Sympathomimetics: Uses, most common brand names, and safety information

Medically reviewed by  Jamie Winn, PharmD

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The first commercial oral sympathomimetic, ephedrine, was extracted from a Chinese herb in the 1920s and found to have actions similar to adrenaline. It quickly became a popular cold, allergy, and asthma treatment. Ephedrine’s success caused drug companies to increase their efforts to find synthetic adrenaline analogs or sympathomimetics. Today, sympathomimetics are a broad class of medications that treat a variety of medical conditions including anaphylaxis, glaucoma, chronic obstructive pulmonary disease (COPD), hypotension, and nasal congestion. Here we will discuss in more depth the properties, brand names, pricing, and safety of sympathomimetics.

The list below includes FDA-approved sympathomimetics and their pricing:

List of Sympathomimetics

What are sympathomimetics?

Sympathomimetics, which are also known as adrenergic drugs or sympathomimetic amines, mimic the effects of endogenous agonists in your sympathetic nervous system. The primary endogenous agonists of the sympathetic nervous system are catecholamines such as epinephrine, norepinephrine, and dopamine. Sympathomimetic agents can be classified based on their direct or indirect action on adrenoceptors. Direct-acting agents such as adrenergic receptor agonists cause the direct stimulation of α- and β-receptors to produce their effects. These receptors can be found on smooth muscle cells in the blood vessels supplying skeletal muscles and the brain. Examples include dobutamine and phenylephrine. Indirect-acting agents such as amphetamine, methamphetamine, and ephedrine stimulate the release of neurotransmitters in your central nervous system (CNS) such as norepinephrine and dopamine. Some of these drugs also inhibit the reuptake of these neurotransmitters.

What is the mechanism of action of sympathomimetics?

The mechanism of action of these medications will depend on how they interact with adrenergic receptors. They can be direct-acting like α- and β-adrenergic agonists or indirect-acting like COMT or monoamine oxidase inhibitors. Sympathomimetics can affect a variety of organ systems and have effects such as:

• Cardiovascular effects
  • Increased heart rate and blood pressure
  • Increased contractility to increase cardiac output
  • Prevent stimulation of the heart (decreased heart rate and blood pressure)
• Respiratory effects
  • Relaxes smooth muscle to produce bronchodilation
• Ocular (eye) effects
  • Mydriasis (dilation of the pupil)
  • Reduces pressure inside the eye
• GI effects
  • Smooth muscle relaxation
  • Vasoconstriction
• Renal (kidney) effects
  • Relaxes the detrusor muscle to help store more urine
• Female reproductive system effects
  • β-2 agonists relax the uterus
  • Terbutaline is used to stop preterm labor
• Male reproductive system effects
  • α-1 agonists cause smooth muscle contraction in the prostate

What conditions are sympathomimetics used to treat?

Sympathomimetics are used to treat conditions such as:

• Low blood pressure that is caused by conditions such as ischemic heart disease, cardiac arrest, or myocardial infarction (heart attack)
• High blood pressure (hypertension)
• Asthma
• Chronic obstructive pulmonary disease (COPD)
• Nasal decongestant for the symptom management of the common cold and flu
• Open-angle glaucoma
• Conjunctivitis (pink eye)
• Attention-deficit hyperactivity disorder (ADHD)
• Tourette’s syndrome tics
• Narcolepsy
• Obesity
• Urinary incontinence and overactive bladder
• Benign prostatic hyperplasia (BPH)

Are sympathomimetics safe?

The use of sympathomimetics is relatively safe and effective when taken as prescribed. Before beginning treatment with sympathomimetics, tell your healthcare provider if you have any of the following:

• Bradycardia (low heart rate)
• Tachycardia (fast heart rate)
• Arrhythmias including ventricular fibrillation
• Heart disease including heart failure, high blood pressure, and chest pain (angina)
• Closed-angle glaucoma
• Coronary artery disease
• Pregnant, plan on becoming pregnant or are breastfeeding

What are some common side effects of sympathomimetics?

The adverse effects you experience from sympathomimetics will depend on several factors including the medication and dose. Some side effects of sympathomimetics include:

• Blurred vision
• Sedation
• High blood pressure
• Urinary retention
• Low heart rate and blood pressure
• Headache
• Tremors
• Sexual dysfunction
• Dry mouth
• Insomnia
• Diarrhea
• Constipation
• Nausea
• Vomiting
• Dizziness
• Nervousness
• Agitation
• Anxiety

More rarely, sympathomimetics can cause more severe adverse reactions, including:

• Serious, life-threatening allergic reaction
• Cerebral hemorrhage
• Ischemia (reduced blood flow)
• Arrhythmias

This is not a complete list of side effects and we encourage you to consult with your healthcare provider for medical advice about any possible side effects.

Who should not take sympathomimetics?

Sympathomimetics are contraindicated in patients with extreme bradycardia (low heart rate), heart failure, cardiac injury, or advanced cardiovascular disease.

What are some drug interactions with sympathomimetics?

The use of sympathomimetics with certain foods or other medications can affect how they work or increase the frequency and severity of side effects. Make sure your healthcare provider is aware of all the over-the-counter and prescription medications you are taking, including:

• Beta-blockers
• Cannabinoids
• Other CNS stimulants such as caffeine
• Alpha-blockers such as doxazosin
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine
• Tricyclic antidepressants (TCAs)
• MAOIs
• Ergot alkaloids which are typically used for headaches
• Antihistamines such as diphenhydramine
• Phenytoin
• Atropine

What are the most abused sympathomimetics?

There are a number of legal and illegal sympathomimetics that are abused. Cocaine, methamphetamine, and MDMA (Molly or ecstasy) are the 3 most common illicit stimulant drugs that cause emergency room visits in the United States. Prescription stimulants such as methylphenidate and albuterol are often causes of sympathomimetic toxicity.

Are sympathomimetics controlled substances?

There are several sympathomimetic medications that are controlled substances. The majority of these medications are used to treat ADHD or narcolepsy.

How do sympathomimetics treat nasal congestion?

Sympathomimetic decongestants such as pseudoephedrine cause the blood vessels in your nose to narrow. This reduced vasodilation in your nasal passages helps open them up so you can breathe better.

How much do sympathomimetics cost?

Sympathomimetics are very expensive with an average cost of around $5,000 per year.

You can purchase Sympathomimetics for $49 per month from NiceRx if eligible for assistance. Prices at the pharmacy vary by location, strength, and quantity, as well as your insurance status.