phenylephrine ophthalmic (Altafrin, Neofrin, Refresh Redness Relief)

Dosing and uses of Altafrin, Neophrin (phenylephrine ophthalmic)

• Adult
• Pediatric

 

Adult dosage forms and strengths

ophthalmic solution

• 0.12% (OTC; Refresh Redness Relief)
• 2.5% (Rx; Altafrin, Neofrin)
• 10% (Rx; Altafrin, Neofrin)

 

Mydriasis Production

Ophthalmoscopy: 1-2 gtt 2.5% solution or 10% solution, may repeat in 10-60 min, mydriasis persists >3 hr, no cycloplegia

Ocular Surgery: 1-2 gtt 2.5% or 10% solution administered 30-60 min preop

Irrigation: 1-2 gtt 0.12% solution into affected eye up to four times daily; not to exceed 72 hr of therapy

 

Posterior Synechiae Prevention

Anterior Uveitis: 1 gtt of 10% solution three times daily or more (with atropine);

Post-iridectomy: 1 gtt of 10% solution qDay or twice daily

 

Eye Redness

OTC strength (0.12%) may be used to decrease appearance of eye redness (bloodshot eyes)

Instill 1-2 gtt in affected eye(s) BID/TId

 

Pediatric dosage forms and strengths

ophthalmic solution

• 2.5% (Rx; Altafrin, Neofrin)
• 10% (Rx; Altafrin, Neofrin)

 

Ocular Procedures

Indicated to provide mydriasis (pupil dilation) needed for ophthalmic procedures

<1 year: 1 gtt of 2.5% solution 15-20 min before procedure

≥1 yr

• Ophthalmoscopy: 1-2 gtt 2.5% solution or 10% solution, may repeat in 10-60 min, mydriasis persists >3 hr, no cycloplegia
• Ocular Surgery: 1-2 gtt 2.5% or 10% solution administered 30-60 min pre-op
• Irrigation: 1-2 gtt 0.12% solution into affected eye up to four times daily; not to exceed 72 hr of therapy

 

Altafrin, Neophrin (phenylephrine ophthalmic) adverse (side) effects

Frequency not defined

Frequent: transient burning or stinging

Arrhythmia

Myocardial infarction

Subarachnoid hemorrhage

Headache or browache

Blurred vision

Syncope

Rebound myosis

Reactive hyperemia

Transient keratitis

Hypersensitivity reactions such as allergic conjunctivitis or dermatitis

Sensitivity to light

 

Warnings

Contraindications

Hypersensitivity, narrow-angle glaucoma, ventricular tachycardia, hypertension

 

Cautions

Reduce dose if used within 21 d of MAO inhibitors or TCAs

Wait 5 min between multiple drops (no >3 drops needed)

Rebound miosis may occur in elderly people 1 day after treatmentwith phenylephrine

Notify healthcare provider if vision changes, worsening of symptoms, or continued redness occur

Caution with marked hypertension, cardiac disorders, advanced arteriosclerotic changes, type 1 diabetes mellitus, hyperthyroidism; in children of low body weight; elderly

May cause false-normal tonometry readings, tonometry should be performed before phenylephrine is administered

Presence of sulfites in some products may cause allergic reactions in susceptible patients

 

Pregnancy and lactation

Pregnancy category: C

Lactation: Not known if distributed in milk, use caution

 

Pregnancy categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

 

Pharmacology of Altafrin, Neophrin (phenylephrine ophthalmic)

Mechanism of action

Acts directly on alpha-adrenergic receptors in eye producing contraction of dilator muscle of pupil & constriction of arterioles in conjunctiva

 

Pharmacokinetics

Onset of action: 15-30 min (mydriasis)

Duration: 1-3 hr (mydriasis)

Peak plasma time: <20 min

Absorption: Minimal (systemic)