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epinephrine (Rx)Brand and Other Names:EpiPen, EpiPen Jr, more...Adrenaclick, Auvi-Q, Adrenalin

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

autoinjector (EpiPen, Twinject, Adrenaclick, Auvi-Q)

  • 0.15mg/0.15mL
  • 0.3mg/0.3mg

injectable solution

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

Cardiac Arrest

1 mg IV/IO q3-5min PRN; may administer up to 0.2 mg/kg if no response

Dose >1 mg not shown to improve survival or neurological oucomes as compared to standard dosing; not recommended

ET: 2-2.5 mg q3-5min until IV/IO access established or spontaneous circulation restored

Asthma, Severe/Anaphylaxis

0.2-0.5 mg IM/SC q5-15min (1:1,000 solution; 1 mg/mL), clinician may shorten 5-min interval between injections for more frequent administration if deemed appropriate

0.1 mg (1:10,000 solution; 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

Autoinjector: 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

Symptomatic Bradycardia (Off-label)

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

Administration

Do not administer autoinjector IV; give only in outer thigh to ensure SC or IM administration

Discard remaining volume after dose has been administered

Dosage Forms & Strengths

autoinjector (EpiPen, Twinject, Adrenaclick, Auvi-Q)

  • 0.15mg
  • 0.3mg

injectable solution

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

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)

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 (<28 days old): 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

Asthma/Anaphylaxis

0.01 mg/kg (0.01 mL/kg of 1:1,000 solution; 1 mg/mL) IM/SC q5-15min , clinician may shorten 5-min interval between injections for more frequent administration if deemed appropriate 

Autoinjector

  • Weight <30 kg: 0.15 mg (contents of 1 autoinjector) SC/IM once; may repeat dose q5-15min
  • Weight ≥30 kg: 0.3 mg (contents of 1 autoinjector) SC/IM once; may repeat dose q5-15min

Administration

When administering to a child, to minimize risk of injection related injury, hold leg firmly in place and limit movement prior to and during an injection; injection may be repeated every 5-10 min as necessary; for IM administration, use a needle long enough (at least 1/2 inch to 5/8 inch) to ensure injection is administered into muscle; monitor patient clinically for severity of allergic reaction and potential cardiac effects of drug, with repeat doses titrated to effect; do not administer repeated injections at same site, as resulting vasoconstriction may cause tissue necrosis

Do not administer autoinjector IV; give only in outer thigh to ensure SC or IM administration

Discard remaining volume after dose has been administered

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Interactions

Interaction Checker

epinephrine and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Angina

            Anxiety

            Apprehensiveness

            Cardiac arrhythmias

            Dizziness

            Dyspnea

            Flushing

            Headache

            Hypertension

            Nausea

            Nervousness

            Pallor

            Palpitations

            Respiratory difficulties

            Restlessness

            Sweating

            Tachycardia

            Tremor

            Vasoconstriction

            Vomiting

            Weakness

            Postmarketing Reports

            Necrotizing fasciitis and myonecrosis caused by Clostridia (gas gangrene)

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            Warnings

            Contraindications

            There are no contraindications for life-threatening situations

            Nonanaphylactic shock

            Narrow-angle glaucoma

            Coadministration during genral anesthesia with halogenated hydrocarbons or cyclopropane

            Labor

            Situations where vasopressors may be contraindicated, including thyrotoxicosis, diabetes

            Maternal blood pressure in excess of 130/80 mm Hg in hypertension and other cardiovascular disorders

            Cautions

            Use caution in patients with cardiac disease, angina (especially with history of CAD) or that are receiving drugs that sensitize the myocardium; treatment may induce cardiac arrhythmias

            Pulmonary edema may occur as the result of cardiac stimulation and peripheral constriction

            Decreased urine output may occur as the result of renal blood vessel constriction

            Use caution in cerebrovascular insufficiency

            Use with caution in patients with hypertension, diabetes mellitus, thyroid disease, prostatic hypertrophy, geriatric patients, pregnancy, and previous hospitalization for asthma

