Dosing & Uses
Dosage Forms & Strengths
prefilled autoinjector or syringe for SC/IM use
- 0.3mg/0.3mL (EpiPen, Auvi-Q, Symjepi)
injectable solution
- 0.1mg/mL (1:10,000)
- 1mg/mL (1:1000)
Cardiac Arrest
1:10,000 solution
IV
- Recommended dose: 0.5-1.0 mg (5-10 mL)
- During a resuscitation effort, 0.5 mg (5 mL) IV q5min
Intracardiac
- Intracardiac injection if there has not been sufficient time to establish an IV route
- Usual dose ranges from 0.3-0.5 mg (3-5 mL)
Endotracheal tube
- Alternatively, if the patient has been intubated, epinephrine can be injected via the endotracheal tube directly into the bronchial tree at the same dosage as for IV injection
- 2-2.5 mg q3-5min until IV/IO access established or spontaneous circulation restored
Hypotension Associated with Septic Shock
Indicated to increase mean arterial blood pressure in adults with hypotension associated with septic shock
Recommended dose: 0.05-2 mcg/kg/minute IV infusion; titrate to desired mean arterial pressure (MAP); may adjust dose q10-15 min by 0.05-0.2 mcg/kg/minute to achieve desired blood pressure goal
After hemodynamic stabilization, may wean incrementally q30min over 12-24 hr
See also Administration
Anaphylaxis
Indicated in emergency treatment of allergic reactions (Type I) including anaphylaxis
1:10,000 solution
- 0.1 mg (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
1:1000 solution
- 0.3-0.5 mg (0.3-0.5 mL) of undiluted epinephrine IM/SC once in anterolateral aspect of the thigh, not to exceed 0.5 mg (0.5 mL) per injection, repeated every 5-10 minutes as necessary
- Monitor clinically for reaction severity and cardiac effects
Prefilled autoinjector or syringe
- 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
See also Administration
Symptomatic Bradycardia
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
Mydriasis
Induction and maintenance of mydriasis during intraocular surgery
1:1000 solution
- After dilution in an ophthalmic irrigating fluid, inject intracamerally as a bolus dose of 0.1 mL at dilution of 1:100,000 to 1:400,000 (10-2.5 mcg/mL)
- See also Administration
Dosing Considerations
Anaphylaxis
- With severe persistent anaphylaxis, repeat injections with an additional autoinjector may be necessary
- More than two sequential doses of epinephrine should only be administered under direct medical supervision
Dosage Forms & Strengths
prefilled autoinjector or syringe for SC/IM use
- 0.1mg/0.1mL (Auvi-Q)
- 0.15mg/0.15mL (EpiPen Jr, Auvi-Q, Symjepi)
- 0.3mg/0.3mL (EpiPen, Auvi-Q, Symjepi)
injectable solution
- 0.1mg/mL (1:10,000)
- 1mg/mL (1:1000)
Anaphylaxis
Indicated in emergency treatment of allergic reactions (Type I) including anaphylaxis
1:1000 solution
- <30 kg (66 lbs): 0.01 mg/kg (0.01 mL/kg) SC/IM, not to exceed 0.3 mg (0.3 mL) per injection, repeated q5-10 min as necessary
- ≥30 kg (66 lbs): 0.3-0.5 mg (0.3-0.5 mL) SC/IM, not to exceed 0.5 mg (0.5 mL) per injection, repeated q5-10 min as necessary
Autoinjector
- May repeat dose after 5-15 minutes if symptoms persist
- Infants weighing 7.5-15 kg (16.5-33 lb); Auvi-Q only: 0.1 mg SC/IM once
- Weight 15 to <30 kg: 0.15 mg (contents of 1 autoinjector/prefilled syringe) SC/IM once; may repeat dose q5-15min
- Weight ≥30 kg: 0.3 mg (contents of 1 autoinjector/prefilled syringe) SC/IM once; may repeat dose q5-15min
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 (aged <28 days): 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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (15)
- disopyramide
epinephrine and disopyramide both increase QTc interval. Contraindicated.
- ibutilide
epinephrine and ibutilide both increase QTc interval. Contraindicated.
- indapamide
epinephrine and indapamide both increase QTc interval. Contraindicated.
- iobenguane I 123
epinephrine decreases effects of iobenguane I 123 by receptor binding competition. Contraindicated. If clinically appropriate, discontinue drugs that compete for NE receptor sites for at least 5 half-lives; may cause false-negative imaging results.
- isocarboxazid
isocarboxazid increases effects of epinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- linezolid
linezolid increases effects of epinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- lurasidone
epinephrine increases toxicity of lurasidone by pharmacodynamic synergism. Contraindicated. Interaction applies only in setting of acute lurasidone overdose. Epinephrine may enhance hypotensive effects of lurasidone in overdose setting.
- pentamidine
epinephrine and pentamidine both increase QTc interval. Contraindicated.
- phenelzine
phenelzine increases effects of epinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- pimozide
epinephrine and pimozide both increase QTc interval. Contraindicated.
- procainamide
epinephrine and procainamide both increase QTc interval. Contraindicated.
- quinidine
epinephrine and quinidine both increase QTc interval. Contraindicated.
- selegiline transdermal
selegiline transdermal increases effects of epinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- sotalol
epinephrine and sotalol both increase QTc interval. Contraindicated.
- tranylcypromine
tranylcypromine increases effects of epinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
Serious - Use Alternative (65)
- amiodarone
epinephrine and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.
