What is Auvi-Q?

Auvi-Q injection contains epinephrine, a chemical that narrows blood vessels and opens airways in the lungs. These effects can reverse severe low blood pressure, wheezing, severe skin itching, hives, and other symptoms of an allergic reaction.

Auvi-Q injection is used to treat severe allergic reactions (anaphylaxis) to insect stings or bites, foods, drugs, and other allergens. Epinephrine is also used to treat exercise-induced anaphylaxis.

Auvi-Q auto-injectors may be kept on hand for self-injection by a person with a history of an severe allergic reaction. This medicine is for use in adults and children who weigh at least 16.5 pounds (7.5 kilograms).

Warnings

Seek emergency medical attention after any use of Auvi-Q to treat a severe allergic reaction. After the injection you will need to receive further treatment and observation.

Before using this medicine

Before using Auvi-Q, tell your doctor if any past use of this medicine caused an allergic reaction to get worse.

To make sure Auvi-Q is safe for you, tell your doctor if you have ever had:

• heart disease or high blood pressure;
• asthma;
• Parkinson’s disease;
• depression or mental illness;
• a thyroid disorder; or
• diabetes.

Having an allergic reaction while pregnant or nursing could harm both mother and baby. You may need to use epinephrine during pregnancy or while you are breastfeeding. Seek emergency medical attention right away after using the injection.

If possible during an emergency, tell your medical caregivers if you are pregnant or breastfeeding.

How should I use Auvi-Q?

The Auvi-Q auto-injector device is a disposable single-use system. Follow all directions on your prescription label and read all medication guides or instruction sheets. Do not inject this medicine if you do not understand these instructions. Use the medicine exactly as directed. Ask your doctor or pharmacist if you do not understand these instructions.

Use an auto-injector only one time. Do not try to reinsert an auto-injector a second time. If the needle is bent from the first use, it may cause serious injury to your skin.

Do not give this medicine to a child without medical advice.

Auvi-Q is injected into the skin (subcutaneously) or muscle (intramuscularly) of your outer thigh. In an emergency, this injection can be given through your clothing.

Your medicine may also come with a “trainer pen.” The trainer pen contains no medicine and no needle. It is only for non-emergency use to practice giving yourself an Auvi-Q injection.

Do not remove the safety cap until you are ready to use the auto-injector. Never put your fingers over the injector tip when removing the safety cap or after the safety cap has been removed.

To use an Auvi-Q auto-injector:

Auvi-Q contains an electronic voice instruction system to help guide you through each step of your injection. If the voice instructions do not work for any reason, use Auvi-Q as directed in the steps below. It will still work during an allergic reaction emergency.

1. Pull Auvi-Q up from the outer case.
2. Pull Red safety guard down and off of Auvi-Q. To reduce the chance of an accidental injection, do not touch the black base of the auto-injector, which is where the needle comes out. If an accidental injection happens, get medical help right away. Note that the red safety guard is made to fit tight. Pull firmly to remove.
3. Place black end of Auvi-Q against the middle of the outer thigh (through clothing, if needed), then push firmly until you hear a click and hiss sound, and hold in place for 2 seconds. Only inject into the middle of the outer thigh. Do not inject into any other part of the body. If you are administering Auvi-Q to a young child or infant, hold the leg firmly in place while administering an injection.The needle automatically retracts after the injection is complete, so the needle will not be visible after the injection. Auvi-Q includes a 2-second countdown after it is activated, then the voice instruction will indicate the injection is complete.
4. Seek emergency medical attention after any use of epinephrine to treat a severe allergic reaction.The effects of epinephrine may wear off after 10 or 20 minutes. You will need to receive further treatment and observation.

Do not use Auvi-Q if it has changed colors or has particles in it, or if the expiration date on the label has passed. Call your pharmacist for a new prescription.

Store at room temperature away from moisture, heat, and light. Do not refrigerate or freeze this medication, and do not store it in a car.

Do not reuse a needle or syringe. Use only once and then place them in a puncture-proof “sharps” container. Follow state or local laws about how to dispose of this container. Keep it out of the reach of children and pets.

What happens if I miss a dose?