            Use caution when administering in conjunction with anesthesia in fingers, toes, ears, nose, or genitalia, due to potential for ischemia due to vasoconstriction

            Use caution in concomitant use of digitalis, mercurial diuretics, quinidine, or drugs that may sensitize the heart to arrhythmias

            Accidental injection into hands, digits, or feet may result in local reactions including injection site coldness, pallor, and hypoesthesia or injury resulting in bruising, discoloration, erythema, bleeding, or skeletal injury

            Rapid IV administration, although necessary in pulesless arrest, may cause death from cerebrovascular hemorrhage or cardiac arrhythmias

            Patients that are sulfite-sensitive, should still be treated during a serious allergic reaction or other emergency even if products available contain sulfites

            May cause worsening of symptoms in patients with Parkinson disease

            Avoid extravasation; ensure proper needle or catheter placement prior to and during infusion

            Correct blood volume depletion before administering any vasopressor

            Injection into buttock may not provide effective treatment of anaphylaxis

            Rare cases of serious skin and soft tissue infections, including necrotizing fasciitis and myonecrosis caused by Clostridia (gas gangrene), reported at injection site following injection for anaphylaxis; to decrease risk, do not inject into buttock; advise patients to seek medical care if they develop signs or symptoms of infection, such as persistent redness, warmth, swelling, or tenderness, at epinephrine injection site; cleansing with alcohol does not kill bacterial spores, and therefore, does not lower risk of infection

            Multiple-dose vial not for ophthalmic use; contains chlorobutanol which may be harmful to corneal endothelium

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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Unknown if excreted into breast milk; use caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Strong alpha-adrenergic effects, which cause an increase in cardio output and HR, a decrease in renal perfusion and PVR, and a variable effect on BP, resulting in systemic vasoconstriction and increased vascular permeability

            Strong beta1- and moderate beta2-adrenergic effects, resulting in bronchial smooth muscle relaxation

            Secondary relaxation effect on smooth muscle of stomach, intestine, uterus, and urinary bladder

            Absorption

            Onset: 5-10 min (SC); 1 min (inhalation)

            Duration: 4 hr

            Metabolism

            Metabolized by MAO and COMT in adrenergic neuron

            Metabolites: Metadrenaline, sulfate conjugates, and hydroxy derivatives of mandelic acid (inactive)

            Elimination

            Excretion: Urine

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            Administration

            IV Incompatibilities

            Solution: Na-bicarbonate 5%, Ionosol PSL, Ionosol T/D5

            Additive: Aminophylline, hyaluronidase, mephentermine, Na-bicarbonate

            Syringe: Na-bicarbonate(?)

            Y-site: Ampicillin, thiopental

            Not specified: Atropine, carbenicillin, diazepam, erythromycin, lidocaine

            IV Compatibilities

            Solution: D5W, D10W, dextrose-Ringer's, dextrose-saline, NS, LR, Ringer's

            Additive: Amikacin, cimetidine, dobutamine, floxacillin, furosemide, metaraminol, ranitidine, verapamil

            Syringe: Caffeine, doxapram, heparin, milrinone

            Y-site: Amiodarone, atracurium, bivalirudin, CaCl2, Ca gluconate, cefpirome, cisatracurium, dexmedetomidine, diltiazem, dobutamine, dopamine, famotidine, fenoldopam, fentanyl, furosemide, heparin, Hextend, hydrocortisone Na succinate, hydromorphone, inamrinone, labetalol, levofloxacin, lorazepam, midazolam, milrinone, morphine SO4, nicardipine, nitroglycerin, norepinephrine, pancuronium, phytonadione, KCl, propofol, ranitidine, remifentanil, nitroprusside, tirofiban, vasopressin, vecuronium, vitamin B/C, warfarin

            Not specified: Meperidine

            IV Preparation

            Solution: 1 mg in 250 mL D5W or NS (4 mcg/mL) to make up concentration of 15-60 mL/hr (1-4 mcg/min)

            IV Administration

            Central line; infusion pump required

            Do not mix with alkaline solutions

            Discard after 24 hours or if solution is discolored or contains precipitate

            Store in light-resistant container

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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