- amitriptyline
epinephrine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
amitriptyline, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron. - amoxapine
epinephrine and amoxapine both increase QTc interval. Avoid or Use Alternate Drug.
amoxapine, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron. - artemether/lumefantrine
epinephrine and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.
- cabergoline
cabergoline, epinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- chlorpromazine
epinephrine and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.
- clarithromycin
epinephrine and clarithromycin both increase QTc interval. Avoid or Use Alternate Drug.
- clomipramine
epinephrine and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.
clomipramine, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron. - desflurane
desflurane increases toxicity of epinephrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
desflurane increases levels of epinephrine by decreasing metabolism. Contraindicated. - desipramine
epinephrine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.
desipramine, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron. - dihydroergotamine
dihydroergotamine, epinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- dihydroergotamine intranasal
dihydroergotamine intranasal, epinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- dofetilide
epinephrine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- dosulepin
epinephrine and dosulepin both increase QTc interval. Avoid or Use Alternate Drug.
- doxapram
doxapram increases effects of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.
- doxepin
epinephrine and doxepin both increase QTc interval. Avoid or Use Alternate Drug.
doxepin, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron. - dronedarone
epinephrine and dronedarone both increase QTc interval. Avoid or Use Alternate Drug.
- droperidol
epinephrine and droperidol both increase QTc interval. Avoid or Use Alternate Drug.
- ergoloid mesylates
ergoloid mesylates, epinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- ergotamine
ergotamine, epinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- erythromycin base
epinephrine and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin ethylsuccinate
epinephrine and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin lactobionate
epinephrine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin stearate
epinephrine and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.
- ether
ether increases toxicity of epinephrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- etomidate
etomidate increases levels of epinephrine by decreasing metabolism. Contraindicated.
- fluconazole
epinephrine and fluconazole both increase QTc interval. Avoid or Use Alternate Drug.
- fluphenazine
epinephrine and fluphenazine both increase QTc interval. Avoid or Use Alternate Drug.
- formoterol
epinephrine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.
- haloperidol
epinephrine and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.
- imipramine
epinephrine and imipramine both increase QTc interval. Avoid or Use Alternate Drug.
imipramine, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron. - iobenguane I 131
epinephrine will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.
- isoflurane
isoflurane increases toxicity of epinephrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- ketamine
ketamine, epinephrine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Intraoperative use of epinephrine and ketamine should be used cautiously and is contraindicated in situations where increased blood pressure would be hazardous (eg, hypertension, stroke, head trauma, intracranial bleeding).
- ketoconazole
epinephrine and ketoconazole both increase QTc interval. Avoid or Use Alternate Drug.
- levomilnacipran
levomilnacipran increases levels of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of paroxysmal HTN, arrhythmia.
- lofepramine
epinephrine and lofepramine both increase QTc interval. Avoid or Use Alternate Drug.
lofepramine, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron. - lumefantrine
epinephrine and lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.
- maprotiline
epinephrine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.
maprotiline, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron. - methoxyflurane
methoxyflurane increases toxicity of epinephrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- methylergonovine
methylergonovine, epinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- milnacipran
milnacipran increases levels of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of paroxysmal HTN, arrhythmia.
- moxifloxacin
epinephrine and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- nadolol
nadolol increases effects of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of hypertension and bradycardia. Consider selective beta 1 blocker (e.g., metoprolol).
- nortriptyline
epinephrine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.
nortriptyline, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron. - octreotide
epinephrine and octreotide both increase QTc interval. Avoid or Use Alternate Drug.
- octreotide (Antidote)
epinephrine and octreotide (Antidote) both increase QTc interval. Avoid or Use Alternate Drug.
- ozanimod
ozanimod increases toxicity of epinephrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.
- perphenazine
epinephrine and perphenazine both increase QTc interval. Avoid or Use Alternate Drug.
- pindolol
pindolol increases effects of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of hypertension and bradycardia. Consider selective beta 1 blocker (e.g., metoprolol).
- procarbazine
procarbazine increases effects of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of acute hypertensive episode.
- prochlorperazine
epinephrine and prochlorperazine both increase QTc interval. Avoid or Use Alternate Drug.
- promazine
epinephrine and promazine both increase QTc interval. Avoid or Use Alternate Drug.
- promethazine
epinephrine and promethazine both increase QTc interval. Avoid or Use Alternate Drug.
- propofol
propofol increases levels of epinephrine by unknown mechanism. Avoid or Use Alternate Drug.
- propranolol
propranolol increases effects of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of hypertension and bradycardia. Consider selective beta 1 blocker (e.g., metoprolol).
- protriptyline
epinephrine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
protriptyline, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron. - sevoflurane
sevoflurane increases toxicity of epinephrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- thioridazine
epinephrine and thioridazine both increase QTc interval. Avoid or Use Alternate Drug.
- timolol
timolol increases effects of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of hypertension and bradycardia. Consider selective beta 1 blocker (e.g., metoprolol).
- trazodone
epinephrine and trazodone both increase QTc interval. Avoid or Use Alternate Drug.
trazodone, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron. - trifluoperazine
epinephrine and trifluoperazine both increase QTc interval. Avoid or Use Alternate Drug.
- trimipramine
epinephrine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
trimipramine, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron. - yohimbe
yohimbe, epinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- ziprasidone
epinephrine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.
