Drug Name

Generic Name : epinephrine (adrenaline), epinephrine bitartrate, epinephrine borate,

epinephrine hydrochloride

Brand Name:

Aerosol: Primatene Mist
Ophthalmic solution: Epinal
Injection, OTC nasal solution: Adrenalin Chloride
Insect-sting emergencies: EpiPen Auto-Injector (delivers 0.3 mg IM adult dose),
EpiPen Jr. Auto-Injector (delivers 0.15 mg IM for children)
OTC solutions for nebulization: AsthmaNefrin, microNefrin, Nephron, S2
Classification: Sympathomimetic, Alpha-adrenergic agonist, Beta1- and beta2-adrenergic
agonist, Cardiac stimulant, Vasopressor, Bronchodilator, Antasthmatic, Nasal decongestant,
Mydriatic

Pregnancy Category C


Dosage & Route

ADULTS

Epinephrine injection

Cardiac arrest: 0.51 mg (510 mL of 1:10,000 solution) IV or by intracardiac
injection into left ventricular chamber; during resuscitation, 0.5 mg q 5 min.
Intraspinal

0.20.4 mL of a 1:1,000 solution added to anesthetic spinal fluid mixture.

Other use with local anesthetic: Concentrations of 1:100,0001:20,000 are usually
used.
1:1,000 solution

Respiratory distress: 0.30.5 mL of 1:1,000 solution (0.30.5 mg), subcutaneously
or IM, q 20 min for 4 hr.
1:200 suspension (for subcutaneous administration only)

Respiratory distress: 0.10.3 mL (0.51.5 mg) subcutaneously.
Inhalation (aerosol)

Begin treatment at first symptoms of bronchospasm. Individualize dosage. Wait 15
min between inhalations to avoid overdose.
Inhalation (nebulization)

Place 815 drops into the nebulizer reservoir. Place nebulizer nozzle into partially
opened mouth. Patient inhales deeply while bulb is squeezed one to three times. If
no relief in 5 min, give 23 additional inhalations. Use four to six times per day
usually maintains comfort.
Topical nasal solution

Apply locally as drops or spray or with a sterile swab, as required.
Ophthalmic solution

Vasoconstriction, mydriasis: Instill 12 drops into the eye or eyes; repeat once if
necessary.
PEDIATRIC PATIENTS

Epinephrine injection

1:1,000 solution, children and infants except premature infants and full-term
newborns: 0.01 mg/kg or 0.3 mL/m2 (0.01 mg/kg or 0.3 mg/m2) subcutaneously q
20 min (or more often if needed) for 4 hr. Do not exceed 0.5 mL (0.5 mg) in a single
dose.
1:200 suspension, infants and children (1 mo1 yr): 0.005 mL/kg (0.025 mg/kg)
subcutaneously.
Children < 30 kg: Maximum single dose is 0.15 mL (0.75 mg). Administer
subsequent doses only when necessary and not more often than q 6 hr.
Topical nasal solution

> 6 yr: Apply locally as drops or spray or with a sterile swab, as required.
Ophthalmic solutions

Safety and efficacy for use in children not established.
GERIATRIC PATIENTS OR PATIENTS WITH RENAL FAILURE

Use with caution; patients > 60 yr are more likely to develop adverse effects.

Therapeutic actions

Epinephrine, an active principle of the adrenal medulla, is a direct-acting
sympathomimetic. It stimulates - and -adrenergic receptors resulting in relaxation
of smooth muscle of the bronchial tree, cardiac stimulation and dilation of skeletal
muscle vasculature. It is frequently added to local anaesthetics to retard diffusion
and limit absorption, to prolong the duration of effect and to lessen the danger of
toxicity.

Indications

IV: In ventricular standstill after all other measures have failed to restore circulation,
given by trained personnel by intracardiac puncture and intramyocardial injection;
treatment and prophylaxis of cardiac arrest and attacks of transitory AV heart block
with syncopal seizures (Stokes-Adams syndrome); syncope due to carotid sinus
syndrome; acute hypersensitivity (anaphylactoid) reactions, serum sickness,
urticaria, angioneurotic edema; in acute asthmatic attacks to relieve bronchospasm
not controlled by inhalation or subcutaneous injection; relaxation of uterine
musculature; additive to local anesthetic solutions for injection to prolong their
duration of action and limit systemic absorption
Injection: Relief from respiratory distress of bronchial asthma, chronic bronchitis,
emphysema, other COPDs
Aerosols and solutions for nebulization: Temporary relief from acute attacks of
bronchial asthma, COPD
Topical nasal solution: Temporary relief from nasal and nasopharyngeal mucosal
congestion due to a cold, sinusitis, hay fever, or other upper respiratory allergies;
adjunctive therapy in middle ear infections by decreasing congestion around
eustachian ostia
0.1% ophthalmic solution: Conjunctivitis, during eye surgery to control bleeding, to
produce mydriasis

