ephedrine (Rx)

Brand and Other Names:Akovaz, Corphedra, more...Emerphed
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

injectable solution

  • 50mg/mL (Akovaz, Corphedra, generics)
  • 50mg/10mL (5mg/mL) (Emerphed)
  • ephedrine sulfate 5mg/mL equivalent to ephedrine base 3.8mg/mL

Hypotension

Indicated for the treatment of clinically important hypotension occurring in the setting of anesthesia

Initial dose: 5-10 mg IV bolus (see Administration for product concentrations requiring further dilution before administration)

Administer additional boluses as needed, not to exceed a total cumulative dosage of 50 mg

Adjust dosage according to the blood pressure goal

Safety and efficacy not established

Start at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy

Drug is substantially excreted by the kidney, and the risk of adverse reactions may be greater with impaired renal function

Because elderly patients are more likely to have decreased renal function, carefully select dose and consider monitoring renal function

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Interactions

Interaction Checker

and ephedrine

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    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Gastrointestinal disorders: Nausea, vomiting

            Cardiac disorders: Tachycardia, palpitations (thumping heart), reactive hypertension, bradycardia, ventricular ectopics, heart rhythm/rate variability

            Nervous system disorders: Dizziness

            Psychiatric disorders: Restlessness

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            Warnings

            Contraindications

            None

            Cautions

            Serious postpartum hypertension and stroke have been described with coadministration of a vasopressor (ie, methoxamine, phenylephrine, ephedrine) and an oxytocic (ie, methylergonovine, ergonovine); monitor blood pressure if patient has received both ephedrine and an oxytocic

            Repeated administration can result in tolerance and tachyphylaxis; an alternative vasopressor may be needed to mitigate unresponsiveness to treatment

            When used to prevent hypotension, ephedrine has been associated with an increased incidence of hypertension compared with when ephedrine is used to treat hypotension

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            Pregnancy & Lactation

            Pregnancy

            Available data from randomized studies, case series, and reports of use in pregnant women have not identified a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes

            There are clinical considerations due to underlying conditions; untreated hypotension associated with spinal anesthesia for cesarean section is associated with increase in maternal nausea and vomiting; a decrease in uterine blood flow due to maternal hypotension may result in fetal bradycardia and acidosis

            Animal data

            In animal reproduction studies, decreased fetal survival and fetal body weights were observed in presence of maternal toxicity after normotensive pregnant rats were administered 60 mg/kg intravenous ephedrine sulfate (12 times the maximum recommended human dose (MRHD) of 50 mg/day);

            No malformations or embryofetal adverse effects were observed when pregnant rats or rabbits were treated with intravenous bolus doses of ephedrine sulfate during organogenesis at doses 1.9 and 7.7 times the MRHD, respectively

            Fetal/neonatal adverse reactions

            • Cases of potential metabolic acidosis in newborns at delivery with maternal ephedrine exposure have been reported in the literature
            • These reports describe umbilical artery pH of ≤7.2 at the time of delivery
            • Monitor newborn for signs and symptoms of metabolic acidosis
            • Monitoring of infant’s acid-base status is warranted to ensure that an episode of acidosis is acute and reversible

            Lactation

            A single published case report indicates that ephedrine is present in human milk; however, no information is available on effects of drug on breastfed infant or on milk production; the developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for drug and any potential adverse effects on breastfed child from drug or from underlying maternal condition

            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.

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            Pharmacology

            Mechanism of Action

            Sympathomimetic amine that directly acts as an agonist at alpha- and beta­adrenergic receptors and indirectly causes the release of norepinephrine from sympathetic neurons

            Resulting pharmacodynamic effects include increased heart rate, BP, cardiac output, and variable increases in peripheral resistance

            Stimulates alpha-adrenergic receptors of smooth muscle cells in the bladder (increases resistance to urinary outflow)

            Activation of beta-adrenergic receptors in the lungs promotes bronchodilation

            Pharmacokinetics

            Half-Life: 2.5-3.6 hr

            Duration: 3-6 hr (PO)

            Duration; hypotension: 60 min (IV/SC)

            Onset; hypotension: immediate (IV); 10-20 min (IM)

            Metabolism: Minimally metabolized in the liver

            Metabolites: Benzoic acid, hippuric acid, norephedrine, p-hydroxyephedrine (inactive)

            Excretion: Urine (60-77%)

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            Administration

            IV Preparation

            50 mg/mL products require dilution before administration

            • 50 mg/mL products (eg, Akovaz, Corphedra) must be diluted before administration to 5 mg/mL
            • Withdraw 50 mg (1 mL) from vial and then dilute with 9 mL of 0.9% NaCl or D5W to obtain dilution of 5 mg/mL
            • Inspect parenteral drug products visually for particulate matter and discoloration prior to administration, whenever solution and container permit

            IV Administration

            Administer concentration of 5 mg/mL as an IV bolus

            Storage

            25°C (77°F); excursions permitted to 15-30°C (59-86°F)

            Store in carton until time of use

            For single use only; discard unused portion

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

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

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            • 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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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.