Since epinephrine is used when needed, it does not have a daily dosing schedule.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

Overdose symptoms may include numbness or weakness, severe headache, blurred vision, pounding in your neck or ears, sweating, chills, chest pain, fast or slow heartbeats, severe shortness of breath, or cough with foamy mucus.

What should I avoid while using Auvi-Q?

Do not inject epinephrine into a vein or into the muscles of your buttocks, or it may not work as well. Inject it only into the fleshy outer portion of the thigh.

Accidentally injecting epinephrine into your hands or feet may result in a loss of blood flow to those areas, and resulting numbness.

What is neffy?

neffy (epinephrine nasal spray) is used to treat severe allergic reactions, including anaphylaxis, in adults and children 4 years of age and older who weigh 33 lbs (15 kg) or more. 

• Each neffy nasal spray for severe allergic reactions contains 1 dose of epinephrine.
• There are 2 strengths:
  • 1 mg/0.1 mL of epinephrine per spray for children 33-66 lbs (15-30 kg) 
  •  2 mg/0.1 mL of epinephrine per spray for patients 66 lbs (30 kg) or greater.
• Administer right away.
• Can be self-administered or a caregiver can give it.

How does neffy work?

neffy’s mechanism of action for anaphylaxis is the same as epinephrine injections. It activates both alpha and beta receptors, which results in the following effects:

• relaxes smooth muscle in the airways to help with breathing
• narrows blood vessels and redirects blood flow to vital organs, such as the heart
• maintains adequate blood pressure and increases heart rate
• relaxes smooth muscles of the stomach and intestine to relieve digestive symptoms.

neffy FDA approval

neffy gained FDA approval on August 9, 2024, and is the first needle-free treatment for severe allergic reactions.

neffy cost

Eligible patients with commercial insurance pay as little as $25 with a neffy Copay card.

If you are uninsured or insured but without any government or commercial drug coverage for neffy and need help paying for it, you may be able to receive it at no cost through the neffy Connect Support Program.

neffy side effects

The most common side effects of neffy are:

• throat irritation
• tingling nose
• headache
• nasal discomfort
• feeling over excitement, nervousness, or anxiety
• tingling sensation
• fatigue
• shakiness
• runny nose
• itchy nose
• sneezing
• stomach pain
• pain in the gums of teeth
• numbness in the mouth
• nasal congestion
• dizziness
• nausea
• vomiting.

Serious side effects and warnings

Always carry neffy with you because you may not know when anaphylaxis may happen. You should carry 2 neffy devices with you because you may need a second neffy nasal spray if symptoms continue or come back.

Talk to your healthcare provider about additional neffy nasal sprays to keep at work, school, or other locations. Tell your family members, caregivers, and others where you keep your neffy nasal spray and how to use it before you need it. You may be unable to speak in an allergic emergency. When you have an allergic emergency (anaphylaxis)

• Use neffy right away.
• Get emergency medical help for further treatment of the allergic emergency (anaphylaxis), if needed after using neffy. Before you receive neffy, your healthcare provider should talk to you about when to get emergency help.

neffy may aggravate angina or affect the heartbeat in people with heart disease.

neffy contains a sulfite but this should not stop people allergic to sulfites from using it. Talk to your healthcare provider about this.

If you have certain medical conditions or take certain medicines, your condition may get worse or you may have more or longer lasting side effects when you use neffy. Talk to your healthcare provider about all your medical conditions.

• You should still use neffy to treat anaphylaxis as prescribed by your healthcare provider, regardless of your medical conditions or the medicine you take.

It is not known if neffy is safe and effective in children who weigh less than 33 pounds (15 kilograms).

Tell your healthcare provider if you have any side effect that bothers you or does not go away. These are not all the possible side effects of neffy. For more information, ask your healthcare provider or pharmacist. Call your doctor for medical advice about side effects. You may report side effects to the FDA .

Before using neffy

People with certain nasal conditions, such as nasal polyps or a history of nasal surgery, should talk to their healthcare provider before using neffy because these conditions may affect the absorption of neffy.