Adverse effects

CNS effects; GI disturbances; epigastric pain; CV disorders; difficulty in micturition
with urinary retention; dyspnoea; hyperglycaemia; sweating; hypersalivation;
weakness, tremors; coldness of extremities; hypokalaemia. Gangrene, tissue
necrosis and sloughing (extravasation) when used in addition to local anaesthetics.
Eye drops: Severe smarting, blurred vision, photophobia; naso-lachrymal ducts
obstruction. Oedema, hyperaemia and inflammation of the eyes with repeated
administration.

Contraindications

Preexisting hypertension; occlusive vascular disease; angle-closure glaucoma (eye
drops); hypersensitivity; cardiac arrhythmias or tachycardia. When used in addition
to local anaesthetics: Procedures involving digits, ears, nose, penis or scrotum.

Nursing considerations

Assessment

History: Allergy or hypersensitivity to epinephrine or components of drug
preparation; narrow-angle glaucoma; shock other than anaphylactic shock;
hypovolemia; general anesthesia with halogenated hydrocarbons or cyclopropane;
organic brain damage, cerebral arteriosclerosis; cardiac dilation and coronary
insufficiency; tachyarrhythmias; ischemic heart disease; hypertension; renal
impairment; COPD; diabetes mellitus; hyperthyroidism; prostatic hypertrophy;
history of seizure disorders; psychoneuroses; labor and delivery; lactation; contact
lens use, aphakic patients (ophthalmic preparations)
Physical: Weight; skin color, T, turgor; orientation, reflexes, IOP; P, BP; R,
adventitious sounds; prostate palpation, normal urine output; urinalysis, renal
function tests, blood and urine glucose, serum electrolytes, thyroid function tests,
ECG
Interventions

WARNING: Use extreme caution when calculating and preparing doses; epinephrine
is a very potent drug; small errors in dosage can cause serious adverse effects.
Double-check pediatric dosage.
Use minimal doses for minimal periods of time; "epinephrine-fastness" (a form of
drug tolerance) can occur with prolonged use.
Protect drug solutions from light, extreme heat, and freezing; do not use pink or
brown solutions. Drug solutions should be clear and colorless (does not apply to
suspension for injection).
Shake the suspension for injection well before withdrawing the dose.
Rotate subcutaneous injection sites to prevent necrosis; monitor injection sites
frequently.
WARNING: Keep a rapidly acting alpha-adrenergic blocker (phentolamine) or a
vasodilator (a nitrate) readily available in case of excessive hypertensive reaction.
WARNING: Have an alpha-adrenergic blocker or facilities for intermittent positive
pressure breathing readily available in case pulmonary edema occurs.
WARNING: Keep a beta-adrenergic blocker (propranolol; a cardioselective beta-
adrenergic blocker, such as atenolol, should be used in patients with respiratory
distress) readily available in case cardiac arrhythmias occur.
Do not exceed recommended dosage of inhalation products; administer pressurized
inhalation drug forms during second half of inspiration, because the airways are open
wider and the aerosol distribution is more extensive. If a second inhalation is
needed, administer at peak effect of previous dose, 35 min.
Use topical nasal solutions only for acute states; do not use for longer than 35
days, and do not exceed recommended dosage. Rebound nasal congestion can occur
after vasoconstriction subsides.
Teaching points

Do not exceed recommended dosage; adverse effects or loss of effectiveness may
result. Read the instructions that come with respiratory inhalant products, and
consult your health care provider or pharmacist if you have any questions.
To give eye drops: Lie down or tilt head backward, and look up. Hold dropper above
eye; drop medicine inside lower lid while looking up. Do not touch dropper to eye,
fingers, or any surface. Release lower lid; keep eye open, and do not blink for at
least 30 seconds. Apply gentle pressure with fingers to inside corner of the eye for
about 1 minute; wait at least 5 minutes before using other eye drops.
You may experience these side effects: Dizziness, drowsiness, fatigue, apprehension
(use caution if driving or performing tasks that require alertness); anxiety, emotional
changes; nausea, vomiting, change in taste (eat frequent small meals); fast heart
rate. Nasal solution may cause burning or stinging when first used (transient).
Ophthalmic solution may cause slight stinging when first used (transient); headache
or brow ache (only during the first few days).
Report chest pain, dizziness, insomnia, weakness, tremor or irregular heart beat
(respiratory inhalant, na