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In pediatric patients

Anaphylaxis

IM or Sub-Q

0.01 mg/kg (0.01 mL/kg of a 1-mg/mL solution) (up to 0.3–0.5 mg per dose depending on
patient weight); repeat every 5–15 minutes as needed. [ref] Some clinicians state that doses
may be repeated at 20-minute to 4-hour intervals depending on severity of the condition and
patient response. [ref]

For self-administration using a prefilled auto-injector, inject 0.15 or 0.3 mg, depending on
body weight; 0.3 mg recommended for patients weighing ≥30 kg and 0.15 mg recommended
for patients weighing 15–30 kg. [ref] Use alternative injectable forms if dose <0.15 mg
considered more appropriate. [ref] For severe persistent anaphylaxis, repeat doses may be
needed; if >2 sequential doses are required, administer subsequent doses only under direct
medical supervision. [ref]

IV
If necessary, initial dose of 0.01 mg/kg (0.1 mL/kg of a 0.1-mg/mL solution) may be
administered. [ref] If repeat doses are required, initiate a continuous IV infusion at a rate of 0.1
mcg/kg per minute; increase gradually to 1.5 mcg/kg per minute to maintain BP.

IM or Sub-Q

Maximum for pediatric patients: 0.3–0.5 mg of epinephrine per dose depending on weight.

Adults

Sensitivity Reactions

Anaphylaxis

IM or Sub-Q

Usual dose is 0.2–0.5 mg (0.2–0.5 mL of a 1-mg/mL solution); repeat every 5–15 minutes as
needed. [ref]

For self-administration using a prefilled auto-injector, inject 0.3 mg. [ref] For severe persistent
anaphylaxis, repeat doses may be needed; if >2 sequential doses are needed, administer
subsequent doses only under direct medical supervision.

IV

In extreme circumstances (e.g., anaphylactic shock, cardiac arrest, or no response to initial

IM injections), IV administration may be necessary. [ref]

Usual IV dose is 0.1–0.25 mg (1–2.5 mL of a 0.1-mg/mL solution); repeat every 5–15

minutes as necessary. [ref]

Alternatively, may administer as a continuous infusion at a rate of 2–15 mcg/minute; titrate

based on severity of the reaction and clinical response.

Single doses should not exceed 0.5 mg.

Αναφυλαξία σε νεογνά και παιδιά

 Αναφυλαξία σε ενήλικες

Pediatric Advanced Life Support (PALS)

IV or IO
 Neonates: Usual IV dose is 0.01–0.03 mg/kg (0.1–0.3 mL/kg of a 0.1-mg/mL solution). [ref]
Higher doses not recommended because of risk of exaggerated hypertension, decreased
myocardial function, and worsening neurologic function. [ref]

Pediatric patients: Usual IV/IO dose is 0.01 mg/kg (0.1 mL/kg of a 0.1-mg/mL solution), up to
a maximum single dose of 1 mg, repeated every 3–5 minutes as needed. [ref] Lack of survival
benefit and potential harm from routine use of higher doses, particularly in cases of
asphyxia. [ref] However, may consider high-dose epinephrine in exceptional circumstances
(e.g., β-adrenergic blocking agent overdose). [ref]

For postresuscitation stabilization in pediatric patients, usual dosage is 0.1–1 mcg/kg per
minute by IV/IO infusion; adjust based on patient response. [ref] Low-dose infusions (<0.3
mcg/kg per minute) generally produce predominantly β-adrenergic effects, while higher-dose
infusions (>0.3 mcg/kg per minute) result in α-adrenergic vasoconstriction. [ref]

For emergency treatment of infants and children with bradycardia and cardiopulmonary compromise (with a
palpable pulse), may give 0.01 mg/kg (0.1 mL/kg of a 0.1-mg/mL solution) by IV/IO injection, repeated every
3–5 minutes as needed.

ΕΝΗΛΙΚΕΣ

ACLS and Cardiac Arrhythmias

Cardiac Arrest

IV or IO

ACLS guidelines recommend 1 mg every 3–5 minutes by IV/IO injection. [ref]

Higher doses (e.g., 0.1–0.2 mg/kg) do not provide any benefits in terms of survival or
neurologic outcomes compared with the standard dose (1 mg) and may be harmful. [ref]

Optimal timing of administration, particularly in relation to defibrillation, not known and may
vary based on patient-specific factors and resuscitation conditions. [ref] In adults with asystole
or PEA, may administer as soon as feasible after onset of cardiac arrest based on studies
demonstrating improved survival to hospital discharge and increased ROSC when the drug
is administered early during course of treatment for a nonshockable rhythm. [ref]

For postresuscitation stabilization, usual IV dosage is 0.1–0.5 mcg/kg per minute; adjust
based on patient response. [ref]

Endotracheal

Optimal dose not established, but typical doses are 2–2.5 times those administered IV. [ref]
Bradycardia:

IV
For symptomatic bradycardia, initial IV infusion rate of 2–10 mcg/minute has been recommended; adjust
according to patient response.