Before using neffy, tell your healthcare provider about all your medical conditions, especially if you:

• have nasal problems including nasal polyps, a history of injury such as a broken nose, or any past nasal surgery
• have heart problems
• have kidney problems
• have low potassium levels in your blood
• have Parkinson’s disease
• have thyroid problems
• have high blood pressure
• have diabetes
• are pregnant or plan to become pregnant
• are breastfeeding or plan to breastfeed.

Pregnancy

It is not known if neffy will harm your unborn baby.

Breastfeeding

It is not known if neffy passes into your breast milk.

How should I use neffy?

Read the neffy Instructions for Use for detailed information about how to use the neffy nasal spray. Use neffy exactly as your healthcare provider tells you to use it. Talk to your healthcare provider or pharmacist if you have questions about the use of neffy.

• neffy is for use in the nose only. Do not spray in the eyes or mouth.
• Each neffy nasal spray has 1 dose of medicine and cannot be reused. Do not test or prime (pre-spray) the device.
• Your neffy comes in a carton with 2 nasal sprays. You may need to use a second neffy nasal spray if symptoms continue or get worse.
• You should always carry 2 neffy nasal sprays with you.

neffy dosing information

neffy is for use in the nose only.

• neffy is given as 1 dose in either nostril.
• If a second dose of neffy is needed, it should be given in the same nostril, starting 5 minutes after the first dose.
• Do not sniff during or after receiving a dose of neffy.

If any liquid drips out of the nose, you may not receive the full dose of medicine.

If your symptoms continue or get worse, give a second dose of neffy in the same nostril, starting 5 minutes after the first dose.

Get emergency help for further treatment of the anaphylactic episode, if needed, after using neffy. Before you receive neffy, your healthcare provider should talk to you about when to get emergency help.

Symptoms of anaphylaxis

Anaphylaxis can be life-threatening, can happen in minutes, and can be caused by stinging and biting insects, allergy injections, foods, medicines, exercise, or other unknown causes. Symptoms of anaphylaxis may include:

• trouble breathing
• wheezing
• hoarseness (changes in the way your voice sounds)
• hives (raised reddened rash that may itch)
• severe itching
• swelling of your face, lips, mouth, or tongue
• skin rash, redness, or swelling
• fast heartbeat
• weak pulse
• feeling very anxious
• confusion
• stomach pain
• losing control of urine or bowel movements (incontinence)
• diarrhea or stomach cramps
• dizziness, fainting, or “passing out” (unconsciousness).

What other drugs will affect neffy?

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Tell your healthcare provider of all known allergies. Especially tell your healthcare provider if you take or use:

• other nasal sprays
• water pills (diuretics)
• medicines to treat depression such as tricyclic antidepressants or monoamine oxidase inhibitors (MAO inhibitors)
• medicines to treat abnormal heartbeats (arrhythmias) such as cardiac glycosides
• medicines to treat Parkinson’s disease such as catechol-O-methyl-transferase inhibitors (COMT inhibitors) and ergot alkaloids
• medicines for heart disease including alpha-blockers (such as phentolamine) and beta-blockers (such as propranolol)
• medicines for thyroid disease such as levothyroxine sodium
• medicines used in labor
• medicines to treat allergies such as diphenhydramine, tripelennamine, or chlorpheniramine (antihistamines).

neffy may affect the way other medicines work, and other medicines may affect how neffy works. Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist when you get a new medicine. See the neffy Prescribing Information for a full list of interactions.

neffy storage

Store neffy at room temperature between 68°F to 77°F (20°C to 25°C).

• Do not freeze. If neffy freezes, the device will not spray.

Your neffy has an expiration date. Replace neffy before the expiration date.

Keep out of the reach of children.

neffy ingredients

Active Ingredient: epinephrine 2 mg.

Inactive Ingredients: benzalkonium chloride, disodium edetate, n-dodecyl beta-D-maltoside, sodium chloride, sodium metabisulfite, and hydrochloric acid or sodium hydroxide to adjust pH, in water for injection.

Each neffy nasal spray contains 1 mg/0.1 mL or 2 mg/0.1 mL of epinephrine per spray.

Who makes neffy?

neffy is made by ARS Pharmaceuticals a pharmaceutical company based in San Diego, California. They specialize in the development of innovative drug delivery technologies, particularly focusing on emergency treatments.

