What is epinephrine?

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Generic Name: Epinephrine Brand Name(s): Generics only. No brands available.

Know the basics

What is epinephrine used for?

Epinephrine is commonly used in emergencies to treat very serious allergic reactions to insect stings/bites, foods, drugs, or other substances. Epinephrine acts quickly to improve breathing, stimulate the heart, raise a dropping blood pressure, reverse hives, and reduce swelling of the face, lips, and throat.

Epinephrine injection may also be used for purposes not listed in this medication guide.

How should I take epinephrine?

Different brands of epinephrine have different directions for preparing and using the injector. Learn how to properly inject epinephrine in advance so you will be prepared when you actually need to use it. Also teach a family member or caregiver what to do if you cannot inject epinephrine yourself. Read the Patient Information Leaflet provided by your pharmacist before you have to use epinephrine and each time you get a refill. If you have any questions, consult your doctor or pharmacist.

The effects of this epinephrine are rapid but not long-lasting. After injecting epinephrine, seek immediate medical attention. Tell the healthcare professional that you have given yourself an injection of epinephrine. Avoid accidentally injecting epinephrine into your hands or areas of your body other than the thigh. If this occurs, tell the healthcare professional immediately. Discard the injector properly.

The solution in this product should be clear. Check this product visually for particles or discoloration from time to time. If it has turned cloudy or pink/brown in color, do not use the product. Obtain a new supply.

How do I store epinephrine?

Keep this product near you at all times.

Epinephrine is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store epinephrine in the bathroom or the freezer. There may be different brands of epinephrine that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush epinephrine down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Know the precautions & warnings

What should I know before using epinephrine?

Before using epinephrine injection,

  • Tell your doctor and pharmacist if you are allergic to epinephrine, any other epinephrines, sulfites or any of the other ingredients in epinephrine injection. Your doctor may tell you to use epinephrine injection even if you are allergic to one of the ingredients because it is a life-saving medication. Epinephrine automatic injection device does not contain latex and is safe to use if you have a latex allergy.
  • Tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: certain antidepressants such as amitriptyline (Elavil), amoxapine, clomipramine (Anafranil), desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), maprotiline, mirtazapine (Remeron), nortriptyline (Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil); antihistamines such as chlorpheniramine (Chlor-Trimeton) and diphenhydramine (Benadryl); beta blockers such as propranolol (Inderal); digoxin (Digitek, Lanoxicaps, Lanoxin); diuretics (‘water pills’); ergot medications such as dihydroergotamine (D.H.E. 45, Migranal), ergoloid mesylates (Hydergine), ergonovine (Ergotrate), ergotamine (in Cafergot, in Migergot), methylergonovine (Methergine), and methysergide (Sansert); levothyroxine (Levothroid, Levoxyl, Synthroid, Unithroid); and medications for irregular heartbeat such as quinidine. Also tell your doctor if you are taking a monoamine oxidase inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate) or have stopped taking it within the past two weeks. Your doctor may need to monitor you carefully for side effects.
  • Tell your doctor if you have or have ever had chest pain, irregular heartbeat, high blood pressure, or other heart disease; diabetes; hyperthyroidism (an overactive thyroid); depression or other mental illness; or Parkinson’s disease. If you will be using the Twinject device, tell your doctor if you have arthritis or difficulty using your hands.
  • Tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. Talk to your doctor about whether and when you should use epinephrine injection if you are pregnant.

Is it safe to take epinephrine during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using epinephrine during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking epinephrine. Epinephrine is pregnancy risk category  C according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Know the side effects

What are the side effects of epinephrine?

Before using epinephrine a second time, call your doctor if your first injection caused a serious side effect such as increased breathing difficulty, or dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).

Less serious side effects may include: sweating; nausea and vomiting; pale skin; feeling short of breath; dizziness; weakness or tremors; headache; or feeling nervous or anxious.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Know the interactions

What drugs may interact with epinephrine?

Epinephrine may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, non-prescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with epinephrine?

Epinephrine may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with epinephrine?

Epinephrine may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have, especially:

  • Bronchial asthma;
  • Type 2 diabetes mellitus;
  • Eye disease (other);
  • Heart or blood vessel disease ;
  • High blood pressure;
  • Overactive thyroid—Epinephrine may make the condition worse;
  • Dental surgery on gums—Dental surgery may include the use of epinephrine in topical or injection form. Use of ophthalmic epinephrine during this time may increase blood levels of the medicine and increase the chance of side effects.

Understand the dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Epinephrine.

What is the dose of Epinephrine for an adult?

Usual Adult Dose for Shock

  • Intravenous: 2 to 10 mcg/min (1 mg in 250 mL of D5W or 4 mcg/mL). May increase as necessary to establish an adequate heart rate and blood pressure. Rarely doses as high as 20 mcg/min are required.
  • Endotracheal: 1 mg (10 mL of 1:10,000) once, followed by 5 quick insufflations.
  • Intracardiac: 0.3 to 0.5 mg (3 to 5 mL of 1:10,000) by direct injection into the left ventricular chamber once.

