Phenylephrine Hydrochloride and Probuphine

• Generic Name: phenylephrine
• Dosage Forms: n.a.
• Other Brand Names: Nasop, Sudafed PE, Sudogest PE, Neo-Synephrine, Ah-Chew D, Despec-SF, Lusonal, Sudafed PE Quick Dissolve, Sudafed PE Extra Strength, Triaminic Thin Strips Nasal Congestion, Triaminic Toddler Congestion Thin Strips, Nasop12, Dimetapp Cold Drops, Triaminic Thin Strips Cold, Triaminic Thin Strips Infant Decongestant, Dimetapp Children's Cold & Allergy, Phenyl-T, PediaCare Children's Decongestant, Sudafed PE Children's Nasal Decongestant, Vazculep, Sudafed PE Congestion, Contac-D

Used parenterally to increase BP in patients with clinically important hypotension resulting principally from vasodilation during anesthesia.

Increases systolic and mean arterial BP when administered IV to patients with hypotension from neuraxial and/or general anesthesia. Such effects observed across a variety of surgical settings, including obstetric surgery (e.g., cesarean delivery with neuraxial anesthesia).

Although ephedrine historically considered the vasopressor of choice in obstetric anesthesia, some evidence suggests that phenylephrine may be preferred because of a more favorable fetal acid-base balance.

Used parenterally to restore adequate BP and tissue perfusion in patients with clinically important hypotension in the setting of septic shock (or other vasodilatory shock).

Pressor therapy is not a substitute for replacement of blood, plasma, fluids, and/or electrolytes. Correct blood volume depletion as fully as possible before administration.

The Surviving Sepsis Campaign International Guidelines for Management of Sepsis and Septic Shock recommend norepinephrine as the first-line vasopressor of choice in adults with septic shock; if adequate BP not achieved, vasopressin or epinephrine may be added. These guidelines state use of phenylephrine should be limited until more information is available regarding clinical outcomes with the drug.

Insufficient evidence to support use in general shock settings, particularly those not associated with a vasodilatory component.

Has been added to solutions of some local anesthetics to decrease rate of vascular absorption and prolong duration of spinal anesthesia.

Decreases risk of systemic toxicity due to the local anesthetic.

Not as effective as epinephrine in prolonging local anesthesia but may be preferred when cardiostimulation is undesirable.

Self-medication for temporary relief of nasal congestion associated with upper respiratory allergy (e.g., hay fever) or the common cold. However, efficacy of oral phenylephrine for this use has been questioned.

Self-medication for temporary relief of sinus congestion and pressure.

Used in fixed combination with other agents (e.g., acetaminophen, chlorpheniramine, dextromethorphan, diphenhydramine, guaifenesin, pheniramine) for temporary relief of nasal/sinus congestion and/or other symptoms (e.g., rhinorrhea, sneezing, lacrimation, itching eyes, oronasopharyngeal itching, cough) associated with seasonal or perennial allergic rhinitis, other upper respiratory allergies, or the common cold.

Because of state and federal actions restricting OTC sale and purchase of preparations containing pseudoephedrine, ephedrine, or phenylpropanolamine (no longer commercially available in the US), some manufacturers have reformulated various OTC preparations by substituting phenylephrine for pseudoephedrine that was previously contained in these preparations.

Has been used for self-medication for temporary relief of nasal congestion associated with sinusitis; however, efficacy data are lacking and/or controversial. In October 2005, FDA issued a final rule to remove this indication from labeling of OTC nasal decongestants (effective in 2007).

Anorectal preparations (e.g., creams, gels, ointments, suppositories) containing phenylephrine hydrochloride are used topically or rectally to provide temporary symptomatic relief of external or internal hemorrhoids.

When applied topically or rectally to the anorectal area, vasoconstrictors such as phenylephrine stimulate α-adrenergic receptors in the vascular beds with a resultant temporary constriction of arterioles and a modest and transient reduction in congestion (swelling) of hemorrhoidal tissues.

May relieve anorectal pruritus, discomfort, and irritation, possibly in part secondary to some weak local anesthetic action; the mechanism of this local anesthetic effect is unknown.

May relieve pruritus associated with histamine release.

If minor bleeding is present, a clinician should be consulted promptly for advice since anorectal bleeding may be a sign of conditions ranging in seriousness from simple abrasions to cancer.

• Generic Name: buprenorphine
• Dosage Forms: implant
• Other Brand Names: Probuphine, Belbuca, Buprenex, Butrans, Sublocade, Subutex

Probuphine (buprenorphine) is an opioid medication. An opioid is sometimes called a narcotic.

Probuphine implants are used to treat narcotic addiction in certain people whose addiction has already been treated and controlled with other forms of buprenorphine (such as Subutex or Suboxone). Probuphine implants are for adults and teenagers who are at least 16 years old.

Probuphine implants are available only from a certified pharmacy under a special program. You must be registered in the program and understand the risks and benefits of using this medicine. The implants are not for use as a pain medication.