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Epinephrine

    Brands

    DEA Class;  Rx

    Common Brand Names; EpiPen, EpiPen Jr, Auvi-Q, Symjepi, Adrenalin, Primatene Mist, AsthmaNefrin, S2

    • Alpha/Beta Adrenergic Agonists; 
    • Alpha/Beta Agonists

    Nonselective adrenergic agonist
    Used for hemodynamic/inotropic support and bronchodilation
    Drug of choice for anaphylaxis; not routinely recommended for asthma

    Indicated to increase mean arterial blood pressure in adults with hypotension associated with septic shock

    Indicated in emergency treatment of allergic reactions (Type I) including anaphylaxis

    Induction and maintenance of mydriasis during intraocular surgery

    Use only preservative-free vials without tartaric acid

    Indicated for temporary relief of mild symptoms of intermittent asthma (eg, wheezing, chest tightness, dyspnea)

    Indicated for temporary relieve of symptoms associated with bronchial asthma (eg, shortness of breath, chest tightening, wheezing)

    There are no contraindications for life-threatening situations

    Nonanaphylactic shock

    Narrow-angle glaucoma

    Coadministration during genral anesthesia with halogenated hydrocarbons or cyclopropane

    Labor

    Situations where vasopressors may be contraindicated, including thyrotoxicosis, diabetes

    Maternal blood pressure in excess of 130/80 mm Hg in hypertension and other cardiovascular disorders

    • Angina
    • Anxiety
    • Apprehensiveness
    • Cardiac arrhythmias
    • Dizziness
    • Dyspnea
    • Flushing
    • Headache
    • Hypertension
    • Nausea
    • Nervousness
    • Pallor
    • Palpitations
    • Respiratory difficulties
    • Restlessness
    • Stress cardiomyopathy
    • Sweating
    • Tachycardia
    • Tremor
    • Vasoconstriction
    • Vomiting
    • Weakness

    Use caution in patients with cardiac disease, angina (especially with history of CAD) or that are receiving drugs that sensitize the myocardium; treatment may induce cardiac arrhythmias

    Pulmonary edema may occur as the result of cardiac stimulation and peripheral constriction

    Decreased urine output may occur as the result of renal blood vessel constriction

    Use caution in cerebrovascular insufficiency

    Use with caution in patients with hypertension, diabetes mellitus, thyroid disease, prostatic hypertrophy, geriatric patients, pregnancy, and previous hospitalization for asthma

    Rapid IV administration, although necessary in pulesless arrest, may cause death from cerebrovascular hemorrhage or cardiac arrhythmias

    Patients that are sulfite-sensitive, should still be treated during a serious allergic reaction or other emergency even if products available contain sulfites

    May cause worsening of symptoms in patients with Parkinson disease

    Avoid extravasation; ensure proper needle or catheter placement prior to and during infusion

    Correct blood volume depletion before administering any vasopressor

    During pregnancy, anaphylaxis can be catastrophic and can lead to hypoxic-ischemic encephalopathy and permanent central nervous system damage or death in the mother and, more commonly, in the fetus or neonate

    There is no information regarding presence of epinephrine in human milk or effects on the breastfed infant or on milk production

    Adults

    Dependent on route of administration and indication for therapy.

    Geriatric

    Dependent on route of administration and indication for therapy.

    Adolescents

    Dependent on route of administration and indication for therapy. For CPR, 0.01 mg/kg/dose (Max: 1 mg/dose) IV/IO and 0.1 mg/kg/dose (Max: 2.5 mg/dose) ET. For anaphylaxis, 0.01 mg/kg/dose (Max: 0.5 mg/dose IM/subcutaneously and 1 mg/dose IV). For bronchospasm, 0.01 mg/kg/dose (Max: 0.5 mg/dose) IM/subcutaneously or 8 oral inhalations/24 hours of epinephrine 0.125 mg oral inhalation (e.g., Primatene Mist inhaler, non-prescription).

    Children
    12 years: Dependent on route of administration and indication for therapy. For CPR, 0.01 mg/kg/dose (Max: 1 mg/dose) IV/IO and 0.1 mg/kg/dose (Max: 2.5 mg/dose) ET. For anaphylaxis, 0.01 mg/kg/dose (Max: 0.5 mg/dose IM/subcutaneously and 1 mg/dose IV). For croup, 0.5 mL/dose of a 2.25% racemic epinephrine solution. For bronchospasm, 0.01 mg/kg/dose (Max: 0.5 mg/dose) IM/subcutaneously or 8 oral inhalations/24 hours of epinephrine 0.125 mg oral inhalation (e.g., Primatene Mist inhaler, non-prescription).
    4 to 11 years weighing more than 30 kg: Dependent on route of administration and indication for therapy. For CPR, 0.01 mg/kg/dose (Max: 1 mg/dose) IV/IO and 0.1 mg/kg/dose (Max: 2.5 mg/dose) ET. For anaphylaxis, 0.01 mg/kg/dose (Max: 0.5 mg/dose IM/subcutaneously and 1 mg/dose IV). For croup, 0.5 mL/dose of a 2.25% racemic epinephrine solution. For bronchospasm, 0.01 mg/kg/dose (Max: 0.5 mg/dose) IM/subcutaneously.
    Infants

    Dependent on route of administration and indication for therapy. For CPR, 0.01 mg/kg/dose (Max: 1 mg/dose) IV/IO and 0.1 mg/kg/dose (Max: 2.5 mg/dose) ET. For anaphylaxis, 0.01 mg/kg/dose (Max: 0.3 mg/dose IM/subcutaneously and 1 mg/dose IV). For croup, 0.5 mL/dose of a 2.25% racemic epinephrine solution. For bronchospasm, 0.01 mg/kg/dose (Max: 0.5 mg/dose subcutaneously and 0.3 mg/dose IM).

    Neonates

    Dependent on route of administration and indication for therapy. For CPR, 0.03 mg/kg/dose IV and 0.1 mg/kg/dose ET.

    Epinephrine

    prefilled autoinjector or syringe for SC/IM use

    • 0.3mg/0.3mL (EpiPen, Auvi-Q, Symjepi)

    injectable solution

    • 0.1mg/mL (1mg/10mL)
    • 1mg/mL
    • Note: Ratio expression of epinephrine concentrations are prohibited on drug labels; however, some may remain in inventory (1:1000 = 1mg/mL; 1:10,000 = 0.1mg/mL)

    suspension for aerosol inhalation

    • 0.125mg/actuation

    solution for nebulization

    • 11.25mg/0.5mL (2.25% as 1.125% dextro-epinephrine and 1.125% levo-epinephrine)