What is norepinephrine?

Norepinephrine is similar to adrenaline. It is used to treat life-threatening low blood pressure (hypotension) that can occur with certain medical conditions or surgical procedures. Norepinephrine is often used during CPR (cardio-pulmonary resuscitation).

Norepinephrine may also be used for purposes not listed in this medication guide.

Norepinephrine side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Tell your caregivers at once if you have:

• pain, burning, irritation, discoloration, or skin changes where the injection was given;
• sudden numbness, weakness, or cold feeling anywhere in your body;
• slow or uneven heart rate;
• blue lips or fingernails, mottled skin;
• little or no urination;
• trouble breathing;
• problems with vision, speech, or balance; or
• severe headache, blurred vision, pounding in your neck or ears.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

Warnings

Tell your caregivers at once if you have a serious side effect such as a cold feeling anywhere in your body, blue lips or fingernails, trouble breathing, little or no urination, irritation or skin changes where the medicine was injected, slow heart rate, sudden numbness or weakness, severe headache, or problems with vision, speech, or balance.

Before taking this medicine

If possible before you receive norepinephrine, tell your caregivers if you have:

• high blood pressure (hypertension);
• diabetes;
• coronary artery disease;
• circulation problems;
• varicose veins;
• overactive thyroid; or
• asthma or a sulfite allergy.

Tell your doctor if you are pregnant or breastfeeding.

In an emergency, you may not be able to tell caregivers about your health conditions or if you are pregnant or breastfeeding. Make sure any doctor caring for you afterward knows you received norepinephrine.

How is norepinephrine given?

Norepinephrine is given as an infusion into a vein. A healthcare provider will give you this injection.

Norepinephrine is usually given for as long as needed until your body responds to the medication. Some people must receive norepinephrine for several days.

Your blood pressure, breathing, and other vital signs will be watched closely while you are receiving norepinephrine.

Tell your caregivers if you feel any pain, irritation, cold feeling, or other discomfort of your skin or veins where the medicine is injected. Norepinephrine can damage the skin or tissues around the injection site if the medicine accidentally leaks out of the vein.

What happens if I miss a dose?

Since norepinephrine is given by a healthcare professional in an emergency setting, you are not likely to miss a dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

Overdose symptoms may include slow heartbeats, severe headache, sweating, vomiting, increased sensitivity to light, pale skin, and stabbing chest pain.

What should I avoid while receiving norepinephrine?

Follow your doctor’s instructions about any restrictions on food, beverages, or activity.

What other drugs will affect norepinephrine?

If possible before you receive norepinephrine, tell your doctor about all your other medicines, especially:

• an antidepressant;
• blood pressure medication; or
• an MAO inhibitor–isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others.

What is phenylephrine?

Oral and nasal phenylephrine are used as nasal decongestants to temporarily unblock a nose or relieve sinus pressure in people with nasal and sinus congestion caused by colds, allergies, or hay fever. While phenylephrine can provide some symptom relief, it doesn’t treat the underlying cause or speed recovery.

Injectable phenylephrine may be used in a hospital setting to increase blood pressure in adults with significantly low blood pressure caused primarily by vasodilation (a widening of the blood vessels), as a result of septic shock or anesthesia.

Phenylephrine works by directly stimulating receptors in the blood vessels of the nose and other parts of the body (called alpha-1 adrenergic receptors), causing vasoconstriction (narrowing of the blood vessels). This reduces nasal congestion by preventing fluid from draining from the blood vessels into the tissues lining the nasal passages. At higher dosages, phenylephrine increases blood pressure and reduces heart rate and cardiac output (particularly in people with preexisting heart disease).

Phenylephrine has been available for over 60 years, which means it wasn’t subject to the same rigorous scrutiny by the FDA as newer medicines.

Phenylephrine side effects

The most common side effects of phenylephrine include:

• flushing (warmth, redness, or tingly feeling)
• loss of appetite
• feeling restless or excited (especially in children).

Serious side effects and warnings

Get emergency medical help if you have signs of an allergic reaction, such as hives; difficulty breathing; or swelling of your face, lips, tongue, or throat.

