Epinephrine

4
Epinephrine
Brands

DEA Class;  Rx

Common Brand Names; EpiPen, EpiPen Jr, Auvi-Q, Symjepi, Adrenalin, Primatene Mist, AsthmaNefrin, S2

  • Alpha/Beta Adrenergic Agonists; 
  • Alpha/Beta Agonists

Nonselective adrenergic agonist
Used for hemodynamic/inotropic support and bronchodilation
Drug of choice for anaphylaxis; not routinely recommended for asthma

Indicated to increase mean arterial blood pressure in adults with hypotension associated with septic shock

Indicated in emergency treatment of allergic reactions (Type I) including anaphylaxis

Induction and maintenance of mydriasis during intraocular surgery

Use only preservative-free vials without tartaric acid

Indicated for temporary relief of mild symptoms of intermittent asthma (eg, wheezing, chest tightness, dyspnea)

Indicated for temporary relieve of symptoms associated with bronchial asthma (eg, shortness of breath, chest tightening, wheezing)

There are no contraindications for life-threatening situations

Nonanaphylactic shock

Narrow-angle glaucoma

Coadministration during genral anesthesia with halogenated hydrocarbons or cyclopropane

Labor

Situations where vasopressors may be contraindicated, including thyrotoxicosis, diabetes

Maternal blood pressure in excess of 130/80 mm Hg in hypertension and other cardiovascular disorders

  • Angina
  • Anxiety
  • Apprehensiveness
  • Cardiac arrhythmias
  • Dizziness
  • Dyspnea
  • Flushing
  • Headache
  • Hypertension
  • Nausea
  • Nervousness
  • Pallor
  • Palpitations
  • Respiratory difficulties
  • Restlessness
  • Stress cardiomyopathy
  • Sweating
  • Tachycardia
  • Tremor
  • Vasoconstriction
  • Vomiting
  • Weakness

Use caution in patients with cardiac disease, angina (especially with history of CAD) or that are receiving drugs that sensitize the myocardium; treatment may induce cardiac arrhythmias

Pulmonary edema may occur as the result of cardiac stimulation and peripheral constriction

Decreased urine output may occur as the result of renal blood vessel constriction

Use caution in cerebrovascular insufficiency

Use with caution in patients with hypertension, diabetes mellitus, thyroid disease, prostatic hypertrophy, geriatric patients, pregnancy, and previous hospitalization for asthma

Rapid IV administration, although necessary in pulesless arrest, may cause death from cerebrovascular hemorrhage or cardiac arrhythmias

Patients that are sulfite-sensitive, should still be treated during a serious allergic reaction or other emergency even if products available contain sulfites

May cause worsening of symptoms in patients with Parkinson disease

Avoid extravasation; ensure proper needle or catheter placement prior to and during infusion

Correct blood volume depletion before administering any vasopressor

During pregnancy, anaphylaxis can be catastrophic and can lead to hypoxic-ischemic encephalopathy and permanent central nervous system damage or death in the mother and, more commonly, in the fetus or neonate

There is no information regarding presence of epinephrine in human milk or effects on the breastfed infant or on milk production

Adults

Dependent on route of administration and indication for therapy.

Geriatric

Dependent on route of administration and indication for therapy.

Adolescents

Dependent on route of administration and indication for therapy. For CPR, 0.01 mg/kg/dose (Max: 1 mg/dose) IV/IO and 0.1 mg/kg/dose (Max: 2.5 mg/dose) ET. For anaphylaxis, 0.01 mg/kg/dose (Max: 0.5 mg/dose IM/subcutaneously and 1 mg/dose IV). For bronchospasm, 0.01 mg/kg/dose (Max: 0.5 mg/dose) IM/subcutaneously or 8 oral inhalations/24 hours of epinephrine 0.125 mg oral inhalation (e.g., Primatene Mist inhaler, non-prescription).

Children
12 years: Dependent on route of administration and indication for therapy. For CPR, 0.01 mg/kg/dose (Max: 1 mg/dose) IV/IO and 0.1 mg/kg/dose (Max: 2.5 mg/dose) ET. For anaphylaxis, 0.01 mg/kg/dose (Max: 0.5 mg/dose IM/subcutaneously and 1 mg/dose IV). For croup, 0.5 mL/dose of a 2.25% racemic epinephrine solution. For bronchospasm, 0.01 mg/kg/dose (Max: 0.5 mg/dose) IM/subcutaneously or 8 oral inhalations/24 hours of epinephrine 0.125 mg oral inhalation (e.g., Primatene Mist inhaler, non-prescription).
4 to 11 years weighing more than 30 kg: Dependent on route of administration and indication for therapy. For CPR, 0.01 mg/kg/dose (Max: 1 mg/dose) IV/IO and 0.1 mg/kg/dose (Max: 2.5 mg/dose) ET. For anaphylaxis, 0.01 mg/kg/dose (Max: 0.5 mg/dose IM/subcutaneously and 1 mg/dose IV). For croup, 0.5 mL/dose of a 2.25% racemic epinephrine solution. For bronchospasm, 0.01 mg/kg/dose (Max: 0.5 mg/dose) IM/subcutaneously.
Infants

Dependent on route of administration and indication for therapy. For CPR, 0.01 mg/kg/dose (Max: 1 mg/dose) IV/IO and 0.1 mg/kg/dose (Max: 2.5 mg/dose) ET. For anaphylaxis, 0.01 mg/kg/dose (Max: 0.3 mg/dose IM/subcutaneously and 1 mg/dose IV). For croup, 0.5 mL/dose of a 2.25% racemic epinephrine solution. For bronchospasm, 0.01 mg/kg/dose (Max: 0.5 mg/dose subcutaneously and 0.3 mg/dose IM).

Neonates

Dependent on route of administration and indication for therapy. For CPR, 0.03 mg/kg/dose IV and 0.1 mg/kg/dose ET.

Epinephrine

prefilled autoinjector or syringe for SC/IM use

  • 0.3mg/0.3mL (EpiPen, Auvi-Q, Symjepi)

injectable solution

  • 0.1mg/mL (1mg/10mL)
  • 1mg/mL
  • Note: Ratio expression of epinephrine concentrations are prohibited on drug labels; however, some may remain in inventory (1:1000 = 1mg/mL; 1:10,000 = 0.1mg/mL)

suspension for aerosol inhalation

  • 0.125mg/actuation

solution for nebulization

  • 11.25mg/0.5mL (2.25% as 1.125% dextro-epinephrine and 1.125% levo-epinephrine)
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