Page 170 - 2023 SMOG Digital

PHENYLEPHRINE C Lactation?(Caution) Trade Name: 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 15-20min.
Indications
Labeled Indications: Treatment of hypotension, vascular failure in shock
Contraindications
• Hypersensitivity to phenylephrine or any component of the formulation
• Ventricular Tachycardia and Hypertension
• Bradycardia
Adverse Reactions / Precautions
• No applicable use in hemorrhagic shock unless fluid replacement therapy maximized!
Maximize use of Blood products / Crystalloids before considering use in hemorrhagic shock.
• Not recommended for routine use in the treatment of septic shock
• Reflexive Bradycardia. Assure adequate circulatory volume to minimize need for vasoconstrictors.
Monitor BP closely, avoid hypertension and adjust infusion rate as needed.
• Vesicant: Avoid extravasation, will cause tissue damage/necrosis, ensure proper needle placement
Dose and Administration: ADULT PEDIATRIC Always Reference BROSELOW Tape
Hypotension / Shock: Hypotension / Shock:
IV Push: IV Push:
• 50-200mcg/dose q5-10min • 5-20mcg/kg/dose q10-15min prn
o Max 1000mcg
o Titrate to blood pressure, use as IV Infusion:
temporary support or bridge to • 0.1-0.5mcg/kg/min
Vasopressor drip
o Mix 10mg phenylephrine in 100mL NS Note: Almost never used in pediatric shock.
for a concentration of 100mcg/mL
Isolated increased afterload usually causes
IV Infusion: significant problems in this population. Use
• 40-200mcg/min; titrate to MAP>60mmHg. with caution and contact Medical Direction if
able.
o To titrate, increase rate by 10mcg/min
q2min.
o Maximum dose is 200mcg/min.
o Mix 10mg phenylephrine in 250mL
D5W/NS for a concentration for 40mcg/
mL
If unable to maintain MAP >60mmHg, add
Epinephrine infusion.

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