Adrenaline (Epinephrine)

Adrenaline (Epinephrine) is used for: Cardiac arrest, Anaphylaxis, Superficial bleeding, Acute asthma

Parenteral Acute asthma or severe bronchospasm Adult: 0.3-0.5 ml (300-500 mcg). The dose may be given via IM or SC inj. Intravenous Advanced cardiac life support (Cardiac Arrest) Adult: 1. Intravenous injection: 1 mg injection repeated every 2-3 minutes as necessary. 2. Endotracheal: 2-3 mg via an endotracheal tube, repeated as necessary. 3. Intracardiac injection: 0.1 to 1 mg, direct into the atrium of the heart. 4. Intraspinal use: Usual dose is 0.2 to 0.4 mg added to anesthetic spinal fluid mixture (to prolong anesthetic action by limiting absorption). Anaphylactic shock Adult: 0.5 mg (5 mL) given at a slow rate of 100 mcg/minute, stopping when a response is achieved. Intramuscular Anaphylactic shock Adult: 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. Hypotension associated with septic shock: Dilute epinephrine in dextrose solution prior to infusion. Infuse epinephrine into a large vein. Titrate 0.05-2 mcg/kg/min to achieve desired blood pressure. Wean gradually Intraocular surgery: Dilute 1 mL with 100 to 1000 mL of an ophthalmic irrigation fluid, for ophthalmic irrigation or intracameral injection.

Parenteral Acute asthma or severe bronchospasm Child: 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 (Cardiac Arrest) 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. Anaphylactic shock Child: 10 mcg/kg. If auto injectors are used, doses are based on body wt: 15-30 kg: 150 mcg and >30 kg: 300 mcg. Intramuscular Anaphylactic shock Child: Dose depends on age and weight. Usual dose: 10 mcg/kg.

Renal Impairment Intravenously administered epinephrine initially may produce constriction of renal blood vessels and decrease urine formation.

IV Preparation Dilute epinephrine in D5W or D5W 0.9% NaCl Administration in saline solution alone is not recommended Add 1 mL (1 mg) of epinephrine from its ampule to 1000 mL of a D5W-containing solution Each mL of this dilution contains 1 mcg of epinephrine Solution: 1 mg in 250 mL D5W or NS (4 mcg/mL) to make up the concentration of 15-60 mL/hr (1-4 mcg/min) IV Administration Correct blood volume depletion as fully as possible prior to administering any vasopressor When, as an emergency measure, intraaortic pressures must be maintained to prevent cerebral or coronary artery ischemia, epinephrine can be administered before and concurrently with blood volume replacement Whenever possible, administer epinephrine infusions into a large vein Avoid using a catheter tie-in technique, because the obstruction to blood flow around the tubing may cause stasis and increased local concentration of the drug Central line; infusion pump required Do not mix with alkaline solutions Discard after 24 hours or if the solution is discolored or contains precipitate Store in a light-resistant container Intraocular Preparation Epinephrine must be diluted prior to intraocular use Dilute 1 mL of epinephrine 1 mg/mL (1:1000) in 100 to 1000 mL of an ophthalmic irrigation fluid to create an epinephrine concentration of 1:100,000 to 1:1,000,000 (10-1 mcg/mL) Use the irrigating solution as needed for the surgical procedure Intraocular Administration After dilution in an ophthalmic irrigating fluid, inject intracamerally SC/IM Administration SC or IM administration only Inject IM or SC into the anterolateral aspect of the thigh, through clothing if necessary Do not administer autoinjector IV; administer only in outer thigh to ensure SC or IM administration Do not inject into buttock, or into digits, hands, or feet To minimize the risk of injection-related injury, instruct caregivers to hold the child's leg firmly in place and limit movement prior to and during injection when administering to young children Discard the remaining volume after the dose has been administered In conjunction with use, seek immediate medical or hospital care

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.

Avoid extravasation into tissues, which can cause local necrosis. Do not inject into buttocks, digits, hands, or feet. Potential for pulmonary edema, which may be fatal. May constrict renal blood vessels and decrease urine formation. May induce potentially serious cardiac arrhythmias or aggravate angina pectoris, particularly in patients with underlying heart disease. Monitoring Parameters Monitor blood pressure and ECG. Monitor patient for acute severe hypertension.

