Epinephrine: Indication, Dosage, Side Effect, Precaution

This information is not country-specific. Please refer to the Malaysia prescribing information.

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.

Pregnancy Category (US FDA)

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.

MIMS Class

Antiasthmatic & COPD Preparations / Cardiac Drugs / Vasoconstrictors

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