Epinephrine

A to Z Drug Facts

Epinephrine

	Actions
	Indications
	Contraindications
	Route/Dosage
	Interactions
	Lab Test Interferences
	Adverse Reactions
	Precautions
Patient Care Considerations
	Administration/Storage
	Assessment/Interventions
	Patient/Family Education

(epp-ih-NEFF-rin)

Adrenalin Chloride

Solution: 0.1%, 1 mg/mL as HCl

Ana-Kit

AsthmaNefrin

Solution for inhalation: 2.25% racepinephrine HCl (1.125% epinephrine base)

Epifrin

Solution: 0.5%, 1%, 2%

Epinal

Solution: 0.5%, 1%

Epipen

Solution: 1 mg/mL as HCl

Epipen Jr.

Solution: 1 mg/mL as HCl

Glaucon

Solution: 1%, 2%

MicroNefrin

Solution for inhalation: 2.25% racepinephrine HCl (1.125% epinephrine base)

Nephron

Solution for inhalation: 2.25% racepinephrine HCl (1.125% epinephrine base)

Primatene Mist

Aerosol: 0.2 mg epinephrine per spray

S-2

Solution for inhalation: 2.25% racepinephrine HCl (1.125% epinephrine base)

Sus-Phrine

Suspension for injection: 5 mg/mL

Bronkaid Mistometer

Epi E•Z Pen Jr

Class: Vasopressor

Actions Stimulates both alpha-and beta-receptors (alpha-receptors at high doses; beta₁ - and beta₂ -receptors at moderate doses) within sympathetic nervous system. Relaxes smooth muscle of bronchi and iris and is antagonist of histamine.

Indications Treatment and prophylaxis of cardiac arrest and attacks of transitory atrioventricular heart block; treatment of Adams-Stokes syndrome; treatment of hay fever; relief of bronchial asthma; treatment of syncope caused by heart block or carotid sinus hypersensitivity; symptomatic relief of serum sickness, urticaria and angioedema; relaxation of uterine musculature; anaphylaxis; allergic reactions (eg, bronchospasm, urticaria, pruritus, angioneurotic edema, or swelling of the lips, eyelids, tongue, and nasal mucosa) because of anaphylactic shock caused by stinging insects (primarily of the order Hymenoptera, which includes bees, wasps, hornets, yellow jackets, bumble bees, and fire ants); severe allergic or anaphylactoid reactions caused by allergy injections; exposures to pollens, dusts molds, foods, drugs, and exercise or unknown substances (so-called idopathic anaphylaxis); severe, life-threatening asthma attacks characterized by wheezing, dysypena, and inability to breathe.

Nasal Solution: Treatment of nasal congestion; relief of eustachian tube congestion. Inhalation: Temporary relief from acute paroxysms of bronchial asthma and other states; treatment of postintubation and infectious croup. Ophthalmic Solution: Treatment of open-angle glaucoma.

Contraindications Hypersensitivity to epinephrine; narrow-angle glaucoma; concomitant use during general anesthesia with halogenated hydrocarbons or cyclopropane; cerebral arteriosclerosis or organic brain damage; use with anesthesia for fingers and toes; use during labor; phenothiazine-induced circulatory collapse; MAOI therapy; nonanaphylactic shock during general anesthesia with halogenated hydrocarbons or cyclopropane; organic heart disease.

Route/Dosage

Cardiac Arrest

ADULTS: IV/Endotracheal/Intracardiac 0.5 to 1 mg (5 to 10 mL of 1:10,000 solution) q 5 min prn. Myocardial injection usually given in left ventricular chamber by trained personnel at dose of 0.3 to 0.5 mg.

Other IV Uses

ADULTS: IV 1 mg in 250 mL of D5W (4 mcg/mL) for infusion at 1 to 4 mcg/min (15 to 60 mL/hr).

Intraspinal Use

ADULTS: Intraspinal 0.2 to 0.4 mL of 1:1000 solution added to anesthetic spinal fluid mixture. Epinephrine 1:100,000 to 1:200,000 is usual concentration employed with local anesthetics.

Open-Angle Glaucoma

ADULTS: Ophthalmic 1 gtt in affected eye(s) 2 time/day.

Nasal Congestion

ADULTS AND CHILDREN ³ 6 yr: Nasal Apply as drops, spray, or with sterile swab as required.

Asthma

ADULTS AND CHILDREN ³ 4 yr (Asthma Nefrin ³ 12 yr): Inhalation Hand pump nebulizer: Place 0.5 mL (» 8 to 10 drops) of racemic epinephrine into nebulizer reservoir. Squeeze bulb 1 to 3 times in partially opened mouth. If relief does not occur within 2 to 3 min, administer 2 to 3 additional inhalations. Do not administer > q 3 hr. Aerosol-nebulizer: Add 0.5 mL (» 10 drops) racemic epinephrine to 3 mL of diluent or 0.2 to 0.4 mL (» 4 to 8 drops) of MicroNefrin to 4.6 to 4.8 mL water. Administer for 15 min q 3 to 4 hr. ADULTS SC/IM Solution (1:1000): 0.2 to 1 mL (0.2 to 1 mg); repeat q 4 hr. SC Suspension (1:200): 0.1 to 0.3 mL (0.5 to 1.5 mg). IV Solution (1:10,000): 0.1 to 0.25 mg (1 to 2.5 mL) injected slowly. INFANTS AND CHILDREN: SC Solution (1:1000): 0.01 mL/kg or 0.3 mL/m² (0.01 mg/kg or 0.3 mg/m²); repeat q 20 min to 4 hr. Do not exceed 0.5 mL (0.5 mg) in single dose. Suspension (1:200): 0.005 mL/kg (0.025 mg/kg). Maximum single dose for children £ 30 kg is 0.15 mL (0.75 mg). IV Solution (1:10,000): 0.01mg/kg to 0.05 mg repeated at 20 to 30 min intervals.

Interactions

Alpha-Adrenergic Blockers (eg, Phentolamine): Vasoconstricting and hypertensive effects are antagonized. Antihistamines: Epinephrine effects may be potentiated. Beta-Blocking Agents: May decrease effects of these agents, resulting in hypertension. Diuretics: Vascular response may be decreased. Ergot Alkaloids/Phenothiazines/Nitrates: Pressor effects of epinephrine may be reversed. General Anesthetics (eg, Halothane, Cyclopropane)/Cardiac Glycosides: The potential for the myocardium to be sensitized to the effects of sympathomimetic amines is increased. Arrhythmias may result with coadministration and may respond to beta-blockers. Guanethidine: May increase pressor response. Levothyroxine: Epinephrine effects may be potentiated. Oxytoxic Drugs: May cause severe persistent hypertension. Rauwolfia Alkaloids, Methyldopa, Furazolidone: May cause hypertension. Tricyclic Antidepressants: May potentiate epinephrine’s vasopressive effects. INCOMPATIBILITIES: Epinephrine is unstable in alkaline solutions (eg, sodium bicarbonate); avoid admixture.

Lab Test Interferences None well documented.

Adverse Reactions

CARDIOVASCULAR: Cardiac arrhythmias and excessive hypertension; palpitations (especially in hyperthyroid and hypertensive patients); anginal pain in predisposed patients; cerebral and subarachnoid hemorrhage; flushing. CNS: Anxiety; headache; restlessness; tremor; weakness; hemiplegia; dizziness; insomnia. EENT: Topical ophthalmic use: Transient stinging; burning; conjunctival hyperemia; pain; allergic lid reaction. May also cause effects seen with systemic use because of absorption. Nasal use: Local irritation; sneezing; rebound congestion. GI: Nausea; vomiting. GU: Decreased urine formation with initial parenteral use. RESPIRATORY: Shortness of breath. OTHER: Severe metabolic acidosis; pallor; urticaria; wheal and hemorrhage at site of injection; necrosis at injection site following repeated injections; sweating; transient elevations of blood glucose; elevated serum lactic acid.

Precautions

Pregnancy: Category C. Labor: Do not use when maternal BP exceeds 130/80 mmHg; may delay second stage or induce uterine atony. Lactation: Excreted in breast milk. CHILDREN: Administer drug with caution. Syncope has occurred in asthmatic children. Special Risk Patients: Use drug with caution in elderly patients, patients with cardiovascular disease, pulmonary edema, hypertension, hyperthyroidism, diabetes, psychoneurotic illness, asthma, prefibrillatory rhythm, or anesthetic cardiac accidents. Cerebrovascular Hemorrhage: May result from overdosage or inadvertent IV injection. Glaucoma: Ophthalmic epinephrine for topical use only; not for injection or intraocular use. Evaluate anterior chamber angle by gonioscopy before using. Maculopathy with decreased visual acuity may occur in aphakic eye; if this occurs, discontinue drug. Pulmonary Edema: May cause fatalities because of peripheral constriction or cardiac stimulation. Sulfite Sensitivity: Use drug with caution in sulfite-sensitive individuals; some products contain sulfites.

PATIENT CARE CONSIDERATIONS

Administration/Storage

Have patient wait 1 full min between inhalations if receiving drug via inhalation therapy.
Do not use if solution appears discolored or contains any precipitate.
Massage SC injection site to reduce vasoconstrictive effects.
Rotate injection sites to avoid irritation.
Protect from light, extreme heat, or freezing. Store at room temperature.

Assessment/Interventions

Obtain patient history, including drug history and any known allergies. Note any hypersensitivity to epinephrine or sulfites.
Perform baseline assessment of vital signs, ECG, peripheral pulses, lung sounds, and level of consciousness.
Determine baseline glucose for patients with diabetes mellitus.
Monitor vital signs frequently.
Assess lung sounds for rhonchi, rales, or wheezes.
Monitor ECG, skin color, changes in mentation, tremors, nervousness, and agitation.

OVERDOSAGE: SIGNS & SYMPTOMS
	Precordial distress, vomiting, headache, shortness of breath, unusually elevated BP, cerebrovascular hemorrhage, pulmonary arterial hypertension, pulmonary edema, ventricular hyperirritability, bradycardia, tachycardia, arrhythmias, extreme pallor, cold skin, metabolic acidosis, kidney failure

Patient/Family Education

Caution patient to use topical decongestant form of drug only in acute states and to not use > 3 to 5 days.
If indicated, teach patient how to self-administer epinephrine for anaphylactic reaction via auto-injector.
Instruct patient to notify health care provider of insomnia, weakness, or palpitations.
Advise patient that nasal burning or stinging may occur with topical decongestant.
Caution patient not to share nasal spray container with others.
Advise patient to notify health care provider if symptoms do not improve after 7 days.
If patient is being treated for glaucoma, advise patient to notify health care provider of prolonged blurred vision, headache, palpitation, tremors, sweating, and faintness, and to use caution while driving or performing hazardous tasks.
Caution patient that stinging of eyes will occur on instillation of ophthalmic epinephrine solution in eyes.
Advise glaucoma patient not to use drug while wearing soft contact lenses; discoloration of lens may result.
If patient is receiving drug SC, advise patient to notify health care provider of syncope, palpitations, weakness, and agitation.
If patient is receiving drug through inhalation therapy, caution patient to notify health care provider if no relief from symptoms is gained. Advise patient to notify health care provider of dizziness or chest pain.

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