Epinephrine
Epinephrine
Epinephrine
(ep-ih- NEF-rin)
Pregnancy Category: C Adrenalin Chloride Solution Ana-Guard Bronkaid Mistometer Epi E-Z Pen Epi E-Z Pen Jr. Epipen Epipen Jr. Primatene Mist Solution Sus-Phrine (Both Rx and OTC)
Epinephrine bitartrate
Epinephrine bitartrate (Primatene Mist Suspension)
Epinephrine
(ep-ih- NEF-rin)
Pregnancy Category: C Asthmahaler Mist (OTC)
Epinephrine borate
Epinephrine borate
Epinephrine
(ep-ih- NEF-rin)
Pregnancy Category: C Epinal Ophthalmic Solution (Rx)
Epinephrine hydrochloride
Epinephrine hydrochloride (Adrenalin Chloride)
Epinephrine
(ep-ih- NEF-rin)
Pregnancy Category: C Adrenalin Chloride AsthmaNefrin Epifrin Glaucon microNefrin Nephron S-2 Inhalant (OTC) (Rx)

Classification: Adrenergic agent, direct-acting

See Also: See also Sympathomimetic Drugs .

Action/Kinetics: Causes marked stimulation of alpha, beta-1, and beta-2 receptors, causing sympathomimetic stimulation, pressor effects, cardiac stimulation, bronchodilation, and decongestion. It crosses the placenta but not the blood-brain barrier. Extreme caution must be taken never to inject 1:100 solution intended for inhalation--injection of this concentration has caused death. SC: Onset, 5-10 min; duration: 4-6 hr. Inhalation: Onset 1-5 min; duration: 1-3 hr. IM, Onset: variable; duration: 1-4 hr. Ineffective when given PO.

Uses: Inhalation: Temporary relief of shortness of breath, tightness of chest, and wheezing due to bronchial asthma. Postintubation and infectious coup. MicroNefrin is used for chronic obstructive lung disease, chronic bronchitis, broncheolitis, bronchial asthma, and other peripheral airway diseases.
Injection: Relieve respiratory distress in bronchial asthma, during acute asthma attacks, and for reversible bronchospasm in chronic bronchitis, emphysema, and other obstructive pulmonary diseases. Severe acute anaphylactic reactions, including anaphylactic shock and cardiac arrest, to restore cardiac rhythm. Allergic reactions caused by bees, wasps, hornets, yellow jackets, bumble bees, and fire ants; severe allergic reactions or anaphylaxis caused by allergy injections; allergic reactions due to exposure to pollens, dusts, molds, foods, drugs, and exercise. Severe, life-threatening asthma attacks with wheezing, dyspnea, and inability to breathe. Vasopressor in shock. Infiltration of tissue to delay absorption of drugs, including local anesthetics.
Ophthalmic: Hemostatic during ocular surgery; treatment of conjunctival congestion during surgery; to induce mydriasis during surgery; treat ocular hypertension during surgery. Adjunct in the treatment of open-angle glaucoma (may be used with miotics, beta blockers, hyperosmotic agents, or carbonic anhydrase inhibitors). To produce mydriasis; to treat conjunctivitis.
Topical: Control bleeding.
NOTE: Autoinjectors are available for emergency self-administration of first aid for anaphylactic reactions due to insect stings or bites, foods, drugs, and other allergens as well as idiopathic or exercise-induced anaphylaxis.

Additional Contraindications: Narrow-angle glaucoma. Use when wearing soft contact lenses (may discolor lenses). Aphakia. Lactation.

Special Concerns: May cause anoxia in the fetus. Safety and efficacy of ophthalmic products have not been determined in children; administer parenteral epinephrine to children with caution. Syncope may occur if epinephrine is given to asthmatic children. Administration of the SC injection by the IV route may cause severe or fatal hypertension or cerebrovascular hemorrhage. Epinephrine may temporarily increase the rigidity and tremor of parkinsonism. Use with caution and in small quantities in the toes, fingers, nose, ears, and genitals or in the presence of peripheral vascular disease as vasoconstriction-induced tissue sloughing may occur. May temporarily increase rigidity and tremor in Parkinson's disease.

Additional Side Effects: CV: Fatal ventricular fibrillation, cerebral or subarachnoid hemorrhage obstruction of central retinal artery. A rapid and large increase in BP may cause aortic rupture, cerebral hemorrhage, or angina pectoris. GU: Decreased urine formation, urinary retention, painful urination. CNS: Anxiety, fear, pallor. Parenteral use may cause or aggravate disorientation, memory impairment, psychomotor agitation, panic, hallucinations, suicidal or homicidal tendencies schizophrenic-type behavior. Miscellaneous: Prolonged use or overdose may cause elevated serum lactic acid with severe metabolic acidosis. At injection site: Bleeding, urticaria, wheal formation, pain. Repeated injections at the same site may cause necrosis from vascular constriction. Ophthalmic: Transient stinging or burning when administered, conjunctival hyperemia, brow ache, headache, blurred vision, photophobia, allergic lid reaction, ocular hypersensitivity, poor night vision, eye ache, eye pain. Prolonged ophthalmic use may cause deposits of pigment in the cornea, lids, or conjunctiva. When used for glaucoma in aphakic clients, reversible cystoid macular edema.

Laboratory Test Alterations: False + or BUN, fasting glucose, lactic acid, urinary catecholamines, glucose (Benedict's). Coagulation time. The drug may affect electrolyte balance.

