Stelfrin
Stelfrin: instructions for use and reviews
- 1. Release form and composition
- 2. Pharmacological properties
- 3. Indications for use
- 4. Contraindications
- 5. Method of application and dosage
- 6. Side effects
- 7. Overdose
- 8. Special instructions
- 9. Application during pregnancy and lactation
- 10. Use in childhood
- 11. In case of impaired renal function
- 12. For violations of liver function
- 13. Use in the elderly
- 14. Drug interactions
- 15. Analogs
- 16. Terms and conditions of storage
- 17. Terms of dispensing from pharmacies
- 18. Reviews
- 19. Price in pharmacies
Latin name: Stelfrin
ATX code: C01CA06
Active ingredient: phenylephrine (Phenylephrine)
Producer: LLC "GROTEKS" (Russia)
Description and photo update: 2020-01-03
Prices in pharmacies: from 80 rubles.
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Stelfrin is an alpha-adrenergic agonist for systemic use.
Release form and composition
Dosage form - injection solution: colorless, transparent (in 1 ml glass ampoules, in a blister strip made of polyvinyl chloride film 5 or 10 ampoules, in a cardboard box, instructions for the use of Stelfrin and 2 packages of 5 ampoules each or 1 package containing 10 ampoules).
Composition of 1 ml solution:
- active substance: phenylephrine hydrochloride - 10 mg;
- auxiliary components: water for injection and anhydrous glycerol.
Pharmacological properties
Pharmacodynamics
The active ingredient in Stelfrin is phenylephrine hydrochloride - alpha 1-adrenostimulant. The beta-adrenergic receptors of the heart are slightly affected. It contains only one hydroxyl group in the aromatic nucleus, therefore it does not belong to catecholamines.
With systemic use, phenylephrine contributes to the narrowing of arterioles, causes an increase in blood pressure (BP) and total peripheral vascular resistance (OPSS). Cardiac output (CO) does not change or decreases, which is associated with an increase in the tone of the vagus nerve (reflex bradycardia) in response to arterial hypertension. Phenylephrine does not increase blood pressure as sharply as norepinephrine or epinephrine, but its effect is longer. This is apparently due to its greater resistance to the destructive effects of catechol-O-methyltransferase (COMT). Does not increase minute blood volume.
After intravenous administration, the effect of phenylephrine develops almost instantly and lasts for 5–20 minutes. With intramuscular and subcutaneous administration, the drug begins to act in 10-15 minutes, the effect is observed for 1-2 hours.
Pharmacokinetics
Phenylephrine, when administered intramuscularly, is rapidly absorbed into the systemic circulation. After a single injection, the volume of distribution is 340 liters. It binds to plasma proteins to a small extent.
The drug undergoes almost complete biotransformation. It is metabolized in the liver with the participation of monoamine oxidase (without the participation of catechol-O-methyltransferase).
It is excreted in the form of metabolites by the kidneys. The final half-life (T 1/2) is about 3 hours.
Indications for use
Stelfrin in ampoules is used in the treatment of the following conditions:
- toxic and traumatic shock;
- acute arterial hypotension;
- vascular insufficiency due to overdose of vasodilators.
In addition, with local anesthesia, the drug is prescribed as a vasoconstrictor.
Contraindications
Absolute:
- acute myocardial infarction;
- ventricular fibrillation;
- arterial hypertension of any severity;
- diseases accompanied by obstruction of the outflow tract of the left ventricle (including hypertrophic cardiomyopathy and severe aortic stenosis);
- angle-closure glaucoma;
- pheochromocytoma;
- thyrotoxicosis;
- porphyria;
- deficiency of glucose-6-phosphate dehydrogenase;
- age up to 18 years;
- pregnancy and lactation;
- carrying out halothane or cyclopropane anesthesia;
- the combined use of monoamine oxidase inhibitors (MAO) and a period of 14 days after their cancellation;
- hypersensitivity to the components of the solution for injection.
