P - Caution when used during pregnancy
L - Caution when used during lactation
|Indication & Dosage||Inhalation
Adult: Spray: Aqueous solution with an adrenaline content equivalent to 1:100. Pressurised aerosols delivering metered doses equivalent to approximately 160-275 mcg: 1-2 inhalations, may repeat after 3 hr if necessary.
Adult: As 1:1,000 aqueous solution: 0.3-0.5 ml (300-500 mcg). Dose may be given via IM or SC inj.
Child: As 1:1,000 aqueous solution: 0.01 ml/kg (10 mcg/kg). Max: 0.5 ml (500 mcg). Dose may be given via IM or SC inj.
Advanced cardiac life support
Adult: Initially, 1 mg (10 mL of a 1:10,000 solution), may repeat as often as every 2-3 minutes throughout the resuscitation process. May also be given via intraosseous route at the same dosage. For endotracheal doses: 2-3 times of the IV dose.
Child: Initially, 10 mcg/kg, may repeat as often as every 2-3 minutes throughout the resuscitation process. Endotracheal doses: 100 mcg/kg. Intraosseous doses are the same as IV doses.
Max Dosage: Intraosseous doses for adults and children are the same as IV doses.
Adult: 0.5 mg (5 mL of a 1:10,000 solution) given at a slow rate of 100 mcg/minute, stopping when a response is achieved.
Child: 10 mcg/kg. If autoinjectors are used, doses are based on body wt: 15-30 kg: 150 mcg and >30 kg: 300 mcg.
Adult: As 1:1,000 solution: 500 mcg (0.5 ml), repeat every 5 minutes as needed until improvement occurs. For emergency self-admin (e.g. via autoinjector): A dose of 300 mcg (0.3 ml) may be used.
Child: Dose depends on age and weight. Usual dose: 10 mcg/kg.
Adult: Instill 0.5%, 1% or 2% eye drops once or twice daily.
Adult: Instill 0.5%, 1% or 2% eye drops once or twice daily.
|Administration||Should be taken with food.
|Overdosage||Overdosage intravascular inj of epinephrine may cause cerebral haemorrhage due to a sharp rise in BP. Fatalities may also result from pulmonary oedema because of peripheral vascular constriction together with cardiac stimulation.|
|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.|
|Special Precautions||CV diseases; hyperthyroidism; DM; Parkinson's disease; elderly; pregnancy, lactation.|
|Adverse Drug Reactions||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.|
|Drug Interactions||Halogenated inhalation anaesthetics; Î²- or
Î±-blocking agents; methyldopa,guanethidine; drugs with vasoconstrictor and pressor effects; antihypertensives; adrenergic neuron blockers;
potassium-depleting drugs; cardiac glycosides; ephedra, yohimbe. TCAs may induce hypertension and arrhythmia.
|Lab Interference||Increase in bilirubin, catecholamines, glucose, uric acid.|
|Pregnancy Category (US FDA)||Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.|
|Storage||Inhalation: Store at 25Â°C. Intramuscular: Store at 25Â°C. Intravenous: Store at 25Â°C. Ophthalmic: Store at 25Â°C. Parenteral: Store at 25Â°C.|
|Pharmacology||Epinephrine, an active principle of the
adrenal medulla, is a direct-acting sympathomimetic. It stimulates Î±- and Î²-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.
Onset: SC: approx 5-10 min; inhalation: approx 1 min; conjunctival instillation: IOP declines approx 1 hr.
Duration: Ocular effect: 12-24 hrs.
|ATC Classification||C01CA24 - epinephrine; Belongs to the class of adrenergic and dopaminergic cardiac stimulants excluding glycosides. Used in the
treatment of heart failure.
A01AD01 - epinephrine; Belongs to the class of other agents for local oral treatment.
R01AA14 - epinephrine; Belongs to the class of topical sympathomimetic agents used as nasal decongestants.
R03AA01 - epinephrine; Belongs to the class of adrenergic inhalants, alpha- and beta-adrenoreceptor agonists. Used in the treatment of obstructive airway diseases.
S01EA01 - epinephrine; Belongs to the class of sympathomimetics used in the treatment of glaucoma.
B02BC09 - epinephrine; Belongs to the class of local hemostatics. Used in the treatment of hemorrhage.
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Why is this medication prescribed?
Adranaline/Epinephrine injection is used along with emergency medical treatment to treat life-threatening allergic reactions caused by insect bites or stings, foods, medications, latex, and other causes. Epinephrine is in a class of medications called alpha- and beta-adrenergic agonists (sympathomimetic agents). It works by relaxing the muscles in the airways and tightening the blood vessels.
How should this medicine be used?
