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BLOOD AND BLOOD FORMING ORGANS › ANTIHEMORRHAGICS › VITAMIN K AND OTHER HEMOSTATICS › Local hemostatics
epinephrine
B02BC09
Forms & Strengths
- Auto-injector: 0.1 mg, 0.15 mg, 0.3 mg, 0.5 mg
- Solution for injection: 1 mg/mL (1:1000)
- Solution for IV/IO injection: 0.1 mg/mL (1:10000)
- Inhalation solution: 11.25 mg/0.5 mL, 22.5 mg/0.5 mL
Adult Dosing
- Anaphylaxis: 0.3 mg to 0.5 mg IM (1:1000) every 5-15 minutes as needed
- Cardiac arrest: 1 mg IV/IO (1:10000) every 3-5 minutes
- Severe asthma: 0.3 mg to 0.5 mg SC every 20 minutes for 3 doses
- Advanced cardiac life support infusion: 2 mcg/min to 10 mcg/min IV titrated to effect
Pediatric Dosing
- Anaphylaxis (weight < 30 kg): 0.15 mg IM every 5-15 minutes as needed
- Anaphylaxis (weight >= 30 kg): 0.3 mg IM every 5-15 minutes as needed
- Cardiac arrest: 0.01 mg/kg IV/IO (0.1 mL/kg of 1:10000 solution) every 3-5 minutes, max 1 mg
- Croup (neb): 0.5 mL/kg of 2.25% racemic epinephrine solution, max 5 mL
Indications
- Emergency treatment of allergic reactions including anaphylaxis
- Treatment of cardiac arrest and maintenance of hemodynamic stability
- Induction and maintenance of mydriasis during intraocular surgery
- Severe bronchospasm refractory to other treatments
Mechanism of Action
- Non-selective alpha-1, alpha-2, beta-1, and beta-2 adrenergic receptor agonist
- Stimulation of alpha receptors causes vasoconstriction, increasing blood pressure and reducing mucosal edema
- Stimulation of beta-1 receptors increases heart rate and myocardial contractility
- Stimulation of beta-2 receptors relaxes bronchial smooth muscle and inhibits release of allergic mediators
Contraindications
- Hypersensitivity to epinephrine or sympathomimetic amines
- Angle-closure glaucoma
- Use during local anesthesia of fingers, toes, ears, nose, or genitalia due to risk of ischemic necrosis
- Shock other than anaphylactic shock (relative)
Adverse Reactions
- Tachycardia, palpitations, arrhythmias, hypertension
- Anxiety, restlessness, tremor, headache, dizziness
- Dyspnea, pulmonary edema with excessive overdose
- Tissue necrosis at injection site following extravasation
Drug Interactions
- Non-selective beta-blockers may cause severe hypertension and reflex bradycardia
- MAO inhibitors and tricyclic antidepressants potentiate pressor response and risk of arrhythmias
- Halogenated hydrocarbon anesthetics sensitize the myocardium to sympathomimetics
- Potassium-depleting diuretics and digitalis glycosides increase risk of cardiac arrhythmias
Curated Content: Needs Vetting Before Put to Clinical Use