Stelphrin should be used with caution in ischemic heart disease (especially in patients who have recently had myocardial infarction), angina pectoris, coronary thrombosis, thrombosis of the mesenteric and other peripheral or visceral vessels, thromboangiitis obliterans (Buerger's disease), atherosclerosis, arterial thromboembolism, spontaneous thromboembolism with frostbite, Raynaud's disease, ventricular arrhythmias, pulmonary hypertension, diabetes mellitus, thyroid dysfunction, diabetic endarteritis, hypoxia, hypercapnia, metabolic acidosis, functional disorders of the liver and / or kidneys, prostate diseases with an increased risk of urinary retention, as well as in the elderly age.
Stelfrin, instructions for use: method and dosage
Solution for injection Stelfrin in ampoules is administered intravenously (intravenously), intramuscularly (intramuscularly) or subcutaneously (subcutaneously).
For intravenous administration, a single dose of the drug is diluted in 20 ml of glucose (dextrose) 5% solution or 0.9% sodium chloride solution. Enter slowly in a stream. If systolic blood pressure drops to 70-80 mm Hg. Art., re-introduction of Stelfrin is possible. The minimum interval between injections is 15 minutes.
The drug can be injected intravenously with an initial rate of 0.18 mg / min and its gradual decrease to 0.03–0.06 mg / min. In this case, 1 ml of the solution is diluted in 250-500 ml of glucose (dextrose) 5% solution.
In case of collapse, a single dose of Stelphrin for intravenous administration is 0.1–0.5 ml.
With prolonged intravenous infusion, the dose of the drug is gradually reduced to avoid the development of a withdrawal syndrome (i.e., a repeated decrease in blood pressure).
A single dose for intramuscular and subcutaneous administration is 0.3–1 ml of solution.
When conducting local anesthesia, Stelfrin is added in an amount of 0.3-0.5 ml to 10 ml of anesthetic.
Maximum doses:
- IV administration: single - 5 mg, daily - 25 mg;
- i / m and s / c introduction: single - 10 mg, daily - 50 mg.
Side effects
- on the part of the organ of vision: very rarely (<0.01%) - mydriasis, pain in the eyes;
- from the respiratory system: rarely (≥ 0.01% and <0.1%) - dyspnea;
- from the digestive system: often (≥ 1% and <10%) - nausea, vomiting; unknown frequency (there is not enough data to estimate the frequency of development) - increased salivation;
- from the central nervous system: very rarely - dizziness, irritability, tremor, nervousness, headache, anxiety, insomnia, paresthesia, irritability, weakness, confusion, cerebral hemorrhage;
- on the part of the cardiovascular system: rarely - a feeling of palpitations, angina pectoris, decrease or increase in blood pressure, tachycardia, bradycardia, ventricular arrhythmias (especially with the introduction of large doses of Stelphrin); unknown frequency - pulmonary edema, cardiac arrest;
- from the urinary system: very rarely - urinary retention, dysuria;
- from the immune system: rarely - urticaria, skin rash;
- other reactions: hyperglycemia, cold extremities, tingling sensation in the hands and feet, pallor of the facial skin, increased sweating; when the solution gets into the tissues or with subcutaneous injections - the formation of a scab, necrosis.
Overdose
When the recommended dose of Stelfrin is exceeded, blood pressure usually rises significantly, which is accompanied by a headache. It is also possible a feeling of heaviness in the head and extremities, the development of ventricular extrasystole, reflex bradycardia, short paroxysms of ventricular tachycardia. With a pronounced overdose, convulsions, hallucinations, confusion are possible.
Patients are shown intravenous administration of short-acting alpha-blockers (5-60 mg of phentolamine for 10-30 minutes). In case of heart rhythm disturbances, beta-blockers are prescribed.
special instructions
During the period of Stelfrin's use, it is important to monitor blood pressure, blood circulation in the extremities and at the injection site, minute blood volume, and electrocardiogram indicators.
In case of drug collapse in patients with arterial hypertension, it is necessary to maintain systolic blood pressure at such a level that it is 30–40 mm Hg lower. Art. than the usual rate.
In case of shock, before or during the administration of Stelfrin, correction of acidosis, hypovolemia, hypercapnia and hypoxia is required.
The drug should be used with caution in patients with arterial hypertension in the pulmonary circulation, ventricular arrhythmia and hypovolemia.