Adranaline/Epinephrine injection comes as a pre-filled automatic injection device containing a solution (liquid) to inject under the skin or into the muscle in the outer side of the thigh. It is usually injected as needed at the first sign of a serious allergic reaction. Use epinephrine injection exactly as directed; do not inject it more often or inject more or less of it than prescribed by your doctor.
You should inject epinephrine injection as soon as you suspect that you may be experiencing a serious allergic reaction. Signs of a serious allergic reaction include closing of the airways, wheezing, sneezing, hoarseness, hives, itching, swelling, skin redness, fast heartbeat, weak pulse, anxiety, confusion, stomach pain, losing control of urine or bowel movements, faintness, or loss of consciousness. Talk to your doctor about these symptoms and be sure you understand how to tell when you are having a serious allergic reaction and should inject epinephrine.
Keep your automatic injection device with you or available at all times so that you will be able to inject epinephrine quickly when an allergic reaction begins. Be aware of the expiration date stamped on the device and replace the device when this date passes. Look at the solution in the device from time to time. If the solution is discolored or contains particles, call your doctor to get a new injection device.
Adranaline/Epinephrine injection helps to treat serious allergic reaction but does not take the place of medical treatment. Get emergency medical treatment immediately after you inject epinephrine. Rest quietly while you wait for emergency medical treatment.
Most automatic injection devices contain enough solution for one dose of epinephrine. One type of automatic injection device (Twinject) can be used according to the package directions to inject two doses of epinephrine if needed to treat an allergic reaction. If your doctor has prescribed this device for you, be sure that you know how to inject the second dose and how to tell whether you should inject a second dose.
Ask your doctor to show you or the person who will be injecting the medication how to inject it. Before you use epinephrine injection for the first time, read the patient information that comes with it. This information includes directions for how to use the pre-filled automatic injection device. Be sure to ask your pharmacist or doctor if you have any questions about how to inject this medication.
Adranaline/Epinephrine should be injected only in the middle of the outer side of the thigh, and can be injected through clothing if necessary in an emergency. Do not inject epinephrine into the buttocks or any other part of your body.
After you inject a dose of adranaline/epinephrine injection, some solution will remain in the injection device. This is normal and does not mean that you did not receive the full dose. Do not use the extra liquid; dispose of the remaining liquid and device properly. Take the used device with you to the emergency room or ask your doctor, pharmacist, or health care provider how to throw away used injection devices safely.
Do not put your thumb, fingers, or hand over the needle area of the automatic injection device. If epinephrine is accidently injected into the fingers, hands, toes, or feet, get emergency medical treatment immediately.
Other uses for this medicine
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.
What special precautions should I follow?
Before using epinephrine injection,
- tell your doctor if you are allergic to epinephrine, any other medications, 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. The 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, amoxapine, clomipramine, desipramine, doxepin, imipramine, maprotiline, mirtazapine, nortriptyline, protriptyline, and trimipramine; antihistamines such as chlorpheniramine and diphenhydramine; beta blockers such as propranolol; digoxin; diuretics; ergot medications such as dihydroergotamine, ergoloid mesylates, ergonovine, ergotamine, methylergonovine, and methysergide; levothyroxine; and medications for irregular heartbeat such as quinidine. Also tell your doctor if you are taking a monoamine oxidase inhibitor such as isocarboxazid, phenelzine, selegiline, and tranylcypromine 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.
What side effects can this medication cause?
Epinephrine injection may cause side effects. When you get emergency medical treatment after you inject epinephrine, tell your doctor if you are experiencing any of these side effects:
pounding, fast, or irregular heartbeat
nervousness, anxiety, or restlessness
uncontrollable shaking of a part of your body
What storage conditions are needed for this medicine?
Keep this medication in the plastic carrying tube it came in, tightly closed, and out of reach of children. Keep it at room temperature and away from light, excess heat and moisture (not in the bathroom). Do not refrigerate epinephrine injection or leave it in your car, especially in hot or cold weather. If the pre-filled automatic injection device is dropped, check to see if it is broken or leaking. Throw away any medication that is damaged, outdated or no longer needed and be sure to have a replacement available. Talk to your pharmacist about the proper disposal of your medication.
In case of overdose, consult your doctor. If the victim has collapsed or is not breathing, consult local medical emergency services.
Symptoms of overdose may include:
sudden weakness or numbness on one side of the body
sudden difficulty speaking
slow or fast heart rate
shortness of breath
tiredness or weakness
cold, pale skin
What other information should I know?
Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to this medicine.
Do not let anyone else use your medication. If you still have symptoms and need further treatment, consult your doctor.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
Ref: U.S. National Library of Medicine.
This information is provided for reference only and not a replacement for and should only be used in conjunction with full consultation with a registered medical practitioner. It may not contain all the available information you require and cannot substitute professional medical care, nor does it take into account all individual circumstances. Although great effort has been made to ensure content accuracy, mph-bd shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise.