Epinephrine (Adrenalin, Sus-Phrine)

Category:

  • Nervous system

Description:

  • Vasopressor, antiglaucoma agent, bronchodilator, decongestant

Indications:

  • Cardiac arrest, acute asthmatic attacks

  • Nasal congestion

  • Open-angle glaucoma

  • Anaphylactic reactions

Contraindications:

  • Cardiac dysrhythmias, angle-closure glaucoma, local anesthetic of fingers and toes

  • General anesthesia with halocarbons or cyclopropane, organic brain damage, labor, coronary insufficiency

Precautions:

  • Pregnancy category C; excreted in breast milk; use caution in nursing mothers

  • Elderly, cardiovascular disease, hypertension, diabetes, hyperthyroidism

  • Psychotic individuals, thyrotoxicosis, parkinsonism

Adverse Reactions (Side Effects):

  • CNS: anxiety, dizziness, fear, headache, hemiplegia, subarachnoid hemorrhage, tremor, weakness, restlessness

  • CV: anginal pain, dysrhythmias, hypertension, palpitations

  • GI: nausea, vomiting

  • GU: urinary retention

  • RESP: respiratory difficulty

  • SKIN: hemorrhage at injection site, pallor, urticaria, wheal  

Dosage:

Administered topically, intravenously, intramuscularly, subcutaneously, inhalation

  • Adult:           

    • Bronchodilator:  

      • IM/SC (1:1000) 0.1-0.5mg every 12-15 minutes up to 4 hours

      • IV 0.1-0.25mg (single dose max 1mg); SC susp (1:200) 0.5-1.5mg (0.1-0.3 ml)

      • NEB instill 8-15 drops into nebulizer reservoir, administer 1-3 inhalations 4-6 times daily

      • MDI 1-2 puffs at 1st sign of bronchospasm

    • Cardiac arrest:  

      • IV/intracardiac 0.1-1mg (1-10 ml of 1/10,000 dilution) every 3-5 minutes as needed

      • IV intermediate dose 2-5mg every 3-5 minutes; escalating dose 1-3-5mg 3 minutes apart; high dose 0.1 mg/kg every 3-5 minutes

      • Intratracheal 1mg every 3-5 minutes (higher doses, eg. 0.1 mg/kg, should be considered only after 1mg doses have failed

    • Hypotension: 

      • IV INF 1-4 mcg/min

    • Anaphylactic reaction: 

      • IM/SC 0.2-0.5mg every 20 minutes for 4 hours (single dose max 1mg)

    • Glaucoma:  

      • Ophth 1 drop 1-2 times daily

    • Nasal congestion:  

      • Intranasal apply as needed; do not use for > 3-5 days

  • Child: 

    • Bronchodilator:  

      • SC 10 mcg/kg (0.1 ml/kg of 1:1000), max single dose 0.5mg

      • Susp (1:200) 0.005 ml/kg/dose (0.025 mg/kg/dose) every 6 hours, max 0.15 ml (0.75mg) per dose

      • NEB 0.25-0.5 ml of 2.25% racemic epinephrine solution diluted in 3 ml NS every 1-4 hours

    • Cardiac arrest:  

      • IV/intratracheal 0.01 mg/kg (0.1 ml/kg) of 1:10,000 solution every 3-5 minutes as needed, max 5 ml

    • Refractory hypotension:  

      • IV INF 0.1-4 mcg/kg/min

    • Anaphylactic reaction: 

      • SC 0.01 mg/kg every 15 minutes for 2 doses then every 4 hours as needed, max 0.5mg per dose

    • Nasal congestion: 

      • (> 6 years) intranasal apply as needed

  • Neonate:           

    • Cardiac arrest:  

      • IV/intratracheal 0.01-0.03 mg/kg (0.1-0.3 ml/kg) of 1:10,000 solution every 3-5 minutes as needed

 
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