Drugs: EPINEPHrine
SAFETY ALERT!
Latest Update
8/14/2024
NEW AVAILABLE FORM
Nasal spray: 2 mg/01.mL per single-dose spray
NEW BRAND
Neffy
NEW INDICATIONS & DOSAGES
Type I allergic reactions, including anaphylaxis
Adults and children weighing 30 kg or more: One spray (2 mg) into one nostril. If no clinical response or worsening symptoms, repeat dose after 5
minutes in the same nostril.
EPINEPHrine
((adrenaline))
ep-i-NEF-rin
EPINEPHrine hydrochloride
Adrenaclick, , Adrenalin, , Auvi-Q, , EpiPen, , EpiPen Jr, , Symjepi
Therapeutic class: Vasopressors
Pharmacologic class: Adrenergics
Available Forms
Injection: 0.1 mg/mL; 1 mg/mL
Injection (premixed for infusion): 2 mg; 4 mg; 5 mg; or 8 mg in 250 mL NSS
Injection device: 0.15 mg/delivery; 0.3 mg/delivery
Indications & Dosages
Anaphylaxis
Adults and children weighing 30 kg or more: 0.3 to 0.5 mg IM or subcut, repeated every 5 to 10 minutes
as needed; maximum single dose, 0.5 mg. Or, 0.3 mg IM or subcut with autoinjector to maximum of 0.5
mg per injection, repeated every 5 to 10 minutes as needed.
Children weighing 15 to less than 30 kg: 0.01 to 0.15 mg/kg IM or subcut to maximum of 0.3 mg per
injection, repeated every 5 to 10 minutes as needed. May use 0.15 mg autoinjector.
Children weighing 7.5 to less than 15 kg: 0.01 mg/kg IM or subcut to maximum of 0.3 mg per injection,
repeated every 5 to 10 minutes as needed.
Hypotension associated with septic shock
Adults: 0.05 to 2 mcg/kg/minute IV infusion titrated to achieve desired mean arterial pressure. May
adjust dosage every 10 to 15 minutes in increments of 0.05 to 0.2 mcg/kg/minute to achieve desired BP
goal. Titrate to patient response. After hemodynamic stabilization, wean incrementally over time, such as
by decreasing epinephrine dosages every 10 minutes, to determine patient tolerance.
Cardiac resuscitation
Adults: 1 mg IV or intraosseously every 3 to 5 minutes until return of spontaneous circulation.
Children: 0.01 mg/kg IV or intraosseously, up to 1 mg, repeated every 3 to 5 minutes until return of
spontaneous circulation.
Administration
Discard solution if it’s discolored or contains precipitate.
IV
Keep solution in light-resistant container, and don’t remove before use.
For IV infusion, just before use, mix with D5W, combinations of dextrose in saline solution, or NSS as
ordered or use premixed bags. Concentration may vary by indication.
Monitor BP, HR, and ECG when therapy starts and frequently thereafter.
Discard solution after 4 hours at room temperature or after 24 hours if refrigerated.
When giving as a continuous infusion, use a central line with an infusion pump. Extravasation can cause
tissue necrosis.
Don’t give autoinjectors IV.
Incompatibilities: Don’t mix with alkaline solutions (such as sodium bicarbonate). Consult a drug
compatibility reference for more information.
IM
Give in anterolateral aspect of thigh, through clothing if necessary. Repeat injection every 5 to 15
minutes, if necessary.
Massage site after IM injection to counteract vasoconstriction. Repeated local injection can cause
necrosis at injection site.
Subcutaneous
Follow manufacturer’s instructions for administration.
Store drug at room temperature. Don’t freeze.
Protect drug from light.
Action
Potentiates alpha and beta receptors. Relaxes bronchial smooth muscle by stimulating beta2 receptors.
Stimulates alpha and beta receptors in the sympathetic nervous system.
Route Onset Peak Duration
IV Immediate 5 min Short
IM Rapid Unknown 1–4 hr
Subcut 5–15 min 30 min 1–4 hr
Half-life: IV injection, less than 5 minutes. IM and subcut, unknown.
Adverse Reactions
CNS: drowsiness, headache, nervousness, tremor, cerebral hemorrhage, stroke, vertigo, pain,
disorientation, agitation, asthenia, tremor, anxiety, apprehensiveness, fear, restlessness, dizziness, weakness,
somnolence, paresthesia, subarachnoid hemorrhage.
CV: palpitations, ventricular fibrillation, shock, widened pulse pressure, HTN, MI, tachycardia, anginal
pain, arrhythmias, altered ECG (including decreased T-wave amplitude), limb ischemia.
GI: nausea, vomiting.
GU: kidney insufficiency.
