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Acetaminophen, Guaifenesin, and Phenylephrine and Atropine injection

Determining the interaction of Acetaminophen, Guaifenesin, and Phenylephrine and Atropine injection and the possibility of their joint administration.

Check result:
Acetaminophen, Guaifenesin, and Phenylephrine <> Atropine injection
Relevance: 20.04.2022 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Atropine may increase the effects of phenylephrine on your blood pressure and heart rate. Before receiving these medications, you should let your doctor know if you have high blood pressure or heart disease. You may not be able to use one or both of these medications, or you may need closer monitoring by your doctor in order to use these medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

MONITOR: The pressor response to phenylephrine may be potentiated by the vagolytic effect of atropine, which inhibits the reflex bradycardia that would normally accompany any increases in blood pressure induced by phenylephrine. Other antimuscarinic agents may also participate in this interaction, although clinical data are lacking. In one report, pseudo-pheochromocytoma (i.e., significant increases in blood pressure and tachycardia) occurred in seven patients who underwent eye surgery and were given phenylephrine 10% ophthalmic solution and systemic atropine, three of whom subsequently developed left ventricular failure and pulmonary edema that required intensive care monitoring. Two patients had preexisting hypertension, while others had no known history of cardiovascular disease. All had received general anesthesia with propofol, phenoperidine, and vecuronium. Since phenylephrine use alone may be associated with cardiovascular toxicities including hypertension, arrhythmia, myocardial infarction and cardiac failure, the extent of involvement by atropine is uncertain. The authors reported no further cardiovascular events following implementation of various measures that reduced phenylephrine dosage and systemic exposure, including: use of a milder strength of phenylephrine ophthalmic solution; swabbing to minimize drainage into the nasolachrymal duct to the nasal mucosa; and use of a cannula to reduce drop size. In a study of six healthy volunteers, diastolic and systolic blood pressure increased by 4 mmHg following administration of phenylephrine (0.42 mcg/kg/min), compared to 17 mmHg when phenylephrine was given after three doses of atropine (0.02, 0.01 and 0.01 mg/kg at 30 minute intervals).

MANAGEMENT: Caution is advised if phenylephrine (systemic or ophthalmic) is used in combination with atropine or other antimuscarinic agents. Cardiovascular status, including blood pressure and heart rate, should be closely monitored. When using ophthalmic formulations, measures to minimize systemic absorption should be employed, such as digital compression of the lacrimal sac or lid closure after instillation. A milder strength (< 10%) is preferable if phenylephrine ophthalmic solution is given.

References
  • Van Der Spek AF, Hantler CB "Phenylephrine eyedrops and anesthesia." Anesthesiology 64 (1986): 812-4
  • Lai YK "Adverse effect of intraoperative phenylephrine 10%: case report." Br J Ophthalmol 73 (1989): 468-9
  • Fraunfelder FT, Fraunfelder FW; Randall JA "Drug-Induced Ocular Side Effects 5th" Boston, MA: Butterworth-Heinemann (2001):
  • Daelman F, Andrejak M, Rajaonarivony D, Bryselbout E, Jezraoui P, Ossart M "Phenylephrine eyedrops, systemic atropine and cardiovascular adverse events." Therapie 49 (1994): 467
  • Levine MA, Leenen FH "Role of vagal activity in the cardiovascular responses to phenylephrine in man." Br J Clin Pharmacol 33 (1992): 333-6
Acetaminophen, Guaifenesin, and Phenylephrine

Generic Name: acetaminophen / guaifenesin / phenylephrine

Brand name: Theraflu Warming Relief Cold & Chest Congestion

Synonyms: Acetaminophen, Guaifenesin, and Phenylephrine Liquid

Atropine injection

Generic Name: atropine

Brand name: Sal-Tropine, AtroPen, Atreza

Synonyms: Atropine (injection), Atropine (Systemic)

In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.