COLCAPS

Indications

• Nasal congestion
• Hypotension (particularly in acute settings)
• Vasopressor support during anesthesia

Dosage

Children: Refer to the BNF for Children for specific dosing information, as it varies based on age and indication.

Adults: For the treatment of hypotension, the recommended initial dose is 0.16–0.33 mL/minute as an intravenous infusion, adjusted according to blood pressure response. For nasal congestion, 0.25 to 0.5 mL of the 0.5% solution may be applied topically.

Mechanism of action

Phenylephrine primarily acts as a selective agonist for α1-adrenergic receptors. Activation of these receptors results in vasoconstriction of blood vessels, leading to increased systemic vascular resistance and blood pressure. It does not significantly stimulate β-adrenergic receptors, which makes it less effective at increasing heart rate compared to other sympathomimetics.

Pharmacodynamics

Phenylephrine's pharmacodynamic effects include increased peripheral vascular resistance and blood pressure due to its vasoconstrictive action. Its decongestant effects arise from vasoconstriction of nasal mucosal blood vessels, reducing swelling and congestion. The duration of action is dose-dependent and can vary based on the route of administration.

Pharmacokinetics

Phenylephrine is absorbed after oral administration but has a significant first-pass metabolism, which reduces its bioavailability. It is metabolized primarily in the liver and has a half-life of about 2.5 to 3 hours. The drug is excreted in urine, primarily as metabolites. The onset of action varies with the route of administration, with intravenous administration providing the most rapid effect.

Adverse effects

• Hypertension
• Reflex bradycardia
• Headache
• Nausea
• Vomiting
• Palpitations

Precautions

• Use with caution in patients with hypertension
• Monitor blood pressure frequently
• Use during pregnancy only if potential benefit outweighs risk

Pregnancy

Manufacturer advises use if potential benefit outweighs risk-may reduce placental perfusion and induce fetal bradycardia.

Storage

Store at room temperature, protect from light.

Formulations

• Phenylephrine hydrochloride 2.5mg tablets
• Phenylephrine hydrochloride 5mg tablets
• Phenylephrine hydrochloride 10mg tablets
• Phenylephrine hydrochloride solution for injection

Indications

• Management of apnea of prematurity
• Enhancement of alertness and cognitive performance
• Relief of headaches, particularly when combined with analgesics
• Enhancement of physical performance in sports

Dosage

Children: For infants, particularly for apnea of prematurity

Adults: The usual adult dose for alertness enhancement is 100 to 200 mg, taken as needed. For the management of apnea of prematurity, doses may vary and should be determined by a healthcare professional.

Mechanism of action

Caffeine acts primarily as an antagonist of adenosine receptors, inhibiting the action of adenosine, which normally promotes sleep and relaxation. This antagonism leads to increased neuronal firing and the release of neurotransmitters such as dopamine and norepinephrine. Caffeine also inhibits phosphodiesterase enzymes, enhancing levels of cyclic AMP and cyclic GMP, which are important for various cellular functions. Additionally, in the context of respiratory function, caffeine stimulates the respiratory centers in the central nervous system, enhancing ventilation.

Pharmacodynamics

Caffeine stimulates the central nervous system, increasing alertness and reducing fatigue. It relaxes smooth muscles, increases cardiac muscle contraction, and can enhance physical performance. Caffeine also promotes gastric acid secretion and gastrointestinal motility, and it exhibits mild diuretic properties. Its effects can lead to restlessness and agitation in some individuals, particularly at higher doses.

Pharmacokinetics

Caffeine is rapidly absorbed from the gastrointestinal tract, with peak plasma concentrations occurring within 30 to 120 minutes after ingestion. It is distributed widely throughout body tissues, readily crossing the blood-brain barrier. Caffeine is metabolized primarily in the liver by cytochrome P450 1A2, producing three primary metabolites: paraxanthine, theobromine, and theophylline. The elimination half-life varies significantly among individuals, influenced by factors such as age, liver function, pregnancy, and the use of certain medications. It is primarily excreted in urine.

