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Indications/Uses
Listed in Dosage.
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Dosage/Direction for Use
Adult : PO Acute bronchospasm As ephedrine HCl: 15-60 mg tid. As ephedrine sulfate: 12.5-25 mg 4 hrly. Max: 150 mg/day. IM/IV/SC Acute bronchospasm As ephedrine sulfate: 12.5-25 mg. Anaesthesia-induced hypotension As ephedrine HCl: 3-6 mg by slow IV inj every 3-4 min as required. Max total dose: 30 mg. As ephedrine sulfate: 25-50 mg (range: 10-50 mg) by SC or IM inj or 5-25 mg by IV inj, may repeat according to patient's response. Max: 150 mg/day. Nasal Nasal congestion As 1% soln: Instill 1-2 drops into each nostril up to 4 times/day as needed.
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Dosage Details
Nasal
Nasal congestion Adult: As 1% soln: Instill 1-2 drops into each nostril up to 4 times daily as needed. Child: >12 yr Same as adult dose. Elderly: Same as adult dose. Oral Acute bronchospasm Adult: As ephedrine HCl: 15-60 mg tid. As ephedrine sulfate: 12.5-25 mg 4 hrly. Max: 150 mg/day. Child: As ephedrine HCl: 1-5 yr 15 mg tid; 6-12 yr 30 mg tid; >12 yr Same as adult dose. As ephedrine sulfate: ≥12 yr Same as adult dose. Elderly: Initial: 50% of adult dose. Parenteral Reversal of spinal or epidural anaesthesia-induced hypotension Adult: As ephedrine HCl: 3-6 mg by slow IV inj every 3-4 min as required. Max total dose: 30 mg. As ephedrine sulfate: 25-50 mg (range: 10-50 mg) by SC or IM inj or 5-25 mg by IV inj, may be repeated according to patient's response. Max: 150 mg/day. Child: 0.5 mg/kg or 16.7 mg/m2 4-6 hrly by SC or IM inj or alternatively, 0.75 mg/kg or 25 mg/m2 4 times daily by SC or IV inj. Elderly: Same as adult dose. Parenteral Acute bronchospasm Adult: As ephedrine sulfate: 12.5-25 mg by SC, IM or IV inj, further dosage may be given according to patient's response.
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Administration
May be taken with or without food.
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Incompatibility
Anionic salts. Y-site: Thiopental.
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Contraindications
Coronary thrombosis, ischaemic heart disease, HTN, thyrotoxicosis, DM, prostatic hypertrophy, angle-closure glaucoma; post nasal or sinus surgery (nasal soln). Lactation. Patients taking MAOIs (or w/in 2 wk of withdrawal), other sympathomimetic drugs, β-blockers, and those who are given volatile anaesth.
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Special Precautions
Patient w/ unstable vasomotor symptoms, history of seizure disorder. Renal impairment. Elderly. Pregnancy.
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Adverse Reactions
Tachycardia, anxiety, nausea, restlessness, insomnia, tremor, dry mouth, impaired circulation to the extremities, HTN, headache, cardiac arrhythmia.
Potentially Fatal: Coronary artery thrombosis, MI, seizures, psychotic reactions, nephrolithiasis, myocarditis. |
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IM/IV/Parenteral/SC: C
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MonitoringParameters
Monitor BP and pulse.
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Overdosage
Symptoms: Nausea, vomiting, HTN, fever, palpitations, tachycardia, restlessness, resp depression, convulsions; paranoid psychosis, delusions and hallucinations may also occur. Management: Supportive and symptomatic treatment. Induce emesis and perform gastric lavage. May give diazepam to control seizures; manage pyrexia w/ external cooling and dexamethasone 1 mg/kg by slow IV inj.
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Drug Interactions
Increased risk of arrhythmias w/ TCAs, cardiac glycosides and quinidine. Increased risk of vasoconstrictor or pressor effects w/ ergot alkaloids and oxytocin. Increased incidence of nausea, nervousness and insomnia w/ theophylline. Decrease pressor effect w/ reserpine and methyldopa. May potentiate the stimulant effect of caffeine. May increase the clearance and prolong the half-life of dexamethasone in patients w/ asthma. Antagonises the antihypertensive effect of guanethidine.
Potentially Fatal: May cause hypertensive crisis w/ MAOIs. Increased risk of cardiac arrhythmias w/ β-blockers and volatile liq anaesth (e.g. halothane, cyclopropane). Additive effects and increased toxicity w/ other sympathomimetic drugs. |
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Lab Interference
May cause false positive amphetamine enzyme multiplied immunoassay technique (EMIT) assay.
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Action
Description: Ephedrine stimulates both α- and β-receptors, thereby causing bronchodilation, peripheral vasoconstriction and CNS stimulation. It also has stimulant action on the resp centre.
Onset: 10-20 min (IM). Duration: 3-6 hr (oral). Pharmacokinetics: Absorption: Readily and completely absorbed from the GI tract. Distribution: Extensively distributed throughout the body; accumulates in liver, lungs, kidneys, spleen and brain; enters breast milk. Metabolism: Undergoes minimal hepatic metabolism, producing small amounts of metabolites, p-hydroxyephedrine, p-hydroxynorephedrine, norephedrine. Excretion: Via urine, mainly as unchanged drug (60-77%) and metabolites (small amounts). Plasma half-life: 3-6 hr. |
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Chemical Structure
 Source: National Center for Biotechnology Information. PubChem Database. Ephedrine, CID=9294, https://pubchem.ncbi.nlm.nih.gov/compound/Ephedrine (accessed on Jan. 22, 2020) |
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Storage
Store between 20-25°C. Protect from light and moisture.
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References
Anon. Ephedrine (Systemic). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 26/06/2015. Buckingham R (ed). Ephedrine. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 24/06/2015. Ephedrine Sulfate Capsule (West-ward Pharmaceutical Corp). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 26/06/2015. Ephedrine Sulfate Injection, Solution (Hospira). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 26/06/2015. McEvoy GK, Snow EK, Miller J et al (eds). Ephedrine, Ephedrine Hydrochloride, Ephedrine Sulfate. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 24/06/2015.
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