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 1^st 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