Metabolic: hyperglycemia, hypoglycemia, hypokalemia, lactic acidosis, insulin resistance.
Respiratory: dyspnea, pulmonary edema, respiratory difficulties.
Skin: urticaria, hemorrhage or necrosis at injection site, pallor, diaphoresis.
Interactions
Drug-drug
Alpha blockers (phentolamine): May cause hypotension from unopposed beta-adrenergic effects. Avoid use
together.
Antihistamines, thyroid hormones: When given with sympathomimetics, may cause severe adverse cardiac
effects. Avoid use together.
Beta-adrenergic blockers (propranolol): May increase BP and decrease HR. Use together cautiously.
Beta blockers (carteolol, nadolol, penbutolol, pindolol, pindolol, timolol): May cause HTN, followed by
bradycardia. Stop beta blocker 3 days before starting epinephrine.
Cardiac glycosides, diuretics, general anesthetics (halogenated hydrocarbons): May increase risk of
ventricular arrhythmias. Monitor ECG closely.
Doxapram, methylphenidate: May enhance CNS stimulation or pressor effects. Monitor patient closely.
Ergot alkaloids: May decrease vaso-constrictor activity. Monitor patient closely.
Levodopa: May enhance risk of arrhythmias. Monitor ECG closely.
MAO inhibitors: May increase risk of hypertensive crisis. Monitor BP closely.
Potassium-depleting diuretics, corticosteroids, theophylline: May increase hypokalemic effects of
epinephrine. Monitor potassium level.
TCAs: May potentiate pressor response and cause arrhythmias. Use together cautiously.
Effects on Lab Test Results
May increase BUN, glucose, and lactic acid levels.
May decrease potassium level.
May increase or decrease glucose level.
Interferes with tests for urinary catecholamines.
Contraindications & Cautions
There are no absolute contraindications in lifesaving situations.
Contraindicated in patients with shock (other than anaphylactic shock), organic brain damage, HF,
cardiac dilation, arrhythmias, coronary insufficiency, or cerebral arteriosclerosis.
Contraindicated in patients receiving general anesthesia with halogenated hydrocarbons or cyclopropane
and in patients in labor (may delay second stage).
Some products contain sulfites. Use is contraindicated in patients with sulfite allergies, except when
epinephrine is used to treat serious allergic reactions or other emergency situations.
Don’t use epinephrine with local anesthetic in fingers, toes, ears, nose, or genitalia.
Use cautiously in patients with longstanding bronchial asthma or emphysema who have developed
degenerative heart disease.
Use cautiously in older adults and in patients with hyperthyroidism, CV disease, HTN, psychoneurosis,
pheochromocytoma, and diabetes.
Dialyzable drug: Unknown.
Overdose Signs & Symptoms: Precordial distress, vomiting, headache, dyspnea, HTN, peripheral
vascular constriction, pulmonary edema, cerebral hemorrhage, arrhythmias, extreme pallor and coldness
of the skin, metabolic acidosis, kidney failure.
Pregnancy-Lactation-Reproduction
Use during pregnancy only if potential benefit justifies fetal risk.
Parenteral administration of epinephrine, if used to support BP during spinal anesthesia for delivery, can
cause accelerated fetal HR and shouldn’t be used in obstetric patients when BP exceeds 130/80 mm Hg.
It isn’t known if drug appears in human milk. Use cautiously during breastfeeding.
Nursing Considerations
Use phentolamine to prevent tissue sloughing and necrosis if epinephrine extravasation occurs.
In patients with Parkinson disease, drug temporarily increases rigidity and tremors.
Epinephrine is drug of choice in emergency treatment of acute anaphylactic reactions.
Closely observe patient for and notify prescriber of adverse reactions; adjusting dosage or stopping drug
may be necessary.
If BP increases sharply, give rapid-acting vasodilators, such as nitrates and alpha blockers, to counteract
the marked pressor effect of large doses.
Oxidizing products, such as iodine, chromates, nitrites, oxygen, and salts of easily reducible metals (such
as iron), rapidly destroy drug.
When treating patient with reactions caused by other drugs given IM or subcut, inject this drug into the
site where the other drug was given to minimize further absorption.
Look alike-sound alike: Don’t confuse epinephrine with ephedrine or norepinephrine.
Patient Teaching
If patient has acute hypersensitivity reactions (such as to bee stings), it may be necessary to teach
patient how to self-inject.
Instruct patient in autoinjector use and disposal. Tell patient to give autoinjector in outer thigh and not
into buttock.
Caution patient or caregiver to only give two sequential doses unless under direct medical supervision.
Patient should seek immediate medical care for acute hypersensitivity reactions.
Tell patient to promptly report all adverse reactions.
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