must have own dispenser.
- Systemic absorption can be minimised by depressing lacrimal sac for 1-2 minutes after instillation of drug.
- Check pupil in 15 minutes.
- Observe for bradycardia during instillation.
- Monitor for adverse effects.
- Monitor oxygenation where appropriate.
- Do not exceed recommended dosage because systemic effects can occur.
- Avoid bright light (photophobia due to cycloplegic action).
- Store in refrigerator 2-5°C.
- Protect from light, heat, air.
- Expires as per date on box.
- Greaney M, Saunders R (eds) NE Compendium: Detailed prescribing information. Auckland, Adis Press 1990; p1048.
- Mirmanesh SJ, Abbasi S, Bhutani VK. Alpha-adrenergic bronchoprovocation in neonates with bronchopulmonary dysplasia. J Pediatr 1992; 121:622-5.
- Nursing 97 Drug Handbook, Springhouse 1997 p1062-63.
- Children's Hospital and Regional Medical Center, Seattle, Washington. Formulary of Medications 1998-1999, Lexicomp p181-1.
- Knight DB. National Women's Hospital Retinopathy of Prematurity Doctors Protocol Book, January 1998.
- 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.
- 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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- Date last published: 21 March 2019
- Document type: Drug Dosage Guideline
- Services responsible: ADHB Pharmacy, Neonatology
- Editor: Sarah Bellhouse
- Review frequency: 2 years