Systemic Absorption and Cardiovascular Effects of Phenylephrine Eyedrops

Kumar, Viney; Schoenwald, Ronald D.; Chien, Du-Shieng; Packer, Andrew J.; Choi, W. W.

doi:10.1016/0002-9394(85)90229-6

Cited by 52 publications

(30 citation statements)

References 7 publications

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“…In the study by Kumar et al, a viscous solution of phenylephrine, 10%, was used, which likely led to greater systemic absorption (Table). As this study provided only Chawdhary et al, 10 1984 Kumar et al, 11 1985 Morgado et al, 12 2010 Mouly et al, 13 10 cases for each of the concentrations and times (overall weighting <5%) and as viscous phenylephrine is not commonly used in clinical practice, the study's results are not representative of BP and HR changes following phenylephrine application in clinical routine and are only retained as a worstcase scenario. No differences were found between studies that used phenylephrine alone and those that combined it with tropicamide, suggesting that concurrent application of tropicamide has no additional effect on BP.…”

Section: Effect On Bpmentioning

confidence: 78%

“…Topical ocular application of phenylephrine, 10%, led to an increase in BP at 5 and 10 minutes after application (mean difference, +15 mm Hg from a weighted baseline BP of 130 mm Hg; 95% CI, 127-133; P < .001), which decreased again to baseline BP at 20 to 30 minutes and remained at this level at 40 to 45 minutes and at 60 minutes and longer (changes between −4.3 and +4.8 mm Hg; all P > .08) (Figure 3). For both concentrations and times, no studies except that by Kumar et al 11 reported any extreme outliers. In the study by Kumar et al, a viscous solution of phenylephrine, 10%, was used, which likely led to greater systemic absorption (Table).…”

Section: Effect On Bpmentioning

confidence: 92%

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Cardiovascular Adverse Effects of Phenylephrine Eyedrops

et al. 2015

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IMPORTANCE Topical phenylephrine hydrochloride is routinely administered with few safety precautions, but evidence regarding its systemic safety to date is controversial. As even short-term variations in 24-hour blood pressure (BP) and heart rate (HR) can adversely affect cardiovascular health, better evidence on phenylephrine's effects on HR and BP is required.OBJECTIVE To perform a meta-analysis of available evidence regarding cardiovascular adverse effects of topical phenylephrine.DATA SOURCES PubMed, MEDLINE, and the Cochrane Database of Systematic Reviews and Clinical Trials were searched for relevant literature from January 1, 1970, to January 1, 2014, using a combination of the following search terms: topical, ocular, ophthalmic, phenylephrine, tropicamide, cardiovascular effect, side effect, blood pressure, heart rate, mydriatic, and eye drops. A total of 70 articles related to the topic were identified and all full texts were retrieved.STUDY SELECTION Randomized clinical trials reporting change in BP and HR for adults were included in this review. All studies reporting results for neonates or infants, not reporting standard deviations, or not specifying the time of measurement or the concentration of phenylephrine used were excluded.DATA EXTRACTION AND SYNTHESIS Data from randomized clinical trials that reported BP and/or HR as well as the time following administration of topical phenylephrine at which measurements were obtained by concentration of phenylephrine as a mean change and its standard deviation were extracted. Data were synthesized by concentration of phenylephrine and time of measurement following topical application using random-effects models with inverse variance weighting to account for heterogeneity across studies. MAIN OUTCOMES AND MEASURES Difference in BP and HR after topical administration of phenylephrine.RESULTS Eight RCTs with a total of 916 participants were included. Data were available for phenylephrine, 2.5%, at 20 to 30 minutes and 60 minutes or longer after administration, and neither BP nor HR changed at either time. Following application of phenylephrine, 10%, BP increased at 5 and 10 minutes (mean difference for both, +15 mm Hg; 95% CI, 11.94-18.54; P < .001) but decreased at 20 to 30 minutes and 60 minutes or longer with no changes detected against baseline. A mean increase in HR by 4.48 beats/min (95% CI, 1.09-7.88; P = .01) was present at 20 to 30 minutes following application of phenylephrine, 10%, and HR decreased by 60 minutes or longer with no changes detected compared with baseline.CONCLUSIONS AND RELEVANCE Phenylephrine, 2.5%, leads to no clinically relevant change in BP or HR, and the changes in BP and HR seen with phenylephrine, 10%, are short lived. Thus, phenylephrine, 2.5%, is safe to use in clinical routine.