Adverse effects

• Restlessness
• Agitation
• Insomnia
• Increased heart rate
• Nausea
• Gastrointestinal discomfort
• Headaches

Interactions

• caffeinecitrate+adenosine: Unknown (decreases efficacy)
• caffeinecitrate+antiarrhythmics: Unknown (decreases efficacy)

Precautions

• Use cautiously in patients with a history of anxiety disorders, insomnia, or cardiac arrhythmias.
• Monitor caffeine intake in individuals with certain medical conditions, such as hypertension.

Pregnancy

Caffeine crosses the placenta; excessive intake during pregnancy may be associated with adverse outcomes. It is generally recommended to limit caffeine consumption.

Breast-feeding

Caffeine is excreted in breast milk; moderate consumption is considered safe, but excessive intake may affect the infant's sleep and behavior.

Storage

Store in a cool, dry place away from direct light. Keep out of reach of children.

Formulations

• Tablets
• Oral solutions
• Injectable preparations
• Caffeine citrate

Indications

• Allergic rhinitis (hay fever)
• Urticaria (hives)
• Allergic conjunctivitis
• Pruritus (itching) associated with allergic reactions
• Common cold symptoms

Dosage

Children: For children, dosing should be determined based on age and weight, and it is recommended to refer to the BNF for Children for specific guidelines.

Adults: For adults, the usual dosage is 4 mg every 4 to 6 hours, not exceeding 24 mg in a 24-hour period.

Mechanism of action

Chlorpheniramine exerts its effects by acting as a competitive antagonist of the H1 histamine receptor. By blocking histamine's action, it alleviates symptoms such as sneezing, itching, and runny nose associated with allergic reactions. Additionally, it has anticholinergic properties, which can contribute to its drying effects on secretions.

Pharmacodynamics

Chlorpheniramine demonstrates a dose-dependent reduction in allergy symptoms by inhibiting histamine-mediated effects. Its anticholinergic activity can also lead to effects such as reduced mucus production and sedation. The drug's effects typically begin within 1 to 2 hours of administration and can last for several hours, depending on the dose and formulation.

Pharmacokinetics

Chlorpheniramine is well absorbed from the gastrointestinal tract, with peak plasma concentrations occurring approximately 2 to 6 hours after oral administration. It is metabolized primarily in the liver via cytochrome P450 enzymes and has a half-life of about 20 hours. The drug is excreted mainly in the urine. Due to its lipophilic nature, chlorpheniramine readily crosses the blood-brain barrier, which accounts for its sedative properties.

Contra-indications

• Hypersensitivity to chlorpheniramine or any of its components
• Severe asthma exacerbation
• Use in neonates or premature infants

Adverse effects

• Drowsiness
• Dizziness
• Dry mouth
• Constipation
• Blurred vision
• Urinary retention
• Tachycardia

Interactions

• Increased sedative effects when taken with alcohol or other CNS depressants
• Anticholinergic effects may be enhanced when used with other anticholinergic drugs
• May interfere with the action of certain medications for Parkinson's disease

Precautions

• Use with caution in patients with glaucoma
• Caution in patients with prostatic hypertrophy
• Caution in patients with cardiovascular diseases
• May impair ability to drive or operate machinery due to sedative effects

Pregnancy

Chlorpheniramine is classified as category B; it should only be used if clearly needed and prescribed by a healthcare provider.

Breast-feeding

Chlorpheniramine is excreted in breast milk and may cause sedation in the nursing infant. Caution is advised.

Storage

Store in a cool, dry place away from light. Keep out of reach of children.

Formulations

• Tablets
• Syrup
• Extended-release formulations

Indications

• Allergic rhinitis
• Urticaria
• Pruritus
• Allergic conjunctivitis
• Sedation in allergic conditions

Dosage

Children: Refer to the BNF for Children for appropriate paediatric dosing guidelines.

Adults: Refer to the BNF for detailed dosing information.