Do not use if you are taking a monoamine oxidase inhibitor (MAOI) or have used one in the past 14 days (2 weeks). MAOIs include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine, and these are typically used for depression, psychiatric or emotional conditions, or Parkinson’s disease, or 2 weeks after stopping the MAOI drug. If you do not know if your prescription drug contains an MAOI, ask a doctor or pharmacist before taking this phenylephrine.

Other reported side effects of phenylephrine include:

• Cardiac disorders: Bradycardia, AV block, ventricular extrasystoles, myocardial ischemia
• Gastrointestinal disorders: Nausea, vomiting
• General disorders and administrative site conditions: Chest pain, extravasation
• Immune system disorders: Sulfite sensitivity
• Nervous system disorders: Headache, nervousness, paresthesia, tremor
• Psychiatric disorders: Excitability
• Respiratory: Pulmonary edema, rales
• Skin and subcutaneous tissue disorders: Diaphoresis, pallor, piloerection, skin blanching, skin necrosis with extravasation
• Vascular disorders: Hypertensive crisis.

Stop using phenylephrine and call your doctor at once if you have:

• fast, pounding, or irregular heartbeat
• severe dizziness or nervousness
• sleep problems (insomnia)
• increased blood pressure. Symptoms may include a severe headache, blurred vision, and pounding in your neck or ears.

Liquid phenylephrine

The liquid form of this medicine may contain phenylalanine. Check the medication label if you have phenylketonuria (PKU).

Injectable phenylephrine

Some injectable preparations of phenylephrine contain sodium metabisulfite, a sulfite that may cause allergic reactions, including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people. The overall prevalence of sulfite sensitivity in the general population is unknown and probably low. Sulfite sensitivity is seen more frequently in asthmatic than in nonasthmatic people.

This is not a complete list of side effects.

Before taking

Do not use phenylephrine if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others.

You should not use phenylephrine if you are allergic to it.

Ask a doctor or pharmacist if this medicine is safe to use if you have:

• heart disease or high blood pressure
• diabetes
• a thyroid disorder
• an enlarged prostate and urination problems
• any drug allergies.

If you are pregnant or breastfeeding, ask a health professional before use.

The liquid form of this medicine may contain phenylalanine. Check the medication label if you have phenylketonuria (PKU).

Pregnancy

It is also not known whether phenylephrine can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Phenylephrine hydrochloride should be given to a pregnant woman only if needed.

Use of phenylephrine during labor and delivery

The most common side effects reported in mothers receiving phenylephrine during neuraxial anesthesia during cesarean delivery include nausea and vomiting, which are commonly associated with low blood pressure, slow heartbeat, reactive high blood pressure, and short-lasting arrhythmias. Phenylephrine does not appear to cause a decrease in perfusion of the placenta that is significant enough to affect the baby’s Apgar score or blood gas levels.

Breastfeeding

It is not known if phenylephrine is excreted in human milk.

How should I take phenylephrine?

Take phenylephrine exactly as directed on the label, or as prescribed by your doctor.

• Cold medicine is only for short-term use until your symptoms clear up.
• Always follow directions on the medicine label about giving cold medicine to a child.
• You must chew the phenylephrine chewable tablet before you swallow it.
• Measure phenylephrine liquid medicine carefully. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).
• Remove an orally disintegrating phenylephrine tablet from the package only when you are ready to take the medicine. Place the tablet in your mouth and allow it to dissolve, without chewing. Swallow several times as the tablet dissolves.

Stop taking phenylephrine and ask a doctor if nervousness, dizziness, or sleeplessness occur or symptoms do not improve within 7 days or occur with a fever, rash, or headaches.

If you need surgery, tell your surgeon if you are currently using phenylephrine.

Phenylephrine dosage

When using phenylephrine do not exceed recommended dose.

• The safety and effectiveness of using phenylephrine in children have not been established.
• The dosage of phenylephrine may need adjusting for liver or kidney disease.

Phenylephrine dosage for nasal congestion

• Adults and children 12 years and older. 10mg every 4 hours. Do not take more than 6 tablets in 24 hours.
• Children under 12 years. Ask a doctor.

