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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

 


The information contained here is an abbreviated summary. For more detailed and complete information, consult the manufacturer's product information sheets or standard textbooks

Source: Operational Medicine 2001,  Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300

This information is provided by The Brookside Associates.  The Brookside Associates, LLC. is a private organization, not affiliated with any governmental agency. The opinions presented here are those of the author and do not necessarily represent the opinions of the Brookside Associates or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the US Department of Defense or the Brookside Associates. All material presented here is unclassified.

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