Dangerous Drug: Epinephrine (Adrenaline)(ep i nef’ rin)
Epinephrine Hydrochloride
Adrenalin, Adrenaclick, Auvi-Q, EpiPen Auto-Injector (delivers 0.3 mg IM adult dose), EpiPen Jr. Auto-Injector (delivers 0.15 mg IM for children)
OTC solutions for nebulization: AsthmaNefrin, S2
PREGNANCY CATEGORY C
Drug Classes
Alpha-adrenergic agonist
Antiasthmatic
Beta1– and beta2-adrenergic agonists
Bronchodilator
Cardiac stimulant
Sympathomimetic
Vasopressor
Therapeutic Actions
Naturally occurring neurotransmitter, the effects of which are mediated by alpha or beta receptors in target organs. Effects on alpha receptors include vasoconstriction, contraction of dilator muscles of iris. Effects on beta receptors include positive chronotropic and
inotropic effects on the heart (beta1 receptors); bronchodilation, vasodilation, and uterine relaxation (beta2 receptors); decreased production of aqueous humor.
inotropic effects on the heart (beta1 receptors); bronchodilation, vasodilation, and uterine relaxation (beta2 receptors); decreased production of aqueous humor.
Indications
IV: In ventricular standstill after all other measures have failed to restore circulation, given by trained personnel by intracardiac puncture and intramyocardial injection; treatment and prophylaxis of cardiac arrest and attacks of transitory AV heart block with syncopal seizures (Stokes-Adams syndrome); syncope due to carotid sinus syndrome; acute hypersensitivity (anaphylactoid) reactions, serum sickness, urticaria, angioneurotic edema; in acute asthmatic attacks to relieve bronchospasm not controlled by inhalation or subcutaneous injection; relaxation of uterine musculature; additive to local anesthetic solutions for injection to prolong their duration of action and limit systemic absorption
Injection: Relief from respiratory distress of bronchial asthma.
Solutions for nebulization: Temporary relief from acute attacks of bronchial asthma, COPD
Contraindications and Cautions
Contraindicated with allergy or hypersensitivity to epinephrine or components of preparation (many of the inhalant and ophthalmic products contain sulfites: Sodium bisulfite, sodium or potassium metabisulfite; check label before using any of these products in a sulfite-sensitive patient); narrow-angle glaucoma; shock other than anaphylactic shock; hypovolemia; general anesthesia with halogenated hydrocarbons or cyclopropane; organic brain damage, cerebral arteriosclerosis; cardiac dilation and coronary insufficiency; tachyarrhythmias; ischemic heart disease; hypertension; renal impairment (drug may initially decrease renal blood flow); COPD patients who have developed degenerative heart disease; diabetes mellitus; hyperthyroidism; lactation.
Use cautiously with prostatic hypertrophy (may cause bladder sphincter spasm, difficult and painful urination), history of seizure disorders, psychoneurotic individuals, labor and delivery (may delay second stage of labor; can accelerate fetal heart beat; may cause fetal and maternal hypoglycemia), children (syncope has occurred when epinephrine has been given to asthmatic children). Use EpiPen Auto-Injector cautiously with hyperthyroidism, CAD, hypertension, diabetes, elderly patients, pregnancy, and patients weighing less than 30 kg.
Available Forms
Solution for inhalation—1:100, 1:1,000, 1.125%, 2.25 %, 1%; injection—1, 5 mg/mL; solution for injection—1:1,000, 1:2,000, 1:10,000, 1:100,000; suspension for injection—1:200; injection device—0.15 mg/0.15 mL, 0.15 mg/0.3 mL, 0.3 mg/0.3 mL
Dosages
Adults
Epinephrine injection
Hypersensitivity or bronchospasm: 0.1–0.25 mg (1–2.5 mL of 1:10,000 solution) IV injected slowly.
Cardiac arrest: 0.1–1 mg (5–10 mL of 1:10,000 solution) IV during resuscitation, 0.5 mg every 5 min. Intracardiac injection into left ventricular chamber, 0.3–0.5 mg (3–5 mL of 1:10,000 solution).
Intraspinal
0.2–0.4 mL added to anesthetic spinal fluid mixture. Concentrations of 1:100,000–1:20,000 are usually used.
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