Phenylephrine dosage for low blood pressure

Perioperative dosing (adults undergoing surgery with neuraxial or general anesthesia):

• Initial dose: 50 to 250 mcg by intravenous bolus (most common doses: 50 to 100 mcg)
• Maintenance dose: 0.5 to 1.4 mcg/kg/min by intravenous continuous infusion (titrate to blood pressure goal)

Septic or Other Vasodilatory Shock

• Adults: 0.5 to 6 mcg/kg/min by intravenous continuous infusion (titrate to blood pressure goal)
• No bolus
• Doses over 6 mcg/kg/min do not show significant incremental blood pressure increases.

Usual Adult Dose for Shock. Perioperative dosing (patients undergoing surgery with neuraxial or general anesthesia):

• Initial dose: 50 to 250 mcg by intravenous bolus (most common doses: 50 to 100 mcg)
• Maintenance dose: 0.5 to 1.4 mcg/kg/min by intravenous continuous infusion (titrate to blood pressure goal)

Does phenylephrine work?

Recently, an FDA advisory panel concluded that phenylephrine is not effective as an oral decongestant and does not significantly improve symptoms compared to a placebo (an inactive pill).

Phenylephrine has been available for more than six decades but it came into use before the FDA developed a stringent approval process for new medicines back in the 1970s and received marketing authorization based on pre-existing use.

A reason for phenylephrine’s lack of effectiveness includes the fact that, even though it is well absorbed from the stomach, it undergoes extensive metabolism in the gut wall. This means only about 40% of a dose reaches the bloodstream and only 3% is excreted unchanged.

Phenylephrine is currently allowed by the FDA as a medicine based on in-house studies provided by pharmaceutical companies, not as a result of clinical trials. These unpublished studies ranged from mild successes to total failures, and a recommendation that phenylephrine should not be accepted as an oral nasal decongestant was made in 1994 but ignored. However, the efficacy of phenylephrine as a nasal spray for nasal congestion is supported by several studies.

On September 14, 2023, the FDA Drug Advisory Committee concluded that current data does not support the effectiveness of phenylephrine as an oral nasal decongestant, although there were no concerns about any toxicity at recommended dosages.

What happens if I miss a dose?

Phenylephrine for nasal symptoms is usually taken as needed according to the recommended dose so if you miss a dose, just go back to your regular dosing schedule. Do not double up the dose or take extra to make up for the next dose.

What happens if I overdose?

In case of overdose, get medical help or contact a Poison Control Center right away.

An overdose of phenylephrine can cause a rapid rise in blood pressure. Symptoms of overdose include headache, vomiting, high blood pressure, reflex slow heart rate, and cardiac arrhythmias, which may cause a sensation of fullness in the head and tingling of the hands and feet.

Storage

Store phenylephrine tablets and nasal spray between 20-25°C (68-77°F).

Do not use it if the blister unit is torn or broken.

Keep out of reach of children.

Phenylephrine ingredients

Active: phenylephrine

Inactive. Inactive ingredients in phenylephrine tablets, nasal sprays, and injections, vary depending on the manufacturer. See the phenylephrine package insert for each particular manufacturer for a list of inactive ingredients.

What other drugs will affect phenylephrine?

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Phenylephrine and other medicines can affect each other causing side effects.

Drugs that cause the uterus to contract (oxytocic drugs) can strengthen the blood pressure-increasing effect (pressor effect) of phenylephrine.

The blood vessel narrowing (vasoconstrictive) effects of phenylephrine are increased in patients receiving:

• Monoamine oxidase inhibitors (MAOI), such as selegiline.
• β-adrenergic blockers
• α-2 adrenergic agonists, such as clonidine
• Steroids
• Tricyclic antidepressants
• Norepinephrine transport inhibitors, such as atomoxetine
• Ergot alkaloids, such as methylergonovine maleate
• Centrally-acting sympatholytic agents, such as guanfacine or reserpine
• Atropine sulfate.

α-adrenergic blocking agents, including phenothiazines (e.g., chlorpromazine) and amiodarone block phenylephrine and are in turn blocked by phenylephrine.

Know the medications you take and the vaccines you receive. Keep a list of them to show your healthcare provider and pharmacist when you get a new medicine. See the phenylephrine package insert for a full list of interactions.