Usual Adult Dose for Asystole

  • Intravenous: 0.5 to 1 mg (5 to 10 mL of 1:10,000) once. May be repeated every 3 to 5 minutes as necessary. If there is inadequate response to 1 mg, then high dose therapy (2 to 5 mg) every 3 to 5 minutes, escalating 1, 3, then 5 mg every 3 minutes, or 0.1 mg/kg every 3 to 5 minutes, has been used.
  • Endotracheal: 1 mg (10 mL of 1:10,000) once, followed by 5 quick insufflations.
  • Intracardiac: 0.3 to 0.5 mg (3 to 5 mL of 1:10,000) by direct injection into the left ventricular chamber once.

Usual Adult Dose for Electromechanical Dissociation

  • Intravenous: 0.5 to 1 mg (5 to 10 mL of 1:10,000) once. May be repeated every 3 to 5 minutes as necessary. If there is inadequate response to 1 mg, then high dose therapy (2 to 5 mg) every 3 to 5 minutes, escalating 1, 3, then 5 mg every 3 minutes, or 0.1 mg/kg every 3 to 5 minutes, has been used.
  • Endotracheal: 1 mg (10 mL of 1:10,000) once, followed by 5 quick insufflations.
  • Intracardiac: 0.3 to 0.5 mg (3 to 5 mL of 1:10,000) by direct injection into the left ventricular chamber once.

Usual Adult Dose for AV Heart Block

Intravenous: 0.5 to 1 mg (5 to 10 mL of 1:10,000) once. May be repeated every 3 to 5 minutes as necessary. If there is inadequate response to 1 mg, then high dose therapy (2 to 5 mg) every 3 to 5 minutes, escalating 1, 3, then 5 mg every 3 minutes, or 0.1 mg/kg every 3 to 5 minutes, has been used.

Usual Adult Dose for Asthma – Acute:

  • Subcutaneous: 0.1 to 0.5 mg (0.1 to 0.5 mL of 1:1000 solution). May be repeated every 20 minutes to once every 4 hours as needed.
  • Subcutaneous suspension: 0.5 mg (0.1 mL of 1:200 suspension) once. An additional dose of 0.5 to 1 mg may be given as needed but not more frequently than every 6 hours.
  • Intramuscular: 0.1 to 0.5 mg (0.1 to 0.5 mL of 1:1000 solution). May be repeated every 20 minutes to once every 4 hours as needed.
  • Inhalation aerosol: 160 to 220 mcg (1 inhalation) once. An additional inhalation may be used after at least one minute. It is recommended that subsequent doses not be administered for at least three hours.
  • Nebulized: 1 to 3 inhalations (8 to 10 drops of a 1% 1:100 solution) once. If relief does not occur within 5 minutes, the dose may be repeated once. It is recommended that subsequent doses not be repeated more often than every 3 hours.
  • Intermittent positive pressure breathing: 0.3 mg (0.03 mL of a 1:100 solution) once. The least amount of tolerated inhalations required to provide relief is the recommended dose. Most patients respond within 15 minutes. This dose may be repeated once every 3 to 4 hours as needed.

Usual Adult Dose for Chronic Obstructive Pulmonary Disease – Acute:

  • Subcutaneous: 0.3 mg (0.3 mL of 1:1000) every 20 minutes for up to 3 doses. May be repeated once every 2 hours as needed.
  • Intramuscular: 0.1 to 0.5 mg (0.1 to 0.5 mL of 1:1000) once. May be repeated every 20 minutes to 4 hours as needed.
  • Inhalation aerosol: 160 to 220 mcg (1 inhalation) once. An additional inhalation may be used after at least one minute. It is recommended that subsequent doses not be administered for at least three hours.
  • Nebulized: 1 to 3 inhalations (8 to 15 drops of a 1% 1:100 solution or 2.25% racepinephrine solution) once. If relief does not occur within 5 minutes, the dose may be repeated once. It is recommended that subsequent doses not be repeated more often than every 3 hours.
  • Intermittent positive pressure breathing: 0.3 mg (0.03 mL of a 1:100 solution) once. The least amount of tolerated inhalations required to provide relief is the recommended dose. Most patients respond within 15 minutes. This dose may be repeated once every 3 to 4 hours as needed.

Usual Adult Dose for Allergic Reaction:

  • Subcutaneous: 0.1 to 0.5 mg (0.1 to 0.5 mL of 1:1000 solution). May be repeated every 20 minutes to once every 4 hours as needed.
  • Subcutaneous suspension: 0.5 mg (0.1 mL of 1:200 suspension) once. An additional dose of 0.5 to 1 mg may be given as needed but not more frequently than every 6 hours.
  • Intramuscular: 0.1 to 0.5 mg (0.1 to 0.5 mL of 1:1000 solution). May be repeated every 10 to 15 minutes.
  • Intravenous: 0.1 to 0.25 mg (1 to 2.5 mL of a 1:10,000 solution) once slowly and cautiously over 5 to 10 minutes. The dose may be repeated every 5 to 15 minutes as needed and tolerated. In some cases of severe anaphylaxis, an intravenous infusion of epinephrine (1 mg in 250 mL of D5W, or 4 mcg/mL) can be started to run at 1 to 4 mcg/min (15 to 60 mL/hour).