Additional Drug Interactions: Alpha-adrenergic blocking agents / Antagonism of vasocontricting and hypertensive effects Antihistamines / Epinephrine effects potentiated Beta-adrenergic blocking agents / Possible initial hypertension followed by bradycardia Diuretics / Vascular response Ergot alkaloids / Reversal of epinephrine pressor effects General anesthetics (halothane, cyclopropane) / Sensitivity of myocardium to epinephrine arrhythmias Levothyroxine / Potentiation of epinephrine effects Nitrites / Reversal of epinephrine pressor effects Phenothiazines / Reversal of epinephrine pressor effects

How Supplied: Epinephrine: Aerosol: 0.2 mg/inh; Injection: 1:200 (5 mg/mL), 1:1000 (1 mg/mL), 1:10,000 (0.1 mg/mL); Kit: 0.5 mg/mL, 1 mg/mL; Solution for Inhalation (Racenephrine HCl): 2.25%. Epinephrine bitartrate: Metered dose inhaler: 0.35 mg/inh. Epinephrine hydrochloride: Solution for Inhalation: 1:100, 1:1000. Ophthalmic solution: 0.5%, 1%, 2%

Dosage
?Nebulization Bronchodilation.
Adults and children 4 years and older (for AsthmaNefrin, 12 years and older). Hand pump nebulizer: 0.5 mL (about 8-10 drops) of racemic epinephrine placed into the reservoir. Place the nebulizer nozzle into the partially opened mouth and squeeze the bulb 1-3 times. Inhale deeply. Give 2-3 additional inhalations if relief does not occur within 2-3 min. Can use 4-6 times/day but no more often than q 3 hr. Aerosol nebulizer: Add 0.5 mL (about 10 drops) of racemic epinephrine to 3 mL of diluent or 0.2-4 mL (about 4-8 drops) of MicroNefrin to 4.6-4.8 mL water. Give for 15 min q 3-4 hr.
?SC, IM Bronchodilation
Adults, initial: 0.2-1 mL (0.2-1 mg) of the 1:1000 solution SC or IM q 4 hr. Infants and children (except premature infants and full-term newborns): 0.01 mL/kg or 0.3 mL/m ² (0.1 mg/kg or 0.3 mg/m ²) SC. Do not exceed 0.5 mL (0.5 mg) in a single pediatric dose. Can repeat q 20 min to 4 hr, if necessary.
The dose of Ana-Guard is as follows. Adults and children over 12 years: 0.3 mL; 6-12 years old: 0.2 mL; 2-6 years old: 0.15 mL; infants to 2 years old: 0.05-0.1 mL. Give a second dose after 10 min if symptoms are not noticeably improved.
?IV Bronchodilation, hypersensitivity reactions.
Adults: 0.1-0.25 mg (1-2.5 mL) of the 1:10,000 solution injected slowly. Infants: 0.05 mg; may be repeated at 20-30 min intervals to manage asthma attacks. Neonates: 0.01 mg/kg.
Note: If the client is intubated, the IV dose of epinephrine can be given via the endotracheal tube directly into the bronchial tree as it is rapidly absorbed through the lung capillary bed.
?SC only, 1:200 Suspension Bronchodilation.
Adults: 0.1-0.3 mL (0.5-1.5 mg). Children, less than 30 kg: Maximum single dose is 0.15 mL (0.75 mg). Infants and children, 1 month to 12 years old: 0.005 mg/kg (0.025 mg/kg).
?Autoinjector, IM First aid for anaphylaxis.
The autoinjectors deliver a single dose of either 0.3 mg or 0.15 mg (for children) of epinephrine. In cases of a severe reaction, repeat injections may be necessary.
Vasopressor.
Adults, IM or SC, initial: 0.5 mg repeated q 5 min if needed; then, give 0.025-0.050 mg IV q 5-15 min as needed. Adults, IV, initial: 0.1-0.25 mg given slowly. May be repeated q 5-15 min as needed. Or, use IV infusion beginning with 0.001 mg/min and increasing the dose to 0.004 mg/min if needed. Pediatric, IM, SC: 0.01 mg/kg, up to a maximum of 0.3 mg repeated q 5 min if needed. Pediatric, IV: 0.01 mg/kg/5-15 min if an inadequate response to IM or SC administration is observed.
Cardiac stimulant.
Adults, intracardiac or IV: 0.1-1 mg repeated q 5 min if needed. Pediatric, intracardiac or IV: 0.005-0.01 mg/kg (0.15-0.3 mg/m ²) repeated q 5 min if needed; this may be followed by IV infusion beginning at 0.0001 mg/kg/min and increased in increments of 0.0001 mg/kg/min up to a maximum of 0.0015 mg/kg/min.
Adjunct to local anesthesia.
Adults and children: 0.1-0.2 mg in a 1:200,000-1:20,000 solution.
Adjunct with intraspinal anesthetics.
Adults: 0.2-0.4 mg added to the anesthetic spinal fluid.
?Solution Antihemorrhagic, mydriatic.
Adults and children, intracameral or subconjunctival: 0.01%-0.1% solution.
Topical antihemorrhagic.
Adults and children: 0.002%-0.1% solution.
Nasal decongestant.
Adults and children over 6 years of age: Apply 0.1% solution as drops or spray or with a sterile swab as needed.
?Borate Ophthalmic Solution, Hydrochloride Ophthalmic Solution Glaucoma.
Adults: 1-2 gtt into affected eye(s) 1-2 times/day. Determine frequency of use by tonometry. Dosage has not been established in children.