Mechanism of action

Mepyramine binds to the H1 receptor in a G protein-coupled form, promoting an inactive state that interferes with Gq/11-mediated signaling. This inverse agonism prevents histamine from exerting its effects at the receptor, thus suppressing histaminic responses like edema, flare, and pruritus. It also has central nervous system sedative effects, enhancing its utility in treating allergic reactions with associated sleep disturbances.

Pharmacodynamics

As an H1 receptor antagonist, mepyramine inhibits various actions of histamine on effector cells, leading to decreased vascular permeability and reduced smooth muscle contraction in response to histamine. Its anticholinergic properties contribute to drying effects on nasal mucosa, further alleviating symptoms of allergic rhinitis and other allergic conditions. The sedative effects are attributed to its action on the central nervous system, which can be beneficial in managing insomnia related to allergic symptoms.

Pharmacokinetics

Mepyramine is absorbed from the gastrointestinal tract and reaches peak plasma concentrations within a few hours after oral administration. It is metabolized in the liver, and its metabolites are excreted primarily through urine. The drug's half-life and detailed pharmacokinetic parameters are influenced by individual patient factors, such as age, hepatic function, and concomitant medications.

Adverse effects

• Drowsiness
• Dizziness
• Dry mouth
• Constipation
• Blurred vision
• Urinary retention

Precautions

• Caution in patients with glaucoma
• Caution in patients with prostatic hypertrophy
• Caution in patients with epilepsy
• Use with caution in elderly patients due to increased sensitivity to side effects

Pregnancy

Mepyramine should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

Mepyramine may be excreted in breast milk; caution is advised when administering to nursing mothers.

Storage

Store in a cool, dry place away from direct sunlight. Keep out of reach of children.

Formulations

• Tablets
• Syrup

Indications

• Hypotension in surgical settings
• Nasal decongestion
• Mydriasis for ophthalmic procedures
• Management of shock states

Dosage

Adults: For intravenous administration, initial doses typically range from 100 to 500 micrograms, repeated as necessary, with careful monitoring of blood pressure. For nasal decongestion, phenylephrine is commonly administered as a 10 mg oral dose every

Mechanism of action

Phenylephrine exerts its effects primarily through agonism of alpha-1 adrenergic receptors, which results in vasoconstriction and mydriasis. The stimulation of these receptors inhibits the production of cyclic adenosine-3',5'-monophosphate (cAMP) by inhibiting adenyl cyclase, leading to increased peripheral vascular resistance and elevated blood pressure. Additionally, phenylephrine indirectly promotes the release of norepinephrine from storage sites, further enhancing its vasoconstrictive effects.

Pharmacodynamics

Phenylephrine causes an increase in blood pressure and local vasoconstriction. Its ophthalmic formulations can induce mydriasis for 3-8 hours, while intravenous administration has a rapid onset with an effective half-life of about 5 minutes and an elimination half-life of approximately 2.5 hours. Caution is advised regarding potential side effects such as hypertension, arrhythmias, and rebound miosis with ophthalmic use, and bradycardia, allergic reactions, and tissue damage with intravenous use.

Pharmacokinetics

Phenylephrine is rapidly absorbed following intravenous administration, leading to a quick elevation in blood pressure. The drug undergoes metabolism primarily in the liver and is eliminated through urine. The pharmacokinetic profile indicates a short effective half-life which necessitates frequent dosing in continuous infusion settings for maintaining blood pressure levels.

Contra-indications

• Severe hypertension
• Hypersensitivity to phenylephrine
• Severe coronary artery disease
• Narrow-angle glaucoma

Adverse effects

• Hypertension
• Reflex bradycardia
• Arrhythmias
• Headache
• Dizziness
• Nausea
• Vomiting
• Local irritation (ophthalmic use)

Interactions

• MAO inhibitors may enhance the hypertensive effect
• Tricyclic antidepressants may increase the pressor response
• Concurrent use with oxytocic drugs may increase the risk of hypertension
• Can interact with other sympathomimetics

Precautions

• Use with caution in patients with hypertension, hyperthyroidism, or diabetes mellitus
• Monitor blood pressure regularly during treatment
• Caution in patients with cardiovascular disease
• Use with caution in elderly patients

Pregnancy

Phenylephrine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Limited data available.

