Ephedrine sulfate
Ephedrine sulfate
Ephedrine sulfate
(eh- FED-rin)
Pregnancy Category: C Nasal decongestants: Kondon's Nasal Pretz-D Vatronol Nose Drops (OTC). Systemic: Ephedrine Sulfate ( Rx: Injection; OTC: Oral dosage forms)

Classification: Adrenergic agent, direct- and indirect-acting

See Also: See also Sympathomimetic Drugs .

Action/Kinetics: Releases norepinephrine from synaptic storage sites. Has direct effects on alpha, beta-1, and beta-2 receptors, causing increased BP due to arteriolar constriction and cardiac stimulation, bronchodilation, relaxation of GI tract smooth muscle, nasal decongestion, mydriasis, and increased tone of the bladder trigone and vesicle sphincter. It may also increase skeletal muscle strength, especially in myasthenia clients. Significant CNS effects include stimulation of the cerebral cortex and subcortical centers. Hepatic glycogenolysis is increased, but not as much as with epinephrine. More stable and longer-lasting than epinephrine. Rapidly and completely absorbed following parenteral use. Onset, IM: 10-20 min; PO: 15-60 min; SC: > 20 min. Duration, IM, SC: 30-60 min; PO: 3-5 hr. t 1/2, elimination: About 3 hr when urine is at a pH of 5 and about 6 hr when urinary pH is 6.3. Excreted mostly unchanged through the urine (rate dependent on urinary pH--increased in acid urine).

Uses: PO: Temporary relief of shortness of breath, tightness of chest, and wheezing due to bronchial asthma. Parenteral: Allergic disorders, including bronchial asthma. Vasopressor in shock. Nasal: Nasal congestion in vasomotor rhinitis, acute sinusitis, hay fever, and acute coryza.

Additional Contraindications: Angle closure glaucoma, anesthesia with cyclopropane or halothane, thyrotoxicosis, diabetes, obstetrics where maternal BP is greater than 130/80. Lactation.

Special Concerns: Geriatric clients may be at higher risk to develop prostatic hypertrophy. May cause hypertension resulting in intracranial hemorrhage or anginal pain in clients with coronary insufficiency or ischemic heart disease.

Additional Side Effects: CNS: Nervousness, shakiness, confusion, delirium, hallucinations. Anxiety and nervousness following prolonged use. CV: Precordial pain, excessive doses may cause hypertension sufficient to result in cerebral hemorrhage. GU: Difficult and painful urination, urinary retention in males with prostatism, decrease in urine formation. Miscellaneous: Pallor, respiratory difficulty, hypersensitivity reactions. Abuse: Prolonged abuse can cause an anxiety state, including symptoms of paranoid schizophrenia, tachycardia, poor nutrition and hygiene, dilated pupils, cold sweat, and fever.

Additional Drug Interactions: Alpha-adrenergic blockers / Antagonism of vasoconstricting and hypertensive effects of ephedrine Dexamethasone / Dexamethasone effect Diuretics / Diuretics response to sympathomimetics Furazolidone / Pressor effect possible hypertensive crisis and intracranial hemorrhage Guanethidine / Guanethidine effect by displacement from its action site Halothane / Serious arrhythmias R/T sensitization of myocardium to sympathomimetics by halothane MAO Inhibitors / Pressor effect possible hypertensive crisis and intracranial hemorrhage Methyldopa / Effect of ephedrine in methyldopa-treated clients Oxytocic drugs / Severe persistent hypertension

How Supplied: Capsule:25 mg; Injection: 50 mg/mL; Spray: 0.25%

Dosage
?Capsules Bronchial asthma, systemic nasal decongestant.
Adults and children over 12 years of age: 12.5-25 mg 4 hr, not to exceed 150 mg in 24 hr. Pediatric, under 12 years: Consult a provider.
?SC, IM, Slow IV Bronchial asthma.
Adults: 25-50 mg SC or IM; or, 5-25 mg by slow IV repeated q 5-10 min, if needed. Children: 0.5 mg/kg or 16.7 mg/m ² SC or IM q 4-6 hr.
Vasopressor.
Adults: 25-50 mg (IM or SC) or 5-25 mg (by slow IV push) repeated at 5- to 10-min intervals, if necessary. Absorption following IM is more rapid than following SC use. Pediatric (IM): 16.7 mg/m ² q 4-6 hr.
?Topical (0.25% Spray) Nasal decongestant.
Adults and children over 6 years: 2-3 gtt of solution or small amount of jelly in each nostril q 4 hr. Do not use topically for more than 3 or 4 consecutive days. Do not use in children under 6 years of age unless ordered by provider.