Monitor Closely (267)
- acebutolol
acebutolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
acebutolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - aceclofenac
aceclofenac increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- acemetacin
acemetacin increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- albuterol
albuterol and epinephrine both decrease serum potassium. Use Caution/Monitor.
albuterol and epinephrine both decrease sedation. Use Caution/Monitor.
albuterol and epinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - alfentanil
alfentanil increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- alprazolam
alprazolam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- amiloride
amiloride increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- amitriptyline
amitriptyline increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
amitriptyline increases effects of epinephrine by unknown mechanism. Use Caution/Monitor. - amobarbital
amobarbital increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- amoxapine
amoxapine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
amoxapine increases effects of epinephrine by unknown mechanism. Use Caution/Monitor. - arformoterol
arformoterol and epinephrine both decrease serum potassium. Use Caution/Monitor.
arformoterol and epinephrine both decrease sedation. Use Caution/Monitor.
arformoterol and epinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - aripiprazole
aripiprazole increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- armodafinil
epinephrine and armodafinil both decrease sedation. Use Caution/Monitor.
- aspirin
aspirin increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- aspirin rectal
aspirin rectal increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- aspirin/citric acid/sodium bicarbonate
aspirin/citric acid/sodium bicarbonate increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- atenolol
atenolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
atenolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - atomoxetine
atomoxetine, epinephrine. Other (see comment). Use Caution/Monitor. Comment: Due to the potential for increases in blood pressure and heart rate, atomoxetine should be used cautiously with vasopressors such as epinephrine.
- azelastine
azelastine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- azithromycin
epinephrine and azithromycin both increase QTc interval. Use Caution/Monitor.
- belladonna and opium
belladonna and opium increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- bendroflumethiazide
epinephrine and bendroflumethiazide both decrease serum potassium. Use Caution/Monitor.
- benperidol
benperidol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- benzphetamine
epinephrine and benzphetamine both decrease sedation. Use Caution/Monitor.
epinephrine and benzphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - betaxolol
betaxolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
betaxolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - bisoprolol
bisoprolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
bisoprolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - bretylium
bretylium increases effects of epinephrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Modify Therapy/Monitor Closely. If catecholamines are administered to treat systolic BP <75 mmHg, a dilute solution should be employed and blood pressure monitored closely. Bretylium causes an initial norepinephrine release and may enhance catecholamine pressor effects.
- bromocriptine
bromocriptine, epinephrine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Hypertension, V tach.
- brompheniramine
brompheniramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- bumetanide
epinephrine and bumetanide both decrease serum potassium. Use Caution/Monitor.
- buprenorphine buccal
buprenorphine buccal increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- butabarbital
butabarbital increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- butalbital
butalbital increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- butorphanol
butorphanol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- caffeine
epinephrine and caffeine both decrease sedation. Use Caution/Monitor.
- carbenoxolone
epinephrine and carbenoxolone both decrease serum potassium. Use Caution/Monitor.
- carbinoxamine
carbinoxamine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- carvedilol
carvedilol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
carvedilol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - celecoxib
celecoxib increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- celiprolol
celiprolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
celiprolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - chloral hydrate
chloral hydrate increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chlordiazepoxide
chlordiazepoxide increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chlorothiazide
epinephrine and chlorothiazide both decrease serum potassium. Use Caution/Monitor.
- chlorpheniramine
chlorpheniramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chlorpromazine
chlorpromazine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
chlorpromazine, epinephrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.
chlorpromazine decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. Block pressor response to epinephrine, which may result in severe hypotension and tachycardia. - chlorthalidone
epinephrine and chlorthalidone both decrease serum potassium. Use Caution/Monitor.
- choline magnesium trisalicylate
choline magnesium trisalicylate increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- cinnarizine
cinnarizine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- clemastine
clemastine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- clomipramine
clomipramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
clomipramine increases effects of epinephrine by unknown mechanism. Use Caution/Monitor. - clonazepam
clonazepam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- clorazepate
clorazepate increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- clozapine
clozapine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
clozapine decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. Block pressor response to epinephrine, which may result in severe hypotension and tachycardia. - codeine
codeine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- cyclizine
cyclizine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- cyclopenthiazide
epinephrine and cyclopenthiazide both decrease serum potassium. Use Caution/Monitor.
- cyproheptadine
cyproheptadine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- deflazacort
epinephrine and deflazacort both decrease serum potassium. Use Caution/Monitor.
- desipramine
desipramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
desipramine increases effects of epinephrine by unknown mechanism. Use Caution/Monitor. - dexchlorpheniramine
dexchlorpheniramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dexfenfluramine
epinephrine and dexfenfluramine both decrease sedation. Use Caution/Monitor.
epinephrine and dexfenfluramine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - dexmedetomidine
dexmedetomidine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dexmethylphenidate
epinephrine and dexmethylphenidate both decrease sedation. Use Caution/Monitor.
epinephrine and dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - dextroamphetamine
epinephrine and dextroamphetamine both decrease sedation. Use Caution/Monitor.
epinephrine and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - dextromoramide
dextromoramide increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- diamorphine
diamorphine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dichlorphenamide
dichlorphenamide and epinephrine both decrease serum potassium. Use Caution/Monitor.
dichlorphenamide, epinephrine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Both drugs can cause metabolic acidosis. - diclofenac
diclofenac increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- diethylpropion
epinephrine and diethylpropion both decrease sedation. Use Caution/Monitor.
epinephrine and diethylpropion both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - difenoxin hcl
difenoxin hcl increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- diflunisal
diflunisal increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- digoxin
digoxin increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dimenhydrinate
dimenhydrinate increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- diphenhydramine
diphenhydramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- diphenoxylate hcl
diphenoxylate hcl increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dipipanone
dipipanone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dobutamine
dobutamine and epinephrine both decrease serum potassium. Use Caution/Monitor.
dobutamine and epinephrine both decrease sedation. Use Caution/Monitor.
dobutamine and epinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - dolasetron
epinephrine and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.