Breast-feeding

It is not known whether phenylephrine is excreted in human milk. Caution is advised when administered to nursing mothers.

Storage

Store in a cool, dry place away from light. Keep out of reach of children.

Formulations

• Ophthalmic solution
• Injectable solution
• Oral tablet

Indications

• Nasal congestion
• Cough-cold formulations
• Appetite suppression

Dosage

Adults: Refer to the BNF for

Mechanism of action

Phenylpropanolamine acts directly on alpha- and, to a lesser extent, beta-adrenergic receptors in the respiratory tract mucosa. Activation of alpha-adrenergic receptors induces vasoconstriction, which decreases tissue hyperemia, edema, and nasal congestion, thereby improving nasal airway patency. PPA may also stimulate beta-receptors, resulting in tachycardia and a positive inotropic effect. The drug likely functions by releasing norepinephrine from its storage sites, with alpha-adrenergic effects emerging from inhibition of adenyl cyclase activity and beta-adrenergic effects from cyclic adenosine 3',5'-monophosphate (AMP) production via adenyl cyclase activation. Repeated use can lead to norepinephrine depletion, resulting in tachyphylaxis.

Pharmacodynamics

Phenylpropanolamine, classified as a sympathomimetic, primarily serves as a decongestant. Its usage has declined due to safety concerns, particularly the risk of hemorrhagic stroke in female patients. Despite its decongestant properties, the FDA has advised against its use in over-the-counter products since 2000, reflecting its potential adverse effects.

Pharmacokinetics

The pharmacokinetics of phenylpropanolamine include its absorption, distribution, metabolism, and excretion characteristics, though specific data on half-life and bioavailability are not detailed in the provided information. Its sympathomimetic effects are mediated through adrenergic receptor stimulation, and prolonged use may lead to decreased efficacy due to tachyphylaxis.

Contra-indications

• Hypersensitivity to phenylpropanolamine or any component of the formulation
• Severe hypertension
• Severe coronary artery disease
• Hyperthyroidism
• Glaucoma
• Concurrent use of monoamine oxidase inhibitors (MAOIs)

Adverse effects

• Hypertension
• Tachycardia
• Nervousness
• Dizziness
• Insomnia
• Headache
• Dry mouth
• Nausea
• Vomiting
• Constipation

Interactions

• MAO inhibitors - may cause hypertensive crisis
• Tricyclic antidepressants - may enhance hypertensive effect
• Beta-blockers - may diminish the effectiveness of phenylpropanolamine
• Other sympathomimetics - increased risk of cardiovascular side effects

Precautions

• Use with caution in patients with cardiovascular disease
• Monitor blood pressure regularly during treatment
• Caution in patients with diabetes, prostate enlargement, or urinary retention
• Not recommended for use in children under 12 years of age

Pregnancy

Phenylpropanolamine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Safety in pregnancy has not been established.

Breast-feeding

It is not known whether phenylpropanolamine is excreted in human milk. Caution is advised when administering to breastfeeding women.

Storage

Store at room temperature, away from moisture and heat. Keep out of reach of children.

Formulations

• Phenylpropanolamine hydrochloride tablet
• Phenylpropanolamine syrup

Indications

• Nasal congestion due to allergies
• Common cold
• Sinusitis
• Appetite suppression

Dosage

Children: Refer to specific product guidelines for dosing information, as it can vary by formulation and indication.

Adults: Refer to specific product guidelines for dosing information, as it can vary by formulation and indication.

Mechanism of action

Phenylpropanolamine acts primarily as an adrenergic agonist, stimulating alpha-1 adrenergic receptors. This stimulation results in vasoconstriction of blood vessels in the nasal mucosa, leading to decreased edema and congestion. Additionally, it may have effects on the central nervous system, contributing to appetite suppression.

Pharmacodynamics

The pharmacodynamics of phenylpropanolamine involves its action on adrenergic receptors, particularly alpha-1 receptors, which mediate smooth muscle contraction and vasoconstriction. This leads to increased blood pressure and decreased blood flow to the nasal mucosa, ameliorating symptoms of nasal congestion. Its central effects may also include increased alertness and decreased appetite, although these effects vary among individuals.

