26/7/2021 EpiPen, Auvi-Q (epinephrine) dosing, indications, interactions, adverse effects, and more

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epinephrine (Rx)
Brand and Other Names: EpiPen, EpiPen Jr, Auvi-Q, Symjepi, Adrenalin
Classes: Alpha/Beta Adrenergic Agonists;
Alpha/Beta Agonists

Dosing & Uses

Adult Pediatric

Dosage Forms & Strengths

prefilled autoinjector or syringe for SC/IM use

0.3mg/0.3mL (EpiPen, Auvi-Q, Symjepi)

injectable solution

0.1mg/mL (1:10,000)
1mg/mL (1:1000)

Cardiac Arrest

1:10,000 solution

IV

Recommended dose: 0.5-1.0 mg (5-10 mL)

During a resuscitation effort, 0.5 mg (5 mL) IV q5min

Intracardiac

Intracardiac injection if there has not been sufficient time to establish an IV route
Usual dose ranges from 0.3-0.5 mg (3-5 mL)

Endotracheal tube

Alternatively, if the patient has been intubated, epinephrine can be injected via the
endotracheal tube directly into the bronchial tree at the same dosage as for IV injection
2-2.5 mg q3-5min until IV/IO access established or spontaneous circulation restored

Hypotension Associated with Septic Shock

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Indicated to increase mean arterial blood pressure in adults with hypotension associated with septic
shock

Recommended dose: 0.05-2 mcg/kg/minute IV infusion; titrate to desired mean arterial pressure
(MAP); may adjust dose q10-15 min by 0.05-0.2 mcg/kg/minute to achieve desired blood pressure
goal

After hemodynamic stabilization, may wean incrementally q30min over 12-24 hr

See also Administration

Anaphylaxis
Indicated in emergency treatment of allergic reactions (Type I) including anaphylaxis

1:10,000 solution

0.1 mg (0.1mg/mL) IV at rate of 1-4 mcg/min over 5 min to prevent the need to repeat injections
frequently OR may initiate with infusion at 5-15 mcg/min (with crystalloid administration); IV
administration should only be done in patients who are profoundly hypotensive or are in
cardiopulmonary arrest refractory to volume resuscitation and several epinephrine injections

1:1000 solution

0.3-0.5 mg (0.3-0.5 mL) of undiluted epinephrine IM/SC once in anterolateral aspect of the thigh,
not to exceed 0.5 mg (0.5 mL) per injection, repeated every 5-10 minutes as necessary
Monitor clinically for reaction severity and cardiac effects

Prefilled autoinjector or syringe

0.3 mg (contents of 1 autoinjector) SC/IM once in anterolateral aspect of the thigh; may repeat
dose after 5-15 minutes if symptoms persist

See also Administration

Symptomatic Bradycardia
Unresponsive to atropine or pacing: 2-10 mcg//min by IV infusion or 0.1-0.5 mcg/kg/min (7-35
mcg/min in 70 kg patient); titrate to patient response

Mydriasis

Induction and maintenance of mydriasis during intraocular surgery

1:1000 solution

After dilution in an ophthalmic irrigating fluid, inject intracamerally as a bolus dose of 0.1 mL at
dilution of 1:100,000 to 1:400,000 (10-2.5 mcg/mL)
See also Administration

Dosing Considerations

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Anaphylaxis

With severe persistent anaphylaxis, repeat injections with an additional autoinjector may be
necessary
More than two sequential doses of epinephrine should only be administered under direct medical
supervision

Dosage Forms & Strengths

prefilled autoinjector or syringe for SC/IM use

0.1mg/0.1mL (Auvi-Q)
0.15mg/0.15mL (EpiPen Jr, Auvi-Q, Symjepi)
0.3mg/0.3mL (EpiPen, Auvi-Q, Symjepi)

injectable solution

0.1mg/mL (1:10,000)
1mg/mL (1:1000)

Anaphylaxis
Indicated in emergency treatment of allergic reactions (Type I) including anaphylaxis

1:1000 solution

<30 kg (66 lbs): 0.01 mg/kg (0.01 mL/kg) SC/IM, not to exceed 0.3 mg (0.3 mL) per injection,
repeated q5-10 min as necessary  
≥30 kg (66 lbs): 0.3-0.5 mg (0.3-0.5 mL) SC/IM, not to exceed 0.5 mg (0.5 mL) per injection,
repeated q5-10 min as necessary  

Autoinjector

May repeat dose after 5-15 minutes if symptoms persist

Infants weighing 7.5-15 kg (16.5-33 lb); Auvi-Q only: 0.1 mg SC/IM once
Weight 15 to <30 kg: 0.15 mg (contents of 1 autoinjector/prefilled syringe) SC/IM once; may
repeat dose q5-15min
Weight ≥30 kg: 0.3 mg (contents of 1 autoinjector/prefilled syringe) SC/IM once; may repeat
dose q5-15min

Asystole/Pulseless Arrest (Off-label)

1:10,000 solution: 0.01 mg/kg (0.1 mg/mL) IO/IV; not to exceed 1 mg; repeat q3-5min until return of
spontaneous circulation  

0.1 mg/kg (0.1 mL/kg of 1:1000 solution; 1 mg/mL) endotracheal; not to exceed 2.5 mg q3-5min until
IO/IVP access established or spontaneous circulation achieved; flush with 5 mL of normal saline
immediately after administration

Symptomatic Bradycardia (Off-label)

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1:10,000 solution: 0.01 mg/kg IO/IV q3-5min; not to exceed 1 mg  

1:1,000 solution: 0.1 mg/kg (0.1mL/kg) of endotracheal q3-5min if necessary; flush each dose with at
least 5 mL isotonic sodium chloride injection

Neonates (aged <28 days): 0.01-0.03 mg/kg IVP (1:10,000 solution) q3-5min; higher doses not
recommended

Neonate IV access not available: 0.05-0.1 mg/kg endotracheal tube (1:10,000 soluiton); lower doses
not effective; follow each dose with at least 5 mL isotonic sodium chloride injection

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