Parenteral Manual

Phenylephrine HCl

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
NEOSYNEPHRINE®
Classification: 
Sympathomimetic
Original Date: 
August 2005
Revised Date: 
April 2021
Indications: 
  • Treatment of hypotension and vascular failure in shock
  • Maintenance of blood pressure during anesthesia
  • Treatment of supraventricular tachycardia
Reconstitution and Stability: 
  • Stable at room temperature
  • DO NOT use darkened solutions or solutions containing a precipitate
  • Stable for 48 hours diluted in D5W and for 24 hours diluted in NS when kept at room temperature
Compatibility: 

- Solutions Compatible: dextrose up to D10W, 0.9% NaCl, ringer's solution, ringer's lactate

- Additive/Above Cassette Compatible: caffeine

- Y-site Compatible: atropine, cefotaxime, cefuroxime, dexamethasone, dobutamine, dopamine, fentanyl, furosemide, lidocaine, midazolam, morphine, KCl, ranitidine

- Incompatible: alkalis, amphotericin B, ferric salts and other metals, phenytoin, thiopental

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC YES
IM YES
IV Direct

YES, BP monitoring
Usual dilution: 100 mcg/mL
Infusion time: 20-30 seconds for paroxysmal tachycardia; 1 minute for other indications

IV Intermittent Infusion NO
IV Continuous Infusion

YES, continuous BP monitoring
Usual dilution: 20-60 mcg/mL or 400mcg/mL

(use standard concentration of 100 mcg/mL on syringe pump)

Infusion rate: rate as per dosage section

Click here to access SDC Drug Infusion Sheet

Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric:
- Hypotension/shock:   

  • 0.1 mg/kg/dose IM/SC Q 1-2 hours PRN (Maximum: 5 mg)
  • 5-20 microgram/kg/dose IV Push Q 10-15 minutes PRN
  • 0.1-0.5 microgram/kg/minuteIV Infusion, titrate as required

- Paroxysmal supraventricular tachycardia:    

  • 5-10 microgram/kg IV over 20-30 seconds, increase by 10 microgram/kg increments up to 100 microgram/kg/total dose

- Tetralogy spells:   

  • 5 microgram/kg/dose IV, followed by infusion of 0.1-4 microgram/kg/minute

Adult:
- Hypotension/shock:   

  • 2-5 mg/dose IM/SC Q 1-2 hours PRN (Maximum: 5 mg)
  • 0.1-0.5 mg/dose IV Push Q 10-15 minutes PRN
  • 100-180 microgram/minuteIV Infusion, titrate as required; maintenance rate of 40-60 mcg/minute

- Paroxysmal supraventricular tachycardia:    

  • 0.25-0.5 mg IV over 20-30 seconds
Potential hazards of parenteral administration: 
  • Ventricular extrasystoles, ventricular tachycardia, hypertension, severe reflex bradycardia, headache
  • Tingling in extremities or feeling of coolness in the skin 
  • Extravasation may produce local vasoconstriction, necrosis and sloughing of the skin (may be treated with local infiltration of phentolamine)
Notes: 
  • Administer into a large vein to prevent the possibility of extravasation
  • Monitor HR, BP, CVP and arterial blood gases  
  • Use with caution in patients with hyperthyroidism, bradycardia, partial heart block, myocardial disease
  • Use with tricyclic antidepressants, MAO inhibitors or oxytocic drugs may produce severe hypotensive

                                    DILUTED PHENYLEPHRINE 100 mcg/mL

                                               FOR MINI BOLUS DOSING

  • Diluted phenylephrine be requested by physicians during resus cases.
  • It is sometimes referred to as a "Phenyl Spritzer".).
  • The physician will use the 10 ml diluted phenylephrine syringe to administer small mini boluses  (eg 1 - 2mL).

A 10 mL syringe of diluted phenylephrine is made by adding 0.1 mL of phenylephrine 10 mg/mL to 9.9mL of 0.9% NaCl.

Phenylephrine 10mg/mL 0.1 mL
0.9% NaCl 9.9 mL

 

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