- dopamine
epinephrine and dopamine both decrease sedation. Use Caution/Monitor.
epinephrine and dopamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - dopexamine
dopexamine and epinephrine both decrease serum potassium. Use Caution/Monitor.
dopexamine and epinephrine both decrease sedation. Use Caution/Monitor.
dopexamine and epinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
dopexamine, epinephrine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. - doxepin
doxepin increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
doxepin increases effects of epinephrine by unknown mechanism. Use Caution/Monitor. - droperidol
droperidol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- drospirenone
drospirenone increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- droxidopa
epinephrine and droxidopa both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. May increase risk for supine hypertension
- entacapone
entacapone will increase the level or effect of epinephrine by decreasing metabolism. Use Caution/Monitor. Entacapone is a COMT inhibitor. Caution if coadministered with drugs metabolized by COMT. If coadministered, monitor for changes in heart rate, heart rhythm, and blood pressure.
- ephedrine
ephedrine and epinephrine both decrease serum potassium. Use Caution/Monitor.
ephedrine and epinephrine both decrease sedation. Use Caution/Monitor.
ephedrine and epinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
ephedrine, epinephrine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. - epinephrine inhaled
epinephrine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- epinephrine racemic
epinephrine and epinephrine racemic both decrease serum potassium. Use Caution/Monitor.
epinephrine and epinephrine racemic both decrease sedation. Use Caution/Monitor.
epinephrine and epinephrine racemic both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
epinephrine, epinephrine racemic. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. - esmolol
esmolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
esmolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - estazolam
estazolam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ethacrynic acid
epinephrine and ethacrynic acid both decrease serum potassium. Use Caution/Monitor.
- ethanol
ethanol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- etodolac
etodolac increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- fenfluramine
epinephrine and fenfluramine both decrease sedation. Use Caution/Monitor.
epinephrine and fenfluramine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - fenoprofen
fenoprofen increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- flecainide
epinephrine and flecainide both increase QTc interval. Modify Therapy/Monitor Closely.
- fluoxetine
epinephrine and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.
- fluphenazine
fluphenazine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
fluphenazine, epinephrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.
fluphenazine decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. Block pressor response to epinephrine, which may result in severe hypotension and tachycardia. - flurazepam
flurazepam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- flurbiprofen
flurbiprofen increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- fluvoxamine
fluvoxamine and epinephrine both increase QTc interval. Modify Therapy/Monitor Closely.
- formoterol
epinephrine and formoterol both decrease serum potassium. Use Caution/Monitor.
epinephrine and formoterol both decrease sedation. Use Caution/Monitor.
epinephrine and formoterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - foscarnet
epinephrine and foscarnet both increase QTc interval. Modify Therapy/Monitor Closely.
- furosemide
epinephrine and furosemide both decrease serum potassium. Use Caution/Monitor.
- gentamicin
epinephrine and gentamicin both decrease serum potassium. Use Caution/Monitor.
- green tea
green tea increases effects of epinephrine by pharmacodynamic synergism. Use Caution/Monitor. Due to caffeine content. Combination may increase CNS stimulatory effects due to caffeine in green tea.
- haloperidol
haloperidol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- hydralazine
hydralazine, epinephrine. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.
- hydrochlorothiazide
epinephrine and hydrochlorothiazide both decrease serum potassium. Use Caution/Monitor.
- hydromorphone
hydromorphone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- hydroxyzine
hydroxyzine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ibuprofen
ibuprofen increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ibuprofen IV
ibuprofen IV increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- iloperidone
epinephrine and iloperidone both increase QTc interval. Modify Therapy/Monitor Closely.
iloperidone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. - imipramine
imipramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
imipramine increases effects of epinephrine by unknown mechanism. Use Caution/Monitor. - indacaterol, inhaled
epinephrine increases effects of indacaterol, inhaled by Other (see comment). Use Caution/Monitor. Comment: If additional adrenergic drugs are to be administered by any route, they should be used with caution because the sympathetic effects of indacaterol may be potentiated.
- indapamide
epinephrine and indapamide both decrease serum potassium. Use Caution/Monitor.
- indomethacin
indomethacin increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- insulin degludec
epinephrine decreases effects of insulin degludec by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.
- insulin degludec/insulin aspart
epinephrine decreases effects of insulin degludec/insulin aspart by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.
- insulin inhaled
epinephrine decreases effects of insulin inhaled by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.
- isoproterenol
epinephrine and isoproterenol both decrease serum potassium. Use Caution/Monitor.
epinephrine and isoproterenol both decrease sedation. Use Caution/Monitor.
epinephrine and isoproterenol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - ketoprofen
ketoprofen increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ketorolac
ketorolac increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ketorolac intranasal
ketorolac intranasal increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- ketotifen, ophthalmic
ketotifen, ophthalmic increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- labetalol
labetalol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
labetalol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - levalbuterol
epinephrine and levalbuterol both decrease serum potassium. Use Caution/Monitor.
epinephrine and levalbuterol both decrease sedation. Use Caution/Monitor.
epinephrine and levalbuterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - levofloxacin
epinephrine and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.
