Phenylephrine Ophthalmic

Phenylephrine Ophthalmic is a medication used to dilate the pupils for eye examinations or procedures, and to treat certain eye conditions. 

• Phenylephrine Ophthalmic is available under the following different brand names: Altafrin, Neofrin, Refresh Redness Relief.

Common side effects of Phenylephrine Ophthalmic include:

• mild upset stomach
• trouble sleeping
• dizziness 
• lightheadedness 
• headache
• nervousness 
• shaking, or fast heartbeat

Serious side effects of Phenylephrine Ophthalmic include:

• hives
• difficult breathing
• swelling of the face, lips, tongue, or throat
• fast/irregular heartbeat
• severe/uncontrolled shaking
• difficulty urinating
• seizures
• mental/mood changes (such as anxiety, panic, confusion, unusual thoughts/behavior)

Rare side effects of Phenylephrine Ophthalmic include:

• none 

Seek medical care or call 911 at once if you have the following serious side effects:

• Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, coordination loss, unsteady, very stiff muscles, high fever, profuse sweating, or tremors.
• Serious eye symptoms such as sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights.
• Serious heart symptoms include fast, irregular, or pounding heartbeats; fluttering in the chest; shortness of breath; sudden dizziness, lightheadedness, or passing out.

This is not a complete list of side effects and other serious side effects or health problems that may occur because of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

Adult and pediatric dosage

Ophthalmic solution

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

Mydriasis production

Adult dosage

• Ophthalmoscopy: 1-2 drops 2.5% solution or 10% solution, may repeat in 10-60 min, mydriasis persists above 3 hours, no cycloplegia.
• Ocular Surgery: 1-2 drops 2.5% or 10% solution administered 30-60 min preop.
• Irrigation: 1-2 drops 0.12% solution into the affected eye up to four times daily; not to exceed 72 hours of therapy.

Ocular procedures

Pediatric dosage

• Children younger than 1 year: 1 drop of 2.5% solution 15-20 min before the procedure.
• Children 1 year and older
• Ophthalmoscopy: 1-2 drops of 2.5% solution or 10% solution, may repeat in 10-60 min, mydriasis persists above 3 hours, no cycloplegia
• Ocular Surgery: 1-2 drops of 2.5% or 10% solution administered 30-60 min pre-op.
• Irrigation: 1-2 drops of 0.12% solution into the affected eye up to four times daily; not to exceed 72 hours of therapy

Posterior synechiae prevention

Adult dosage

• Anterior Uveitis: 1 drop of 10% solution three times daily or more (with atropine).
• Post-iridectomy: 1 drop of 10% solution once a day or twice daily.

Eye redness

Adult dosage

• OTC strength (0.12%) may be used to decrease the appearance of eye redness (bloodshot eyes)
• Instill 1-2 drops in the affected eye(s) two times a day/three times a day.

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, healthcare provider, or pharmacist first.

• Phenylephrine Ophthalmic has severe interactions with no other drugs
• Phenylephrine Ophthalmic has serious interactions with no other drugs
• Phenylephrine Ophthalmic has moderate interactions with the following drugs:
  • amitriptyline
  • amoxapine
  • clomipramine
  • desipramine
  • doxepin
  • imipramine
  • isocarboxazid
  • linezolid
  • lofepramine
  • maprotiline
  • nortriptyline
  • phenelzine
  • procarbazine
  • protriptyline
  • tranylcypromine
  • trazodone
  • trimipramine
• Phenylephrine Ophthalmic has minor interactions with no other drugs

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all the products you use. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your healthcare professional or doctor for additional medical advice, health questions, or concerns.

Contraindications

• Hypersensitivity, narrow-angle glaucoma, ventricular tachycardia, hypertension.

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Phenylephrine Ophthalmic?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Phenylephrine Ophthalmic?”

Cautions

• Reduce dose if used within 21d of monoamine oxidase inhibitors (MAOIs) or tricyclic antidepressants (TCAs)
• Wait 5 min between multiple drops (no more than 3 drops needed)
• Rebound miosis may occur in elderly people 1 day after treatment with phenylephrine
• Notify the healthcare provider if vision changes, worsening of symptoms, or continued redness occurs
• Caution with marked hypertension, cardiac disorders, advanced arteriosclerotic changes, type 1 diabetes status of low body weight; elderly
• May cause false-normal tonometry readings, tonometry should be performed before phenylephrine is administered
• The presence of sulfites in some products may cause allergic reactions in susceptible patients

Pregnancy and Lactation

• Not known whether the drug can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity; administer to a pregnant woman only if needed
• Lactation
  • It is not known whether this drug is excreted in human breast milk; because many drugs are excreted in human milk, caution should be exercised when therapy is administered to a nursing woman