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SENSORY ORGANS › OPHTHALMOLOGICALS › ANTIGLAUCOMA PREPARATIONS AND MIOTICS › Sympathomimetics in glaucoma therapy
epinephrine
S01EA01
Forms & Strengths
- Injectable solution 1 mg/mL (1:1000)
- Injectable solution 0.1 mg/mL (1:10 000)
- Auto‑injector 0.15 mg (0.15 mL) and 0.3 mg (0.3 mL)
- Inhalation solution 0.5 mg/2 mL for nebulization
- Ophthalmic solution 0.1 % (1 mg/mL)
- Topical 0.1 % spray for nasal use
Adult Dosing
- Anaphylaxis IM 0.3–0.5 mg (1:1000) every 5–15 min, max 1 mg
- Cardiac arrest IV/IO 1 mg every 3–5 min, may repeat up to 10 mg total
- Severe asthma nebulized 0.1–0.5 mg diluted in 3 mL saline over 5 min
- Hypotension IV 0.05–0.5 µg/kg/min infusion titrated to response
- Ophthalmic surgery 1–2 drops (0.1 %) every 15–30 min
Pediatric Dosing
- Anaphylaxis IM 0.01 mg/kg (max 0.3 mg) every 5–15 min, repeat up to 0.5 mg total
- Cardiac arrest IV/IO 0.01 mg/kg (max 0.5 mg) every 3–5 min
- Asthma nebulized 0.01 mg/kg (max 0.25 mg) diluted in 3 mL saline
- Hypotension IV infusion 0.01–0.03 µg/kg/min titrated
- Ophthalmic 1–2 drops (0.1 %) q15‑30 min
Indications
- Acute anaphylaxis and systemic allergic reactions
- Cardiac arrest (asystole, pulseless electrical activity)
- Severe bronchospasm / status asthmaticus
- Hypotension/shock unresponsive to fluids
- Local vasoconstriction for ophthalmic surgery and nasal decongestion
Mechanism of Action
- Non‑selective α1, α2, β1 and β2 adrenergic agonist
- α1 → peripheral vasoconstriction, ↑ systemic vascular resistance
- β1 → ↑ heart rate, contractility, AV node conduction
- β2 → bronchodilation, uterine relaxation, glycogenolysis
Contraindications
- Known hypersensitivity to epinephrine
- Pheochromocytoma (risk of hypertensive crisis)
- Uncontrolled narrow‑angle glaucoma (ophthalmic)
- Severe peripheral vascular disease (relative)
- Use of non‑selective β‑blockers may blunt effect (relative)
Adverse Reactions
- Tachycardia, palpitations, arrhythmias
- Hypertension, headache, anxiety, tremor
- Hyperglycemia, lactic acidosis
- Nausea, vomiting, abdominal cramps
- Local tissue necrosis with extravasation
- Ocular irritation, burning, blurred vision
Drug Interactions
- β‑blockers → attenuated bronchodilation, risk of severe hypertension
Curated Content: Needs Vetting Before Put to Clinical Use