Phenylephrine contraindications

Ephedrine —contraindicated with MAOIs Pseudoephedrine —contraindicated with MAOIs Phenylephrine —contraindicated with MAOIs Phenylpropanolamine —contraindicated with MAOIs Seriously elevated blood pressure (hypertensive crisis), elevated temperature, seizures, cerebral hemorrhage, death... 

Phenylephrine is a nasal decongestant that mimics the sympathetic system, thereby increasing the heart rate and blood pressure. It may aggravate conditions such as diabetes, hypertension and glaucoma. Patients with hypertension, ischaemic heart disease, hyperthyroidism, diabetes and glaucoma are therefore given topical nasal sympathomimetics rather than systemic sympathomimetics. Both topical and systemic sympathomimetics are contraindicated in patients taking monoamine oxidase inhibitors, because concurrent administration of the two products may lead to a hypertensive crisis. 

Contraindications Phenylephrine HCl injection should not be used with patients with severe hypertension, ventricular tachycardia or fibrillation, acute myocardial infarction (Ml), atrial flutter or fibrillation, cardiac arrhythmias, cardiac disease, cardiomyopathy, closed-angle glaucoma, coronary artery disease, patients who have a known hypersensitivity to phenylephrine, sulfites, or to any one of its components. 

Contraindications Ophthalmic solutions (both strengths) of phenylephrine HCl are contraindicated in patients with anatomically narrow angles or narrow-angle glaucoma, severe arteriosclerotic cardiovascular or cerebrovascular disease, use during intraocular operative procedures when the corneal epithelial barrier has been disturbed, and in persons with a known sensitivity to phenylephrine, sulfites, or any of its components including preservatives. The 10% solution is contraindicated in patients with aneurysms. 

Patients taking certain systemic medications are also more sensitive to the pressor effects of phenylephrine. In individuals taking atropine, the pressor effect of phenylephrine is augmented, and tachycardia can occur. Tricyclic antidepressants and monoamine oxidase (MAO) inhibitors also potentiate the cardiovascular effects of topical phenylephrine. The concomitant use of phenylephrine is contraindicated with these agents, even up to 21 days after cessation of MAO inhibitor therapy. Similarly, patients taking reserpine, guanethidine, or methyldopa are at increased risk for adverse pressor effects from topical phenylephrine because of denervation hypersensitivity accompanying the chemical sympathectomy. 

Contraindications to the topical use of hydroxyamphetamine for routine mydriasis are similar to those to phenylephrine. Because of its tachyphylaxis and ineffectiveness in postganglionic denervation, however, hydroxyamphetamine may be a safer mydriatic for use in patients with insulin-dependent diabetes, idiopathic orthostatic hypotension, or chemical sympathectomy produced by therapy with systemic guanethidine, reserpine, or methyl-dopa. Thus hydroxyamphetamine seems to be less strongly contraindicated than phenylephrine for certain high-risk patients. 

Because of its risk of adverse pressor effects, the 10% concentration of topical phenylephrine should be avoided for pupillary dilation, especially in patients with cardiac disease, systemic hypertension, aneurysms, and advanced arteriosclerosis. However, mild hypertension is not necessarily a contraindication to the use of the 2.5% concentration phenylephrine. 

Hydrocodone bitartrate is absolutely contraindicated in patients with known hypersensitivity reactions to hydrocodone. Commercial preparations may also contain sulfite compounds that can produce allergic reactions, including bronchospasm and anaphylaxis, in certain susceptible individuals, particularly asthmatic patients. In addition, the dye tartrazine is present in one preparation of hydrocodone bitartrate, combined with chlorpheniramine maleate and phenylephrine hydrochloride, that is used as an antitussive and expectorant agent (Vanex). Also known as FD C yellow No. 5, tartrazine can cause asthmatic and other allergic reactions in some susceptible patients, especially those with aspirin sensitivities. 

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