Name

epinephrine (Adrenalin®)

Class

Sympathomimetic

Description/Mechanism

Epinephrine stimulates alpha, beta 1 and beta 2 adrenergic receptors in dose-related fashion. Rapid injection produces a rapid increase in blood pressure, ventricular contractility, and heart rate. In addition, epinephrine causes vasoconstriction in the arterioles of the skin and mucosa. It antagonizes the effects of histamine by decreasing its release and decreasing membrane permeability.

Onset

(SQ) 5-10 minutes

(IV, ET) 1-2 minutes

Duration

5-10 minutes

Indications

Bronchoconstriction

Anaphylaxis

All forms of cardiac arrest

Profound symptomatic bradycardia

Contraindications

Hypersensitivity

Hypovolemic shock

Coronary insufficiency

Hypertension

Adverse Reactions

Headache, nausea, restlessness

Weakness, dysrhythmias, hypertension

Precipitation of angina pectoris

Drug Interactions

MAO inhibitors and bretylium may potentiate the effect of epinephrine

Beta adrenergic antagonists may blunt inotropic response.

Sympathomimetics and phosphodiesterase inhibitors may exacerbate dysrhythmia response.

May be deactivated by alkaline solutions (sodium bicarbonate, Furosemide)

Supplied

1mg/ml (1:1,000)

0.1mg/ml (1:10,000) ampule and prefilled syringes

Dose/Administration

Cardiac Arrest (all rhythms)

Adult

1mg IV or 2 – 2 ½ times the IV dose via ET, repeat every 3-5 minutes.

Pediatric

Initial Dose:

• IV/IO 0.01mg/kg (1:10,000)
• ET dose is 0.1 ml/kg (1:1,000) diluted to 3-5 ml

Repeat Doses:

• IV/IO/ET 0.1ml/kg (1:1,000) every 3-5 minutes

Allergic Reactions/Bronchoconstriction

Adult

Moderate allergice reaction/bronchoconstriction

• 0.3-0.5mg (1:1,000) SQ

Anaphylaxis (Severe allergic reaction)

• 1 mg (1:10,000) slow IV

Pediatric

Moderate allergice reaction/bronchoconstriction

• 0.01 ml/kg (1:1,000) SQ

Anaphylaxis (Severe allergic reaction)

• 0.05-0.5 mcg/kg/min INFUSION

Infusion

Adult

2-10 mcg/min titrated to increased HR/BP

Suggested concentration: mix 1 mg in 500 ml solution to get 2 mcg/ml concentration

Pediatric

0.1 mcg/kg/min titrated to increase HR/BP

Suggested concentration: mix 0.6 mg/kg to create a 100 ml solution.

Special Consideration

Pregnancy Safety: Category C

Do not use prefilled syringes for epinephrine infusions

Syncope has occurred following epinephrine administration to asthmatic children.

May increase myocardial oxygen demand