- levorphanol
levorphanol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- levothyroxine
levothyroxine will increase the level or effect of epinephrine by unspecified interaction mechanism. Use Caution/Monitor.
- lisdexamfetamine
epinephrine and lisdexamfetamine both decrease sedation. Use Caution/Monitor.
epinephrine and lisdexamfetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - lofepramine
lofepramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
lofepramine increases effects of epinephrine by unknown mechanism. Use Caution/Monitor. - lofexidine
lofexidine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- loprazolam
loprazolam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lorazepam
lorazepam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lormetazepam
lormetazepam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lornoxicam
lornoxicam increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- loxapine
loxapine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- loxapine inhaled
loxapine inhaled increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- maprotiline
maprotiline increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
maprotiline increases effects of epinephrine by unknown mechanism. Use Caution/Monitor. - marijuana
marijuana increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- meclofenamate
meclofenamate increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- mefenamic acid
mefenamic acid increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- melatonin
melatonin increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- meloxicam
meloxicam increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- meperidine
meperidine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- meprobamate
meprobamate increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metaproterenol
epinephrine and metaproterenol both decrease serum potassium. Use Caution/Monitor.
epinephrine and metaproterenol both decrease sedation. Use Caution/Monitor.
epinephrine and metaproterenol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - methadone
epinephrine and methadone both increase QTc interval. Modify Therapy/Monitor Closely.
methadone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. - methamphetamine
epinephrine and methamphetamine both decrease sedation. Use Caution/Monitor.
epinephrine and methamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - methyclothiazide
epinephrine and methyclothiazide both decrease serum potassium. Use Caution/Monitor.
- methyldopa
methyldopa increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.
- methylenedioxymethamphetamine
epinephrine and methylenedioxymethamphetamine both decrease sedation. Use Caution/Monitor.
epinephrine and methylenedioxymethamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - methylphenidate
epinephrine and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- metolazone
epinephrine and metolazone both decrease serum potassium. Use Caution/Monitor.
- metoprolol
metoprolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
metoprolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - midazolam
midazolam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- midodrine
epinephrine and midodrine both decrease sedation. Use Caution/Monitor.
epinephrine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - mirtazapine
mirtazapine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- modafinil
epinephrine and modafinil both decrease sedation. Use Caution/Monitor.
- morphine
morphine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- motherwort
motherwort increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- moxonidine
moxonidine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nabilone
nabilone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nabumetone
nabumetone increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nadolol
nadolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
nadolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - nalbuphine
nalbuphine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- naproxen
naproxen increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nateglinide
epinephrine decreases effects of nateglinide by pharmacodynamic antagonism. Use Caution/Monitor. Coadministration may reduce nateglinide's hypoglycemic action.
- nebivolol
nebivolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
nebivolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - norepinephrine
epinephrine and norepinephrine both decrease serum potassium. Use Caution/Monitor.
epinephrine and norepinephrine both decrease sedation. Use Caution/Monitor.
epinephrine and norepinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - nortriptyline
nortriptyline increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
nortriptyline increases effects of epinephrine by unknown mechanism. Use Caution/Monitor. - ofloxacin
epinephrine and ofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.
- olanzapine
olanzapine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- olodaterol inhaled
epinephrine and olodaterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Caution with coadministration of adrenergic drugs by any route because of additive sympathetic effects
- opicapone
opicapone will increase the level or effect of epinephrine by decreasing metabolism. Use Caution/Monitor. Opicapone is a COMT inhibitor. Caution if coadministered with drugs metabolized by COMT. If coadministered, monitor for changes in heart rate, heart rhythm, and blood pressure.
- opium tincture
opium tincture increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxaprozin
oxaprozin increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxazepam
oxazepam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxycodone
oxycodone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxymetazoline topical
oxymetazoline topical and epinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- oxymorphone
oxymorphone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxytocin
oxytocin increases effects of epinephrine by pharmacodynamic synergism. Use Caution/Monitor.
- paliperidone
epinephrine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
paliperidone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. - papaveretum
papaveretum increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- parecoxib
parecoxib increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- paroxetine
epinephrine and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.
- penbutolol
penbutolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
penbutolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - pentazocine
pentazocine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pentobarbital
pentobarbital increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- perphenazine
perphenazine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
perphenazine, epinephrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.
perphenazine decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. Block pressor response to epinephrine, which may result in severe hypotension and tachycardia. - phendimetrazine
epinephrine and phendimetrazine both decrease sedation. Use Caution/Monitor.
epinephrine and phendimetrazine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - phenobarbital
phenobarbital increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenoxybenzamine
phenoxybenzamine, epinephrine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Hypotension, tachycardia.
- phentermine
epinephrine and phentermine both decrease sedation. Use Caution/Monitor.
epinephrine and phentermine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - phentolamine
phentolamine, epinephrine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Hypotension, tachycardia.