Pharmacokinetics

Phenylpropanolamine is absorbed from the gastrointestinal tract and reaches peak plasma concentrations within 1 to 3 hours after oral administration. It is metabolized by monoamine oxidase and other pathways in the liver, with a half-life ranging from 2 to 4 hours. The drug is primarily excreted in the urine, both as unchanged drug and metabolites. Factors such as age, liver function, and other medications can influence its pharmacokinetics.

Contra-indications

• Hypersensitivity to phenylpropanolamine or any component of the formulation
• Severe hypertension
• Severe cardiovascular disorders
• Hyperthyroidism
• Glaucoma
• Use in patients taking monoamine oxidase inhibitors (MAOIs)

Adverse effects

• Insomnia
• Nervousness
• Dizziness
• Headache
• Tachycardia
• Palpitations
• Hypertension
• Dry mouth
• Nausea

Interactions

• Increased risk of hypertension when used with other sympathomimetics
• Potentially increased effects with MAOIs leading to hypertensive crises
• May decrease effectiveness of antihypertensive medications

Precautions

• Use with caution in patients with a history of hypertension
• Monitor blood pressure regularly during treatment
• Caution in patients with diabetes mellitus or prostate enlargement
• Avoid use in pregnant or breastfeeding women unless clearly necessary

Pregnancy

Phenylpropanolamine is not recommended during pregnancy due to potential risks. Consult a healthcare provider for alternative treatments.

Breast-feeding

It is advisable to avoid phenylpropanolamine while breastfeeding due to potential effects on the infant. Consult a healthcare provider for safer alternatives.

Storage

Store at room temperature, away from moisture and heat. Keep out of reach of children.

Formulations

• Tablets
• Capsules
• Syrup

Indications

• Mild to moderate pain
• Fever

Dosage

Children: Refer to the BNF for Children for specific dosing information.

Adults: Refer to the BNF for specific dosing guidelines.

Mechanism of action

Salicylamide exerts its effects primarily through the inhibition of cyclooxygenase (COX) enzymes, leading to decreased synthesis of prostaglandins. Prostaglandins are mediators of inflammation and pain, and their reduction results in analgesic and antipyretic effects.

Pharmacodynamics

The analgesic effect of salicylamide is mainly due to its action on the central nervous system, where it inhibits pain perception. The antipyretic effect is achieved through its action on the hypothalamic heat-regulating center, which facilitates heat dissipation.

Pharmacokinetics

Salicylamide is absorbed from the gastrointestinal tract and reaches peak plasma concentrations within a few hours post-administration. It is metabolized in the liver, and its metabolites are excreted primarily in the urine. The elimination half-life varies but typically ranges from 2 to 4 hours.

Pregnancy

Salicylamide should be used with caution during pregnancy and only if the benefits outweigh the risks. It is advisable to consult healthcare professionals for individual assessment.

Breast-feeding

Caution is advised when using salicylamide during breastfeeding, as it is not known if it is excreted in human milk. Individual assessment is recommended.

Storage

Store in a cool, dry place, protected from light. Ensure it is kept out of reach of children.