Influence on the ability to drive vehicles and complex mechanisms
Stelfrin can cause disturbances on the part of the organ of vision and the central nervous system, therefore, during the period of treatment, caution should be exercised in patients whose activities pose a potential danger and require from the performer an increased concentration of attention and speed of psychomotor reactions.
Application during pregnancy and lactation
Adequate and well-controlled studies of the effects of phenylephrine hydrochloride during pregnancy and lactation have not been conducted. In animals in late pregnancy, the drug promoted fetal growth retardation, caused premature onset of labor. There is no information on the penetration of phenylephrine into breast milk.
In pregnant and breastfeeding women, Stelfrin is not used. If treatment is necessary during lactation, the issue of stopping breastfeeding is decided.
Pediatric use
Treatment with Stelfrin is contraindicated in patients under the age of 18 years.
With impaired renal function
Stelfrin must be used with caution for the treatment of patients with impaired renal function.
For violations of liver function
Stelfrin must be used with caution to treat patients with impaired liver function.
Use in the elderly
Stelfrin should be used with caution in the elderly. It should be borne in mind that the number of adrenergic receptors sensitive to phenylephrine decreases in old age.
Drug interactions
The hypertensive effect of phenylephrine is reduced by antipsychotics and phenothiazide derivatives.
Phenylephrine reduces the antihypertensive effect of diuretics, antihypertensive drugs, beta-blockers, which is accompanied by the risk of developing arterial hypertension and other cardiovascular disorders.
The drug reduces the antianginal effect of nitrates. They, in turn, can reduce the pressor effect of Stelfrin, which is fraught with the development of arterial hypotension. However, the simultaneous use of these drugs is possible if there is a reason (for example, to achieve a certain therapeutic effect).
The arrhythmogenic and pressor effects of phenylephrine are enhanced by tricyclic antidepressants, ergot alkaloids, adrenomimetics, MAO inhibitors, methylphenidate, oxytocin.
The cardiac stimulating activity of Stelfrin decreases with the simultaneous use of beta-blockers.
The introduction of phenylephrine after previous therapy with reserpine can cause a hypertensive crisis, which is due to the depletion of stores of catecholamines in the adrenergic endings and an increase in sensitivity to alpha-adrenergic agonists.
The pressor effect of phenylephrine is increased by tricyclic antidepressants.
With the combined use of thyroid hormones, a mutual enhancement of the effects is noted, there is a risk of coronary insufficiency, especially in patients with coronary atherosclerosis.
In patients receiving digoxin or other cardiac glycosides, phenylephrine increases the risk of cardiac arrhythmias and myocardial infarction.
The use of Stelfrin during childbirth to correct arterial hypotension caused by the administration of drugs that stimulate labor (ergometrine, ergotamine, methylergometrine, vasopressin, oxytocin) can cause a persistent increase in blood pressure in the postpartum period. These agents, in turn, enhance the vasoconstrictor effect of phenylephrine.
The simultaneous use of inhalation anesthetics (including isoflurane, halothane, methoxyflurane, enflurane and chloroform) is associated with the risk of developing severe atrial and ventricular arrhythmias (including ventricular fibrillation), since they significantly increase the sensitivity of the myocardium to sympathomimetics.
Stelfrin must not be mixed with other medicinal solutions in the same container.
Analogs
The analogue of Stelfrin is Mezaton.
Terms and conditions of storage
Keep out of the reach of children at a temperature not exceeding 25 ° C.
The shelf life is 3 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Stelfrin
The drug is used in a hospital in severe conditions, therefore there are no reviews of Stelfrin from patients on specialized medical sites.
The opinions of doctors about phenylephrine hydrochloride are positive: the drug quickly normalizes blood pressure, rarely causes side effects.
Price for Stelfrin in pharmacies
The approximate price of Stelfrin in the form of a solution for injection 10 mg / ml is 70 rubles. per package containing 10 ampoules.
Stelfrin: prices in online pharmacies
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Drug name Price Pharmacy |
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Stelfrin solution for in. 10mg / ml amp. 1ml 10 pcs. RUB 80 Buy |
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Stelfrin supra eye drops 2.5% dropper bottle 10ml RUB 565 Buy |
Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!