- phenylephrine
epinephrine and phenylephrine both decrease sedation. Use Caution/Monitor.
epinephrine and phenylephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - phenylephrine PO
epinephrine and phenylephrine PO both decrease sedation. Use Caution/Monitor.
epinephrine and phenylephrine PO both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - pholcodine
pholcodine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pimozide
pimozide increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pindolol
pindolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
pindolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - pirbuterol
epinephrine and pirbuterol both decrease serum potassium. Use Caution/Monitor.
epinephrine and pirbuterol both decrease sedation. Use Caution/Monitor.
epinephrine and pirbuterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - piroxicam
piroxicam increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- posaconazole
epinephrine and posaconazole both increase QTc interval. Modify Therapy/Monitor Closely.
- potassium acid phosphate
potassium acid phosphate increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- potassium chloride
potassium chloride increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- potassium citrate
potassium citrate increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- primidone
primidone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- prochlorperazine
prochlorperazine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
prochlorperazine, epinephrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.
prochlorperazine decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. Block pressor response to epinephrine, which may result in severe hypotension and tachycardia. - promazine
promazine, epinephrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.
promazine decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. Block pressor response to epinephrine, which may result in severe hypotension and tachycardia. - promethazine
promethazine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
promethazine, epinephrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.
promethazine decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. Block pressor response to epinephrine, which may result in severe hypotension and tachycardia. - propranolol
propranolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
propranolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - propylhexedrine
epinephrine and propylhexedrine both decrease sedation. Use Caution/Monitor.
epinephrine and propylhexedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - protriptyline
protriptyline increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
protriptyline increases effects of epinephrine by unknown mechanism. Use Caution/Monitor. - pseudoephedrine
epinephrine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- quazepam
quazepam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- quetiapine
quetiapine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ranolazine
epinephrine and ranolazine both increase QTc interval. Modify Therapy/Monitor Closely.
- rasagiline
rasagiline increases effects of epinephrine by pharmacodynamic synergism. Use Caution/Monitor. Avoid concomitant use if possible. Caution is advised.
- risperidone
epinephrine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.
risperidone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. - sacubitril/valsartan
sacubitril/valsartan increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- salicylates (non-asa)
salicylates (non-asa) increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- salmeterol
epinephrine and salmeterol both decrease serum potassium. Use Caution/Monitor.
epinephrine and salmeterol both decrease sedation. Use Caution/Monitor.
epinephrine and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - salsalate
salsalate increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- scullcap
scullcap increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- secobarbital
secobarbital increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- selegiline
selegiline increases effects of epinephrine by pharmacodynamic synergism. Use Caution/Monitor. Avoid concomitant use if possible. Caution is advised.
- shepherd's purse
shepherd's purse increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol
epinephrine and sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.
- solriamfetol
epinephrine and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- sotalol
sotalol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
sotalol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - spironolactone
spironolactone increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- succinylcholine
succinylcholine increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- sufentanil
sufentanil increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- sulfamethoxazole
epinephrine and sulfamethoxazole both increase QTc interval. Modify Therapy/Monitor Closely.
- sulfasalazine
sulfasalazine increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- sulindac
sulindac increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- tapentadol
tapentadol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- telavancin
epinephrine and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.
- temazepam
temazepam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- terbutaline
epinephrine and terbutaline both decrease serum potassium. Use Caution/Monitor.
epinephrine and terbutaline both decrease sedation. Use Caution/Monitor.
epinephrine and terbutaline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - thioridazine
thioridazine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
thioridazine, epinephrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.
thioridazine decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. Block pressor response to epinephrine, which may result in severe hypotension and tachycardia. - thiothixene
thiothixene increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- timolol
timolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
timolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - tolcapone
tolcapone will increase the level or effect of epinephrine by decreasing metabolism. Use Caution/Monitor. Tolcapone is a COMT inhibitor. Caution if coadministered with drugs metabolized by COMT. If coadministered, monitor for changes in heart rate, heart rhythm, and blood pressure.
- tolfenamic acid
tolfenamic acid increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- tolmetin
tolmetin increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- tolvaptan
tolvaptan increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- topiramate
topiramate increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- torsemide
epinephrine and torsemide both decrease serum potassium. Use Caution/Monitor.
- tramadol
tramadol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- trazodone
trazodone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
trazodone increases effects of epinephrine by unknown mechanism. Use Caution/Monitor. - triamterene
triamterene increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- triazolam
triazolam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- triclofos
triclofos increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- trifluoperazine
trifluoperazine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
trifluoperazine, epinephrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.
trifluoperazine decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. Block pressor response to epinephrine, which may result in severe hypotension and tachycardia. - trimethoprim
epinephrine and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- trimipramine
trimipramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
trimipramine increases effects of epinephrine by unknown mechanism. Use Caution/Monitor. - triprolidine
triprolidine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- tropisetron
epinephrine and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.
- venlafaxine
epinephrine and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.
- voriconazole
epinephrine and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.
- xylometazoline
epinephrine and xylometazoline both decrease sedation. Use Caution/Monitor.
epinephrine and xylometazoline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - yohimbine
epinephrine and yohimbine both decrease sedation. Use Caution/Monitor.
epinephrine and yohimbine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - ziconotide
ziconotide increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ziprasidone
ziprasidone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
Minor (18)
- bendroflumethiazide
epinephrine, bendroflumethiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- bumetanide
epinephrine, bumetanide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- chlorothiazide
epinephrine, chlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- chlorthalidone
epinephrine, chlorthalidone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- cyclopenthiazide
epinephrine, cyclopenthiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- desmopressin
desmopressin increases effects of epinephrine by pharmacodynamic synergism. Minor/Significance Unknown.