Usual Adult Dose for Pupillary Dilation:

Induction and Maintenance of Mydriasis during Intraocular Surgery:

  • use the irrigating solution as needed for the surgical procedure.
  • inject intracamerally a 0.1 ml bolus dose diluted to a concentration of 1:100,000 to 1:400,000 (10 mcg/ml to 2.5 mcg/ml).

What is the dose of Epinephrine for a child?

Usual Pediatric Dose for Asystole:

Neonates:

  • intravenous or intratracheal: 0.01 to 0.03 mg/kg (0.1 to 0.3 ml/kg of 1:10,000) every 3 to 5 minutes as needed. dilute intratracheal dose in 1 to 2 ml of normal saline.

Infants and children:

  • intravenous: initial dose 0.01 mg/kg (0.1 ml/kg of 1:10,000). may be repeated every 3 to 5 minutes. maximum dose: 1 mg or 10 ml.
  • intratracheal: 0.1 mg/kg (0.1 ml of 1:1,000 solution). doses as high as 0.2 mg/kg may be effective. may be repeated every 3 to 5 minutes.

Usual Pediatric Dose for Shock:

Neonates:

  • intravenous or Intratracheal: 0.01 to 0.03 mg/kg (0.1 to 0.3 mL/kg of 1:10,000) every 3 to 5 minutes as needed. Dilute intratracheal dose in 1 to 2 mL of normal saline.

Infants and children:

  • intravenous: initial dose 0.01 mg/kg (0.1 mL/kg of 1:10,000). May be repeated every 3 to 5 minutes. Maximum dose: 1 mg or 10 mL.
  • intratracheal: 0.1 mg/kg (0.1 mL of 1:1,000 solution). Doses as high as 0.2 mg/kg may be effective. May be repeated every 3 to 5 minutes.

Usual Pediatric Dose for Allergic Reaction:

Infants to 2 years: 0.05 to 0.1 mL IM or subcutaneously of 1:1000 solution. If after 10 minutes from the first injection symptoms are not noticeably improved, administer a second dose.

Children:

  • 2 to 5 years: 0.15 mL intramuscular or subcutaneously;
  • 6 to 11 years: 0.2 mL intramuscular or subcutaneously;
  • 12 years older: 0.3 mL intramuscular or subcutaneously;
  • if after 10 minutes from the first injection symptoms are not noticeably improved, administer a second dose.
  • alternative subcutaneous dosing: 0.01 mg/kg (0.01 ml/kg/dose of 1:1000 solution) not to exceed 0.5 mg.
  • subcutaneous suspension: 0.025 mg/kg (0.005 ml/kg of 1:200) once. not to exceed 0.15 ml every 8 to 12 hours.

Usual Pediatric Dose for Asthma – Acute:                 

Infants to 2 years: 0.05 to 0.1 mL intramuscular or subcutaneously of 1:1000 solution. If after 10 minutes from the first injection symptoms are not noticeably improved, administer a second dose.

Children:

  • 2 to 5 years: 0.15 mL intramuscular or subcutaneously;
  • 6 to 11 years: 0.2 mL intramuscular or subcutaneously;
  • 12 years or older: 0.3 mL intramuscular or subcutaneously;
  • if after 10 minutes from the first injection symptoms are not noticeably improved, administer a second dose.
  • alternative subcutaneous dosing: 0.01 mg/kg (0.01 ml/kg/dose of 1:1000 solution) not to exceed 0.5 mg.
  • subcutaneous suspension: 0.025 mg/kg (0.005 ml/kg of 1:200 suspension) not to exceed 0.15 ml every 8 to 12 hours.
  • 4 years or older: Inhalation aerosol: 220 mcg (1 inhalation) once. An additional inhalation may be used after at least one minute. It is recommended that subsequent doses not be administered for at least three hours.

Usual Pediatric Dose for Pupillary Dilation:

Induction and Maintenance of Mydriasis during Intraocular Surgery:

  • use the irrigating solution as needed for the surgical procedure
  • inject intracamerally a 0.1 ml bolus dose diluted to a concentration of 1:100,000 to 1:400,000 (10 mcg/ml to 2.5 mcg/ml)

How is epinephrine available?

Epinephrine is available in the following dosage forms and strengths:

  • Device, Injection: 0.15mg/0.15 m, 0.3 mg/0.3 mL, 0.15 mg/0.3 mL
  • Nebulization Solution, Inhalation: 2.25%
  • Solution, Injection: 0.1 mg/mL (10 mL); 1 mg/mL (1 mL)
  • Solution, Injection, as hydrochloride: 1 mg/mL

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services (115) or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Epinephrine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: May 30, 2016 | Last Modified: January 4, 2017

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