Page 162 - 2026 SMOG

PHENYLEPHRINE (NEOSYNEPHRINE)
Class/Mechanism of Action
• Alpha Adrenergic Agonist
Potent, direct-acting alpha-adrenergic agonist with virtually no beta-adrenergic activity; causes
systemic arterial vasoconstriction.
˚ Onset of action—IV: Immediate; Duration: approximately 5–10min
Indications
• Labeled Indications
˚ Treatment of hypotension, vascular failure in shock
Contraindications
• Hypersensitivity to Phenylephrine or any component of the formulation
Adverse Reactions/Precautions
• No applicable use in hemorrhagic shock unless fluid replacement therapy is maximized!
Maximize use of blood products/crystalloids before considering their use in hemorrhagic
shock.
• Not recommended for routine use in the treatment of septic shock
• Reflexive bradycardia. Assure adequate circulatory volume to minimize the need for
vasoconstrictors. Monitor BP closely, avoid hypertension, and adjust infusion rate as needed
• Vesicant (causes blisters): Avoid extravasation, which will cause tissue damage/necrosis; ensure
proper needle placement
• Pregnancy: Category C
• Lactation: Yes, use caution
Dose/Administration
PEDIATRIC
ADULT
(Always reference Broselow Tape)
Hypotension/Shock Hypotension/Shock
• IV Push • IV Push
˚ 50–200mcg/dose q510min (max dose: • IV Infusion
˚
5–20mcg/kg/dose q10–15min prn
1000mcg). Titrate to blood pressure;
use as temporary support or bridge to ˚ 0.1–0.5mcg/kg/min
Vasopressor drip
˚ Mix 10mg phenylephrine in 100mL NS
for a concentration of 100mcg/mL
• IV Infusion
˚ 40–200mcg/min; titrate to MAP
>60mmHg. To titrate, increase rate
by 10mcg/min q2min (max dose:
200mcg/min)
˚ Mix 10mg Phenylephrine in 250mL
D5W/NS for a concentration for
40mcg/mL
˚ Cardiogenic Shock: 0.1–10mcg/kg/min

154 • MEDICATIONS