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Indications/Uses
Listed in Dosage.
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Dosage/Direction for Use
Adult : IV Advanced cardiac life support 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. Anaphylactic shock As 1:10,000 soln: 5 mL infused slowly until a response is achieved. IM Anaphylactic shock As 1:1,000 soln: 0.5 mL, repeat every 5 mins as needed. IM/SC Acute asthma As 1:1,000 soln: 0.3-0.5 mL. Ophth Open-angle glaucoma; Ocular HTN As 0.5, 1 or 2% soln: Instill 1-2 times/day. Inhalation Acute asthma Per metered dose from pressurised aerosols contains 160-275 mcg of epinephrine: 1-2 inhalations, repeat 3 hr later if needed.
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Dosage Details
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. |
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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.
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Special Precautions
CV diseases; hyperthyroidism; DM; Parkinson's disease; elderly; pregnancy, lactation.
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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.
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IM/Intraocular/IV/Parenteral/SC: C
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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.
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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.
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Lab Interference
Increase in bilirubin, catecholamines, glucose, uric acid.
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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. |
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Storage
Store at 25°C.
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MIMS Class
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