- ethacrynic acid
epinephrine, ethacrynic acid. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- eucalyptus
eucalyptus increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.
- furosemide
epinephrine, furosemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- hydrochlorothiazide
epinephrine, hydrochlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- indapamide
epinephrine, indapamide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- methyclothiazide
epinephrine, methyclothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- metolazone
epinephrine, metolazone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- noni juice
noni juice increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Minor/Significance Unknown.
- sage
sage increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.
- thiothixene
thiothixene decreases effects of epinephrine by pharmacodynamic antagonism. Minor/Significance Unknown.
- torsemide
epinephrine, torsemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- vasopressin
epinephrine decreases effects of vasopressin by pharmacodynamic antagonism. Minor/Significance Unknown.
Adverse Effects
Frequency Not Defined
Angina
Anxiety
Apprehensiveness
Cardiac arrhythmias
Dizziness
Dyspnea
Flushing
Headache
Hypertension
Nausea
Nervousness
Pallor
Palpitations
Respiratory difficulties
Restlessness
Stress cardiomyopathy
Sweating
Tachycardia
Tremor
Vasoconstriction
Vomiting
Weakness
Postmarketing Reports
Necrotizing fasciitis and myonecrosis caused by Clostridia (gas gangrene)
Reduced blood flow to digits, hands, or feet with accidental injection to those areas
Arrhythmias, including fatal ventricular fibrillation, reported, particularly in patients with underlying cardiac disease or those receiving certain drugs
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
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
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
Solutions must be diluted prior to intraocular use; other epinephrine products containing sodium bisulfite have been associated with corneal endothelial damage when used in the eye at undiluted concentrations (1 mg/mL)
Autoinjector is to be used in conjunction with immediate medical or hospital care; more than two sequential doses of epinephrine should only be administered under direct medical supervision
Extravasation
- Avoid extravasation; ensure proper needle or catheter placement prior to and during infusion
- To prevent sloughing and necrosis in areas has extravasation, infiltrate the area with 10-15 mL of 0.9% NaCl solution containing phentolamine 5-10 mg
- Use a syringe with a fine hypodermic needle, with solution being infiltrated liberally throughout the area, which has a cold, hard, and pallid appearance
- Phentolamine may cause immediate and conspicuous local hyperemic changes if area is infiltrated within 12 hr
Injection related complications
- Injection into buttock may not provide effective treatment of anaphylaxis
- 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
- To minimize the risk of injection-related injury when administering autoinjector to children or infants, instruct caregivers to firmly hold child’s leg in place and limit movement prior to and during injection
Drug interactions overview
- Coadministration with cardiac glycosides, diuretics, or anti-arrhythmics should be observed carefully for the development of cardiac arrhythmias
- Effects of epinephrine may be potentiated by tricyclic antidepressants, monoamine oxidase inhibitors, levothyroxine sodium, and certain antihistamines, notably chlorpheniramine, tripelennamine, and diphenhydramine
- Cardiostimulating and bronchodilating effects of epinephrine are antagonized by beta-adrenergic blocking drugs, such as propranolol
- Vasoconstricting and hypertensive effects of epinephrine are antagonized by alpha-adrenergic blocking drugs, such as phentolamine
- Ergot alkaloids may reverse the pressor effects of epinephrine
Pregnancy & Lactation
Pregnancy
During pregnancy, anaphylaxis can be catastrophic and can lead to hypoxic-ischemic encephalopathy and permanent central nervous system damage or death in the mother and, more commonly, in the fetus or neonate
The prevalence of anaphylaxis occurring during pregnancy is reported to be approximately 3 cases per 100,000 deliveries; management of anaphylaxis during pregnancy is similar to management in the general population
Epinephrine is the first line-medication of choice for treatment of anaphylaxis; it should be used in the same manner in pregnant and non-pregnant patients
In conjunction with the administration of epinephrine, the patient should seek immediate medical or hospital care
Hypotension associated with septic shock is a medical emergency in pregnancy which can be fatal if left untreated; delaying treatment in pregnant women with hypotension associated with septic shock may increase risk of maternal and fetal morbidity and mortality
Life-sustaining therapy for pregnant woman should not be withheld due to potential concerns regarding effects of epinephrine on fetus
Labor and delivery
- Epinephrine usually inhibits spontaneous or oxytocin-induced contractions of the pregnant human uterus and may delay second stage of labor; avoid epinephrine during second stage of labor; in dosage sufficient to reduce uterine contractions, the drug may cause a prolonged period of uterine atony with hemorrhage
- Avoid epinephrine in obstetrics when maternal blood pressure exceeds 130/80 mmHg; although epinephrine may improve maternal hypotension associated with septic shock and anaphylaxis, it may result in uterine vasoconstriction, decreased uterine blood flow, and fetal anoxia
Lactation
There is no information regarding presence of epinephrine in human milk or effects on the breastfed infant or on milk production
However, due to poor oral bioavailability and short half-life, epinephrine exposure is expected to be very low in breastfed infant
