EPINEPHRINE (ADRENALIN)

Class
Description
Onset and Duration
Indications
Contraindications
Adverse Reactions
Drug Interactions
How Supplied
Dosage and Administration
Special Considerations

EPINEPHRINE (ADRENALIN)
Class

Sympathomimetic

EPINEPHRINE (ADRENALIN)
Description

Epinephrine stimulates alpha-, beta1-, and beta2-adrenergic receptors in dose-related fashion. It is the initial drug of choice for treating bronchoconstriction and hypotension resulting from anaphylaxis as well as all forms of cardiac arrest. It is useful in managing reactive airway disease, but beta-adrenergic agents are often used initially because of their convenience and oral inhalation route. Rapid injection produces a rapid increase in systolic pressure, ventricular contractility, and heart rate. In addition, epinephrine causes vasoconstriction in the arterioles of the skin, mucosa, and splanchnic areas and antagonizes the effects of histamine.

EPINEPHRINE (ADRENALIN)
Onset & Duration

Onset:

(SQ) 5-10 min (IV) 1-2 min

Duration:

5-10 min

EPINEPHRINE (ADRENALIN)
Indications

Bronchial asthma
Acute allergic reaction
Cardiac arrest
Asystole
Electromechanical dissociation
Ventricular fibrillation unresponsive to initial defibrillatory attempts

EPINEPHRINE (ADRENALIN)
Contraindications

Hypersensitivity
Hypovolemic shock
Coronary insufficiency
Hvpertension

EPINEPHRINE (ADRENALIN)
Adverse Reactions

Headache
Nausea
Restlessness
Weakness
Dysrhythmias
Hypertension
Precipitation of angina pectoris

EPINEPHRINE (ADRENALIN)
Drug Interactions

MAOIs and bretylium may potentiate the effect of epinephrine.
Beta-adrenergic antagonists may blunt inotropic response.
Sympathomimetics and phosphodiesterase inhibitors may exacerbate dysrhythmia response.
May be deactivated by alkaline solutions (sodium bicarbonate, Furosemide).

EPINEPHRINE (ADRENALIN)
How Supplied

Parenteral:
1 mg/ml ( 1: 1000), 0.1 mg/ml (1:10,000) ampule and prefilled syringe
Autoin jector (EpiPen) 0.5 mg/ml (1:2000)
0.01 mg/ml ( 1: 100,000) pediatric

EPINEPHRINE (ADRENALIN)
Dosage and Administration

Adult:

Initial:

1 mg IV push, repeat q 3-5 min

Intermediate:

2-5 mg IV push q 3-5 min

Escalating:

1 mg-3 mg-5 mg IV (3 min apart)

High:

0.1 mg/kg IV push, q 3-5 min

Pediatric:

First dose:

Standard (0.1 ml/kg 1: 10,000) IV/IO

High (0.1 ml/kg 1 :1000) ET

High (0.1 ml/kg 1 :1000) IV/IO

Second and subsequent doses:

High (0.1 ml/kg 1:1000) ET

Bradycardia refractory to other interventions

Adult:

2-10 mcg/min (1 mg 1:1,000 in 500 ml of normal saline or D5W)

Pediatric:

Standard: 0.1 ml/kg 1:10,000 IV/IO

High: 0.1 ml/kg 1: 1 000 ET

EPINEPHRINE (ADRENALIN)
Special Considerations

Pregnancy safety: Category C.
Syncope has occurred after epinephrine administration to asthmatic children.
May increase myocardial oxygen demand.