Mechanism of action

The mechanism of action of caffeine is complex, as it impacts several body systems, which are listed below. The effects as they relate to various body systems are described as follows: **General and cellular actions** Caffeine exerts several actions on cells, but the clinical relevance is poorly understood. One probable mechanism is the inhibition of nucleotide phosphodiesterase enzymes, adenosine receptors, regulation of calcium handling in cells, and participates in adenosine receptor antagonism. Phosphodiesterase enzymes regulate cell function via actions on second messengers cAMP and cGMP. This causes lipolysis through activation of hormone-sensitive lipases, releasing fatty acids and glycerol. **Respiratory** The exact mechanism of action of caffeine in treating apnea related to prematurity is unknown, however, there are several proposed mechanisms, including respiratory center stimulation in the central nervous system, a reduced threshold to hypercapnia with increased response, and increased consumption of oxygen, among others. The blocking of the adenosine receptors enhances respiratory drive via an increase in brain medullary response to carbon dioxide, stimulating ventilation and respiratory drive, while increasing contractility of the diaphragm. **Central nervous system** Caffeine demonstrates antagonism of all 4 adenosine receptor subtypes (A1, A2a, A2b, A3) in the central nervous system. Caffeine's effects on alertness and combatting drowsiness are specifically related to the antagonism of the A2a receptor. **Renal system** Caffeine has diuretic effects due to is stimulatory effects on renal blood flow, increase in glomerular filtration, and increase in sodium excretion. **Cardiovascular system** Adenosine receptor antagonism at the A1 receptor by caffeine stimulates inotropic effects in the heart. Blocking of adenosine receptors promotes catecholamine release, leading to stimulatory effects occurring in the heart and the rest of the body. In the blood vessels, caffeine exerts direct antagonism of adenosine receptors, causing vasodilation. It stimulates the endothelial cells in the blood vessel wall to release nitric oxide, potentiating blood vessel relaxation. Catecholamine release, however, antagonizes this and exerts inotropic and chronotropic effects on the heart, ultimately leading to vasoconstriction. Finally, caffeine is shown to raise systolic blood pressure measurements by 5 to 10 mmHg when it is not taken regularly, versus no effect in those who consume it regularly. The vasoconstricting effects of caffeine are beneficial in migraines and other types of headache, which are normally caused by vasodilation in the brain. Caffeine competitively inhibits phosphodiesterase, the enzyme that degrades cyclic 3',5'-adenosine monophosphate (AMP). Increased levels of intracellular cyclic AMP mediate most of caffeine's pharmacologic actions. Caffeine stimulates all levels of the CNS... Caffeine's cortical effects are milder and of shorter duration than those of amphetamines. In slightly larger doses, caffeine stimulates medullary, vagal, vasomotor, and respiratory centers, promoting bradycardia, vasoconstriction, and increased respiratory rate. Caffeine constricts cerebral vasculature. In contrast, the drug directly dilates peripheral blood vessels...

Pharmacodynamics

Caffeine stimulates the central nervous system (CNS), heightening alertness, and sometimes causing restlessness and agitation. It relaxes smooth muscle, stimulates the contraction of cardiac muscle, and enhances athletic performance. Caffeine promotes gastric acid secretion and increases gastrointestinal motility. It is often combined in products with analgesics and ergot alkaloids, relieving the symptoms of migraine and other types of headaches. Finally, caffeine acts as a mild diuretic.

Mechanism of action

Mepyramine is a histamine H1 receptor inverse agonist. It binds to a G protein-coupled form of the receptor and promotes a G protein-coupled inactive state of the H1 receptor that interferes with the Gq/11-mediated signaling. Mepyramine competes with histamine for binding at H₁-receptor sites on the effector cell surface, resulting in suppression of histaminic edema, flare, and pruritus. The sedative properties of Mepyramine occur at the subcortical level of the CNS. Antihistamines used in the treatment of allergy act by competing with histamine for H1-receptor sites on effector cells. They thereby prevent, but do not reverse, responses mediated by histamine alone. Antihistamines antagonize, in varying degrees, most of the pharmacological effects of histamine, including urticaria and pruritus. Also, the anticholinergic actions of most antihistamines provide a drying effect on the nasal mucosa. /Antihistamines/ H1 antagonists inhibit most responses of smooth muscle to histamine. Antagonism of the constrictor action of histamine on respiratory smooth muscle is easily shown in vivo and in vitro. /Histamine Antagonists: H1 Antagonists/ H1 antagonists strongly block the action of histamine that results in increased permeability and formation of edema and wheal. /Histamine Antagonists: H1 Antagonists/ Some H1 antagonists possess local anesthetic activity ... . /Histamine Antagonists: H1 Antagonists/ For more Mechanism of Action (Complete) data for PYRILAMINE (6 total), please visit the HSDB record page.