Pregnancy 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 The prevalence of anaphylaxis occurring during pregnancy is reported to be approximately 3 cases per 100,000 deliveries; management of anaphylaxis during pregnancy is similar to management in the general population Epinephrine is the first-line medication of choice for the treatment of anaphylaxis; it should be used in the same manner in pregnant and non-pregnant patients In conjunction with the administration of epinephrine, the patient should seek immediate medical or hospital care Hypotension associated with septic shock is a medical emergency in pregnancy that can be fatal if left untreated; delaying treatment in pregnant women with hypotension associated with septic shock may increase risk of maternal and fetal morbidity and mortality Life-sustaining therapy for pregnant women should not be withheld due to potential concerns regarding effects of epinephrine on fetus Labor and delivery Epinephrine usually inhibits spontaneous or oxytocin-induced contractions of the pregnant human uterus and may delay second stage of labor; avoid epinephrine during the second stage of labor; in a dosage sufficient to reduce uterine contractions, the drug may cause a prolonged period of uterine atony with hemorrhage Avoid epinephrine in obstetrics when maternal blood pressure exceeds 130/80 mmHg; although epinephrine may improve maternal hypotension associated with septic shock and anaphylaxis, it may result in uterine vasoconstriction, decreased uterine blood flow, and fetal anoxia Lactation There is no information regarding the presence of epinephrine in human milk or its effects on the breastfed infant or on milk production However, due to poor oral bioavailability and short half-life, epinephrine exposure is expected to be very low in breastfed infant Epinephrine is the first-line medication of choice for the treatment of anaphylaxis; it should be used in the same manner for anaphylaxis in breastfeeding and non-breastfeeding patients

Drugs that counter the pressor effects of epinephrine include alpha-blockers, vasodilators such as nitrates, diuretics, antihypertensives, and ergot alkaloids. Drugs that potentiate the effects of epinephrine include sympathomimetics, beta-blockers, tricyclic antidepressants, MAO inhibitors, COMT inhibitors, clonidine, doxapram, oxytocin, levothyroxine sodium, and certain antihistamines. Drugs that increase the arrhythmogenic potential of epinephrine include beta-blockers, cyclopropane and halogenated hydrocarbon anesthetics, quinidine, antihistamines, exogenous thyroid hormones, diuretics, and cardiac glycosides. Observe for the development of cardiac arrhythmias. Potassium-depleting drugs, including corticosteroids, diuretics, and theophylline, potentiate the hypokalemic effects of epinephrine. Contraindicated (15) disopyramide ibutilide indapamide iobenguane I 123 isocarboxazid linezolid lurasidone pentamidine phenelzine pimozide procainamide quinidine selegiline transdermal sotalol tranylcypromine Serious - Use Alternative (66) amiodarone amitriptyline amoxapine artemether/lumefantrine cabergoline chlorpromazine clarithromycin clomipramine desflurane desipramine dihydroergotamine dihydroergotamine intranasal dofetilide dosulepin doxapram doxepin dronedarone droperidol ergoloid mesylates ergotamine erythromycin base erythromycin ethylsuccinate erythromycin lactobionate erythromycin stearate ether etomidate fluconazole fluphenazine formoterol haloperidol imipramine iobenguane I 131 isoflurane ketamine ketoconazole levoketoconazole levomilnacipran lofepramine lumefantrine maprotiline methoxyflurane methylergonovine milnacipran moxifloxacin nadolol nortriptyline octreotide octreotide (Antidote) ozanimod perphenazine pindolol procarbazine prochlorperazine promazine promethazine propofol propranolol protriptyline sevoflurane thioridazine timolol trazodone trifluoperazine trimipramine yohimbe ziprasidone

Side effects of Adrenaline (Epinephrine) : Frequency Not Defined 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

Epinephrine, an active principle of the adrenal medulla, is a direct-acting sympathomimetic. It stimulates alpha- and beta-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.