APCC DATA
The ASPCA Animal Poison Control Center (APCC) toxicology database was searched for oral phenylephrine exposures in dogs. Cases
involving combinations of phenylephrine with other medications (e.g. analgesics, antihistamines, antitussives) and multiple agent exposures were excluded. Between January 1, 2007, and December
31, 2011, 178 dogs with clinical signs were identified. These dogs were considered to have a medium or high likelihood of
suffering from phenylephrine toxicosis based on history of exposure and the clinical signs present. Of the 178 exposures,
89 were due to ingestion of hemorrhoid medications (creams, ointments, or suppositories), 80 were from ingesting tablets or
capsules, and nine were due to ingestion of nasal drops and sprays.7
After ingestion of hemorrhoid preparations in 89 dogs, the most common signs were vomiting (75 dogs; 84%), lethargy (8 dogs;
9%), diarrhea (5 dogs; 6%), bradycardia (4 dogs; 4%), tachycardia (4 dogs; 4%), and trembling (4 dogs; 4%). In most cases,
the dosages were unknown, so a range could not be determined. Hypertension was reported in two cases (2%). A systolic blood
pressure of 170 mm Hg was reported at 11.9 mg/kg and a systolic blood pressure of 210 mm Hg was reported after an estimated
dosage of 7 mg/kg.
In the nine dogs with clinical signs as a result of nasal spray or drop exposure, vomiting (9 dogs; 100%) and trembling (1
dog; 1%) were the only signs reported.7
The most common signs after tablet or capsule ingestion in 80 dogs were vomiting (63 dogs; 79%), hyperactivity (9 dogs; 11%),
lethargy (7 dogs; 9%), panting (6 dogs; 8%), and trembling (4 dogs; 5%). Dosages ranged from 0.23 to 30 mg/kg. Hypertension
was not reported.7
The ASPCA APCC data are consistent with the expected low oral toxicity of phenylephrine, probably due to phenylephrine's
low bioavailability. Based on phenylephrine's physiologic effects, hypertension is expected to be the main serious concern
after phenylephrine overdose. However, hypertension was noted in only 2% of cases and only after exposures to hemorrhoid medications.
This may possibly be due to oral mucosal absorption of phenylephrine from the creams, ointments, and suppository formulations.
One of the hypertensive dogs made a full recovery within five hours. The outcome for the other dog was not known.7
TREATMENT
An exact dosage of concern in dogs after oral exposure is unknown. Because of phenylephrine's low bioavailability, severe
signs after oral exposure are unlikely. If needed, emesis with 3% hydrogen peroxide (2.2 ml/kg orally—maximum of 45 ml—repeat
once in 15 minutes if not successful) or apomorphine (0.03 mg/kg intravenously or into the conjunctival sac) could be considered
if the exposure is recent and the patient is not exhibiting clinical signs.8,9 Consider the risk for aspiration if inducing emesis after ingestion of ointments. Activated charcoal is not typically necessary.
Monitor dogs for gastrointestinal upset, hyperactivity, lethargy, and, potentially, hypertension (especially after ingestion
of creams, ointments, or suppositories containing phenylephrine).
Acepromazine (0.02 mg/kg intravenously) can be used to control the stimulatory signs and mild hypertension.10 Nitroprusside (1 to 2 µg/kg/minute) may be necessary if marked hypertension persists.11 Intravenous fluids can be used for supportive care. The gastrointestinal signs are often self-limiting but should respond
to symptomatic care if necessary.
MONITORING
In dogs exhibiting marked clinical signs, monitor blood pressure, heart rate and rhythm, temperature, and central nervous
system status. Also, monitor for gastrointestinal upset. A baseline complete blood count and serum chemistry profile may be
performed in patients exhibiting marked central nervous system or cardiovascular effects, although no direct specific laboratory
changes are expected.
SUMMARY
Phenylephrine is a sympathomimetic alpha1-adrenergic agonist commonly found alone or in combination as a decongestant and as the active ingredient in hemorrhoid preparations.
Because of its low oral bioavailability, phenylephrine has a wider safety margin than does pseudoephedrine (another common
sympathomimetic decongestant). Per ASPCA APCC experience, the most common signs in dogs after ingestion are vomiting, hyperactivity,
and lethargy. However, there is a risk for more serious sequelae such as hypertension, heart rate changes, and central nervous
system stimulation.
Acknowledgements
The author thanks Mary Kay McLean, MS, research associate at the ASPCA Animal Poison Control Center, for her contribution
to this article.
Colette Wegenast, DVM
ASPCA Animal Poison Control Center
1717 S. Philo Road, Suite 36
Urbana, IL 61802
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