Mechanism of action

Phenylephrine is an alpha-1 adrenergic agonist that mediates vasoconstriction and mydriasis depending on the route and location of administration. Systemic exposure to phenylephrine also leads to agonism of alpha-1 adrenergic receptors, raising systolic and diastolic pressure as well as peripheral vascular resistance. Increased blood pressure stimulates the vagus nerve, causing reflex bradycardia. Phenylephrine acts predominantly by a direct effect on alpha-adrenergic receptors. In therapeutic doses, the drug has no substantial stimulant effect on the beta-adrenergic receptors of the heart (beta1-adrenergic receptors) but substantial activation of these receptors may occur when larger doses are given. Phenylephrine does not stimulate beta-adrenergic receptors of the bronchi or peripheral blood vessels (beta2-adrenergic receptors). It is believed that alpha-adrenergic effects result from the inhibition of the production of cyclic adenosine-3',5'-monophosphate (cAMP) by inhibition of the enzyme adenyl cyclase, whereas beta-adrenergic effects result from stimulation of adenyl cyclase activity. Phenylephrine also has an indirect effect by releasing norepinephrine from its storage sites.

Pharmacodynamics

Phenylephrine is an alpha-1 adrenergic agonist that raises blood pressure, dilates the pupils, and causes local vasoconstriction. Ophthalmic formulations of phenylephrine act for 3-8 hours while intravenous solutions have an effective half life of 5 minutes and an elimination half life of 2.5 hours. Patients taking ophthalmic formulations of phenylephrine should be counselled about the risk of arrhythmia, hypertension, and rebound miosis. Patients taking an intravenous formulation should be counselled regarding the risk of bradycardia, allergic reactions, extravasation causing necrosis or tissue sloughing, and the concomitant use of oxytocic drugs.

Mechanism of action

Phenylpropanolamine acts directly on alpha- and, to a lesser degree, beta-adrenergic receptors in the mucosa of the respiratory tract. Stimulation of alpha-adrenergic receptors produces vasoconstriction, reduces tissue hyperemia, edema, and nasal congestion, and increases nasal airway patency. PPA indirectly stimulates beta-receptors, producing tachycardia and a positive inotropic effect. The mechanism of action of phenylpropanolamine has not been conclusively determined. The drug may directly stimulate adrenergic receptors but probably indirectly stimulates both A- and B-adrenergic receptors by releasing norepinephrine from its storage sites. It is believed that B-adrenergic effects result from stimulation of cyclic adenosine 3',5'-monophosphate (AMP) production by activation of the enzyme adenyl cyclase, whereas A-adrenergic effects result from inhibition of adenyl cyclase activity. With prolonged use or too frequent administration, indirectly acting sympathomimetics may deplete norepinephrine in sympathetic nerve endings and tachyphylaxis may develop. Tachyphylaxis induced by one indirectly acting sympathomimetic may result in refractoriness to other drugs of the same class. /Phenylpropanolamine hydrochloride/ Whether the alpha1- and alpha2-adrenoceptor mediated increases in diastolic blood pressure effected by phenylpropanolamine and its enantiomers are altered by, or independent of beta2-mediated vasodilation, or beta2-adrenoceptor blockade were studied in pithed rats. The pressor responses were enhanced in the presence of the antagonist ICI-118551 and diminished in the presence of albuterol. It was concluded that each form of phenylpropanolamine possesses the intrinsic ability to interact with all of the adrenoceptors in the system used and that the interaction with those adrenoceptors determines the net increase in diastolic blood pressure that follows the intravenous administration of the compounds. These findings have a bearing on the recent controversy regarding the use of beta-blocking agents in the treatment of overdosage of phenylpropanolamine.

Pharmacodynamics

Phenylpropanolamine (PPA), a sympathomimetic agent structurally similar to pseudoephedrine, is used to treat nasal congestion. Phenylpropanolamine is found in appetite suppressant formulations and with guaifenesinin in cough-cold formulations. In 2000, the FDA requested that all drug companies discontinue marketing products containing phenylpropanolamine, due to an increased risk of hemorrhagic stroke in women who used phenylpropanolamine.