Drug Interaction:
Nasal decongestants include-
Arylalkalamine-
Phenylpropanolamine, Pseudoephedrine, Phenylephrine, Epinephrine, Ephedrine,
Desoxyephedrine,
Irridazolines-
Naphazoline, Oxymetazoline, Tetrahydrozoline, Xylomethazoline,
Cycloalkyamine-
Propylhexedrine
Refer-phenylpropanolamine
Drug interactions -Summary
+ Ophthalmic sympathomimetics-
Anesthetics
cautiously use anesthetics that sensitize the myocardium to sympathomimetics
(eg cyclopropane, halothane). Local anesthetics can increase absorption of
topical drugs, excercise caution when applying prior to use of phenylephrine
Beta blockers
systemic side effects occur more readily in patients taking these drugs
MAOIs
when given with,or upto 21 days after NAOIs, exagerrated adrenergic effects
may result. supervise and adjust dosage carefully
Indication:
Nasal decongestants include-
Arylalkalamine- Phenylpropanolamine, Pseudoephedrine, Phenylephrine, Epinephrine, Ephedrine, Desoxyephedrine, Irridazolines- Naphazoline, Oxymetazoline, Tetrahydrozoline, Xylomethazoline, Cycloalkyamine- Propylhexedrine
Refer Phenylpropanolamine
Adverse Reaction:
Ophthalmic- transitory stinging, om initial instillation, blurring of vision, mysriasis, increased redness, irritation, discomfort, blurring, punctuate keratitis, lacrimation, increased IOP
Cardiovascular- palpitation, tachycardia, cardiac arrhythmias, hypertension, ventricular arrhythmias, (ie, premature ventricular contractions), reflux bradycardia, coronary occulsion, pulmonary embolism, subarachoid hemorrhage, myocardial infarction., stroke, death associated with cardiac reactions.
Headache may occur.
Phenylephrine 10%- significant elevation of blood pressure is rare but can occur after conjunctivial instillation.
Miscellaneous- headche, blanching, tremor, trembling, sweating, dizziness, nausea, nervousness, drowsiness, weakness, hyperglycemia.
Contra-Indications:
Hypersensitivity to any of the components
Special precations:
Special risk patients- use with caution in the presence of hypertension, diabetes, hyperthyroidism, cardiovascular abnormalities, arteriosclerosis Narrow angle glaucoma- ordrinarily any mydriatic is contraindicated in patients with glaucoma. However, when temporary pupil dilation may free adhesions or when vasoconstriction of intrinsic vessels may lower intraocular tension these advantages may temporarily outweigh danger from coincident pupil dilation.
Rebound congestion- may occur with frequent or extended use of ophthalmic vasoconstritors. this may be of importance when there is retinal deatchment or prior to cataract surgery. Rebound miosis have occured in older persons 1 day after receiving phenylephrine, reinstillation produced a reduction in mydriasis.
Pigment floaters- older individuals may develop transcient pigment floaters in the aqueous humor 30 to 45 minutes after instillation of phenylephrine
Warnings-
Anesthetics- discontinue prior to use of anesthetics which sensitize the myocardium to sympathomimetics (eg cyclopropane, halothane) Local anesthetics can increase absorption of topically applied drugs. Excercise caution when applying prior to use of phenylephrine Over use- may produce increased redness of the eye.
Pregnancy- safety for use during pregnancy is not established
Lactation- safety for use during breast feeding has not established, Use with caution when administerting to a nursing woman.
Children- safety and efficacy have not been not established
Dosages/ Overdosage Etc:
Indications:
Nasal decongestant
Dosage:
Adults and children over 12 years- 1 or 2 drops in each nostril as needed.
Patient Information:
1. Do not use beyond 48 to 72 hours
2. If irriation, burning or redness persists, or if severe eye pain, headache,
vision changes, floating spots, dizziness, decrease in body temperature,
drowsiness, acute eye redness or pain with light exposure occur, discontinue
use and consult physician
3. Do not use if you have glaucoma except under the advice of a physician
4. Potentially hazardous tasks- phenylephrine may cause temporary blurred vision
or unstable vision.
Observe caution while driving or performing other hazardous tasks.
Ref - USP PDI Vol II 17th Edition (1997)
1.Allergies-
Tell your doctor if you have ever had any unusual or allergic reaction to
naphazoline.. Also tell your healthcare care professional if you are allergic
to any other substances such as foods. preservatives or dyes.
2.Pregnancy-
This medicine may be absorbed into the body. However, studies on the
effects on pregnancy has not been done in either humans or animals.
3. Breast-feeding-
Naphazoline may be absorbed into the mothers body. However, this medicine
has not been reported to cause any problems in nursing babies.
4.Children-
Use by infants and children is not recommened, since thy are especially
sensitive to the effects of naophazoline.
5.Older adults-
There is no specific information comparing use of naphazoline in the elderly
with use in other age groups
6. Other medicines-
Tell your doctor if you are using any other prescription or non-prescription
(Over-the counter) OTC medicine.
7. Other medical problems-
Make sure you tell your doctor if you have any other medical problems
especially-
Diabetes mellitus or
Heart disease or
High blood pressure or
Overactive steroids - use of naphazoline may make the condition worse
Eye disease, infection or injury- the symptoms of these conditions may
be confused possible side effects of ophthalmic naphazoline
Pregnancy and lactation:
Pregnancy-
Safety for use during pregnancy is not established
Lactation-
Safety for use during breast feeding has not established, Use with caution when administerrting to a nursing woman.
Children-
Safety and efficacy have not been not established
