Epinephrine


Generic Medicine Info
Indications and Dosage
Inhalation/Respiratory
Acute asthma
Adult: Spray: Aqueous solution with an adrenaline content equivalent to 1:100. Pressurised aerosols delivering metered doses equivalent to approximately 160-275 mcg: 1-2 inhalations, may repeat after 3 hr if necessary.

Intramuscular
Anaphylactic shock
Adult: As 1:1,000 solution: 500 mcg (0.5 ml), repeat every 5 minutes as needed until improvement occurs. For emergency self-admin (e.g. via autoinjector): A dose of 300 mcg (0.3 ml) may be used.
Child: Dose depends on age and weight. Usual dose: 10 mcg/kg.

Intravenous
Advanced cardiac life support
Adult: Initially, 1 mg (10 mL of a 1:10,000 solution), may repeat as often as every 3-5 minutes throughout the resuscitation process. May also be given via intraosseous route at the same dosage. For endotracheal doses: 2-2.5 mg every 3-5 minutes.
Child: Initially, 10 mcg/kg, max single dose 1mg, may repeat as often as every 3-5 minutes throughout the resuscitation process via IV or Intraosseous. Endotracheal doses: 100 mcg/kg.  Max single dose 2.5 mg. 

Intravenous
Anaphylactic shock
Adult: 0.5 mg (5 mL of a 1:10,000 solution) given at a slow rate of 100 mcg/minute, stopping when a response is achieved.
Child: 10 mcg/kg. If autoinjectors are used, doses are based on body wt: 15-30 kg: 150 mcg and >30 kg: 300 mcg.

Ophthalmic
Ocular hypertension, Open-angle glaucoma
Adult: Instill 0.5%, 1% or 2% eye drops once or twice daily.

Parenteral
Acute asthma
Adult: As 1:1,000 aqueous solution: 0.3-0.5 ml (300-500 mcg). Dose may be given via IM or SC inj.
Child: As 1:1,000 aqueous solution: 0.01 ml/kg (10 mcg/kg). Max: 0.5 ml (500 mcg). Dose may be given via IM or SC inj.
Contraindications
Preexisting hypertension; occlusive vascular disease; angle-closure glaucoma (eye drops); hypersensitivity; cardiac arrhythmias or tachycardia. When used in addition to local anaesthetics: Procedures involving digits, ears, nose, penis or scrotum.
Special Precautions
CV diseases; hyperthyroidism; DM; Parkinson's disease; elderly; pregnancy, lactation.
Adverse Reactions
CNS effects; GI disturbances; epigastric pain; CV disorders; difficulty in micturition with urinary retention; dyspnoea; hyperglycaemia; sweating; hypersalivation; weakness, tremors; coldness of extremities; hypokalaemia. Gangrene, tissue necrosis and sloughing (extravasation) when used in addition to local anaesthetics. Eye drops: Severe smarting, blurred vision, photophobia; naso-lachrymal ducts obstruction. Oedema, hyperaemia and inflammation of the eyes with repeated administration.
IM/Intraocular/IV/Parenteral/SC: C
Overdosage
Overdosage intravascular inj of epinephrine may cause cerebral haemorrhage due to a sharp rise in BP. Fatalities may also result from pulmonary oedema because of peripheral vascular constriction together with cardiac stimulation.
Drug Interactions
Halogenated inhalation anaesthetics; β- or α-blocking agents; methyldopa, guanethidine; drugs with vasoconstrictor and pressor effects; antihypertensives; adrenergic neuron blockers; potassium-depleting drugs; cardiac glycosides; ephedra, yohimbe. TCAs may induce hypertension and arrhythmia.
Lab Interference
Increase in bilirubin, catecholamines, glucose, uric acid.
Action
Description: Epinephrine, an active principle of the adrenal medulla, is a direct-acting sympathomimetic. It stimulates α- and β-adrenergic receptors resulting in relaxation of smooth muscle of the bronchial tree, cardiac stimulation and dilation of skeletal muscle vasculature. It is frequently added to local anaesthetics to retard diffusion and limit absorption, to prolong the duration of effect and to lessen the danger of toxicity.
Onset: SC: approx 5-10 min; inhalation: approx 1 min; conjunctival instillation: IOP declines approx 1 hr.
Duration: Ocular effect: 12-24 hrs.
Storage
Store at 25°C.
Disclaimer: This information is independently developed by MIMS based on Epinephrine from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2021 MIMS. All rights reserved. Powered by MIMS.com
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