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Section: Effect On Bpmentioning

confidence: 78%

Section: Effect On Bpmentioning

confidence: 92%

Cardiovascular Adverse Effects of Phenylephrine Eyedrops

et al. 2015

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“…Direct absorption may occur through the conjuctival blood vessels 10. Several methods had been described to reduce systemic absorption of topical phenylephrine.…”

Section: Discussionmentioning

confidence: 99%

Ocular phenylephrine 2.5% continues to be dangerous

Ahmed

Riad²,

Altorpaq³

et al. 2009

Case Reports

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Phenylephrine 10% is used for pupillary dilatation and capillary decongestion. It had been advised to use a 2.5% concentration instead of 10% to guard against systemic reactions. Here, a case of severe systemic manifestation following conjuctival application of 2.5% phenylephrine is described.A healthy adult was admitted for pterygium excision under ophthalmic blockade. Vital signs remained normal until a sponge soaked with phenylephrine 2.5% was applied over the excised pterygium to control bleeding. The patient developed bradycardia (heart rate of 30 bpm) and hypotension (pressure 80/40 mmHg), so intravenous atropine was given. This was followed by tachycardia (heart rate of 150 bpm) and hypertension (pressure 240/130 mmHg) and ECG showed ischaemic changes. Treatment included propofol, labetalol, frusamide, morphine and dexamethasone. The next day, a 12-lead ECG showed no ischaemic changes and the myocardial infarction screen was negative. Fundus examination showed no sign of papilloedema. This report emphasises that phenylephrine 2.5% is still dangerous, with unpredictable response.

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“…Estudo prospectivo 10 em 2009, não demonstrou elevação estatisticamente significativa da pressão arterial sistêmica em 87% de normotensos (55) e 76% dos hipertensos (34) estudados, após aplicação de fenilefrina tópica a 10%. Apenas um paciente apresentou aumento significativo da pressão arterial, sugerindo que sua utilização é segura 10,11 . A reação adversa estaria relacionada a superdose ou idiossincrasia individual, e a interação com outros fatores não foi elucidada.…”

Section: Fenilefrinaunclassified

Indicação de cardioversor desfibrilador implantável após morte súbita por fibrilação ventricular em pré-operatório de catarata: relato de caso

Lima

Dias

Mozzaquatro

et al. 2017

Rev. Med. (São Paulo)

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RESUMO:Introdução: A fibrilação ventricular (FV) é um evento grave e fatal na maioria dos pacientes. Neste relato, descrevemos um caso de parada cardíaca durante pré-operatório de cirurgia de catarata em um paciente, com indicação subsequente de cardioversor desfibrilador implantável (CDI) para prevenção secundária de morte súbita cardíaca (MSC). Trata-se de um homem, 72 anos de idade, admitido para cirurgia de catarata com cardiomiopatia dilatada de etiologia desconhecida (DCM). O paciente apresentava hipertensão arterial, diabetes mellitus, hipotireoidismo e dislipidemia. Durante o período pré-operatório foi administrado, para realização de facectomia, colírio de tropicamida, fenilefrina e proximetacaína e, na sequência, o paciente desenvolveu FV e parada cardíaca. A parada foi revertida após 13 minutos de manobras de reanimação. O paciente foi encaminhado à Unidade de Estimulação Cardíaca de nossa instituição para avaliação. A ressonância magnética cardíaca não mostrou fibrose miocárdica e a coronariografia foi normal. Conclusão: Descrevemos um caso de FV intra-hospitalar, que acometeu paciente com DCM sem substrato anatômico arritmogênico. O mecanismo mais provável da arritmia ventricular foi hiperautomatismo induzido por estresse pré-operatório. O implante de CDI foi indicado para prevenção secundária de MSC, e afastadas causas reversíveis ou controláveis.Descritores: Desfibriladores implantáveis; Extração de catarata; Felinefrina; Tropicamida; Estresse psicológico/cirurgia. ABSTRACT:Introduction: Ventricular fibrillation is a potentially fatal event. We describe herein a case of cardiac arrest during preoperative of cataract surgery in a patient,

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Systemic Absorption and Cardiovascular Effects of Phenylephrine Eyedrops

Cited by 52 publications

References 7 publications

Cardiovascular Adverse Effects of Phenylephrine Eyedrops

Cardiovascular Adverse Effects of Phenylephrine Eyedrops

Ocular phenylephrine 2.5% continues to be dangerous

Indicação de cardioversor desfibrilador implantável após morte súbita por fibrilação ventricular em pré-operatório de catarata: relato de caso

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