Epinephrine

Indications
 Inhalation
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.
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.
Intravenous
Advanced cardiac life support
Adult: Initially, 1 mg (10 mL of a 1:10,000 solution), may repeat as often as every 2-3 minutes throughout the resuscitation process. May also be given via intraosseous route at the same dosage. For endotracheal doses: 2-3 times of the IV dose.
Child: Initially, 10 mcg/kg, may repeat as often as every 2-3 minutes throughout the resuscitation process. Endotracheal doses: 100 mcg/kg. Intraosseous doses are the same as IV doses.
Max Dosage: Intraosseous doses for adults and children are the same as IV doses.
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.
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.
Ophthalmic
Ocular hypertension
Adult: Instill 0.5%, 1% or 2% eye drops once or twice daily.
Ophthalmic
Open-angle glaucoma
Adult: Instill 0.5%, 1% or 2% eye drops once or twice daily.
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.
Warnings / 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.
Overdose Reactions
 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.
See Below for More epinephrine Drug Interactions
Lab Interactions
 Increase in bilirubin, catecholamines, glucose, uric acid.
Mechanism of Actions
 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 Conditions
 Inhalation: Store at 25°C. Intramuscular: Store at 25°C. Intravenous: Store at 25°C. Ophthalmic: Store at 25°C. Parenteral: Store at 25°C.
ATC Classification
 C01CA24 - epinephrine ; Belongs to the class of adrenergic and dopaminergic cardiac stimulants excluding glycosides. Used in the treatment of heart failure.
A01AD01 - epinephrine ; Belongs to the class of other agents for local oral treatment.
R01AA14 - epinephrine ; Belongs to the class of topical sympathomimetic agents used as nasal decongestants.
R03AA01 - epinephrine ; Belongs to the class of adrenergic inhalants, alpha- and beta-adrenoreceptor agonists. Used in the treatment of obstructive airway diseases.
S01EA01 - epinephrine ; Belongs to the class of sympathomimetics used in the treatment of glaucoma.
B02BC09 - epinephrine ; Belongs to the class of local hemostatics. Used in the treatment of hemorrhage.
Storage
 Inhalation: Store at 25°C. Intramuscular: Store at 25°C. Intravenous: Store at 25°C. Ophthalmic: Store at 25°C. Parenteral: Store at 25°C.
Available As
  • Epinephrine 2 mg

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