Phenylephrine hydrochloride, a synthetic sympathomimetic agent, is a vasoconstrictor and pressor drug chemically related to adrenaline and ephedrine.
Pharmacology. Phenylephrine hydrochloride produces vasoconstriction that lasts longer than that of adrenaline and ephedrine. Responses are more sustained than those to adrenaline, lasting 20 minutes after intravenous and as long as 50 minutes after subcutaneous injection. Its action on the heart contrasts sharply with that of adrenaline and ephedrine, in that it slows the heart rate and increases the stroke output, producing no disturbance in the rhythm of the pulse.
Phenylephrine hydrochloride is a powerful postsynaptic alpha-receptor stimulant with little effect on the beta-receptors of the heart. In therapeutic doses, it produces little if any stimulation of either the spinal cord or cerebrum. A singular advantage of this drug is the fact that repeated injections produce comparable effects.
The predominant actions of phenylephrine hydrochloride are on the cardiovascular system. Parenteral administration causes a rise in systolic and diastolic blood pressures in humans and other species. Accompanying the pressor response to phenylephrine hydrochloride is a marked reflex bradycardia that can be blocked by atropine; after atropine, large doses of phenylephrine hydrochloride increase the heart rate only slightly. In humans cardiac output is slightly decreased and peripheral resistance is considerably increased. Circulation time is slightly prolonged and venous pressure is slightly increased; venous constriction is not marked. Most vascular beds are constricted; renal splanchnic, cutaneous and limb blood flows are reduced but coronary blood flow is increased. Pulmonary vessels are constricted and pulmonary arterial pressure is raised.
The drug is a powerful vasoconstrictor, with properties very similar to those of noradrenaline but almost completely lacking the chronotropic and inotropic actions on the heart. Cardiac irregularities are seen only very rarely even with large doses.