Epinephrine is first-line medication of choice for treatment of anaphylaxis; it should be used in same manner for anaphylaxis in breastfeeding and non-breastfeeding patients
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.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
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
Dilute epinephrine in D5W or D5W 0.9% NaCl
Administration in saline solution alone is not recommended
Add 1 mL (1 mg) of epinephrine from its ampule to 1000 mL of a D5W containing solution
Each mL of this dilution contains 1 mcg of epinephrine
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
Correct blood volume depletion as fully as possible prior to administering any vasopressor
When, as an emergency measure, intraaortic pressures must be maintained to prevent cerebral or coronary artery ischemia, epinephrine can be administered before and concurrently with blood volume replacement
Whenever possible, administer epinephrine infusions into a large vein
Avoid using a catheter tie-in technique, because the obstruction to blood flow around the tubing may cause stasis and increased local concentration of the drug
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
Intraocular Preparation
Epinephrine must be diluted prior to intraocular use
Dilute 1 mL of epinephrine 1 mg/mL (1:1000) in 100 to 1000 mL of an ophthalmic irrigation fluid to create an epinephrine concentration of 1:100,000 to 1:1,000,000 (10-1 mcg/mL)
Use the irrigating solution as needed for the surgical procedure
Intraocular Administration
After dilution in an ophthalmic irrigating fluid, inject intracamerally
SC/IM Administration
SC or IM administration only
Inject IM or SC into the anterolateral aspect of the thigh, through clothing if necessary
Do not administer autoinjector IV; administer only in outer thigh to ensure SC or IM administration
Do not inject into buttock, or into digits, hands, or feet
To minimize the risk of injection-related injury, instruct caregivers to hold the child's leg firmly in place and limit movement prior to and during injection when administering to young children
Discard remaining volume after dose has been administered
In conjunction with use, seek immediate medical or hospital care
Storage
Injection
Unused vials
- Store at room temperature, 20-25°C (68-77°F)
- Protect from light until ready to use; do not refrigerate; protect from freezing
- Protect from alkalis and oxidizing agents
Diluted solutions
- Store at room temperature (25°C) or refrigeration (4°C) is 24 hr
Autoinjector
- Store at room temperature 20-25°C (68-77°F); excursions permitted to 15-30°C (59-86°F; do not refrigerator
- The trainer for AUVI-Q should not be used at temperatures <50ºF (10ºC) or >104ºF (40ºC)
- Store the trainer for AUVI-Q in its outer case; keep away from dirt, chemicals, and water
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| epinephrine injection - | 0.15 mg/0.3 mL device |  | |
| epinephrine injection - | 0.3 mg/0.3 mL device |  | |
| epinephrine injection - | 0.3 mg/0.3 mL device |  | |
| epinephrine injection - | 0.15 mg/0.3 mL device |  | |
| epinephrine injection - | 0.15 mg/0.3 mL device |  | |
| epinephrine injection - | 0.3 mg/0.3 mL device |  | |
| epinephrine injection - | 0.15 mg/0.15 mL device |  | |
| epinephrine injection - | 0.3 mg/0.3 mL device |  | |
| epinephrine injection - | 0.3 mg/0.3 mL device |  | |
| epinephrine injection - | 0.15 mg/0.3 mL device |  | |
| epinephrine injection - | 1 mg/mL (1 mL) solution |  | |
| epinephrine injection - | 0.1 mg/mL solution |  | |
| EpiPen Jr injection - | 0.15 mg/0.3 mL device |  | |
| EpiPen injection - | 0.3 mg/0.3 mL device |  | |
| Adrenalin injection - | 1 mg/mL (1 mL) vial |  | |
| Adrenalin injection - | 1 mg/mL vial |  | |
| Epinephine Professional EMS injection - | 1 mg/mL kit |  | |
| Epinephrine Professional injection - | 1 mg/mL kit |  | |
| Auvi-Q injection - | 0.15 mg/0.15 mL device |  | |
| Auvi-Q injection - | 0.3 mg/0.3 mL device |  | |
| EpiPen Jr 2-Pak injection - | 0.15 mg/0.3 mL device |  | |
| EpiPen 2-Pak injection - | 0.3 mg/0.3 mL device |  | |
| EpinephrineSnap-EMS injection - | 1 mg/mL kit |  | |
| EpinephrineSnap-V injection - | 1 mg/mL kit |  | |
| EpinephrineSnap-V injection - | 1 mg/mL kit |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
epinephrine injection
EPINEPHRINE AUTO-INJECTOR - INJECTION
(ep-in-EFF-rin)
COMMON BRAND NAME(S): Auvi-Q, Epipen, Twinject
USES: This medication is 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.
HOW TO USE: Keep this product near you at all times. (See also Storage section).Different brands of this medication have different directions for preparing and using the injector. Learn how to properly inject this medication 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 the medication yourself. For infants and children, make sure to hold their leg in place before and during the injection of the medication to prevent injuries from occurring. 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 dosage is based on your medical condition, weight, and response to treatment. The effects of this medication are rapid but not long-lasting. After injecting epinephrine, get medical help right away. Tell the healthcare professional that you have given yourself an injection of epinephrine. Avoid injecting this medication into your hands, feet, buttocks, or areas of your body other than the thigh. If this occurs, tell the healthcare professional right away. 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.Also, check that the product comes out of its carrying case easily before you have an emergency. If it does not, consult your pharmacist.
SIDE EFFECTS: Fast/pounding heartbeat, nervousness, sweating, nausea, vomiting, trouble breathing, headache, dizziness, anxiety, shakiness, or pale skin may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: irregular heartbeat, signs of infection at the injection site (such as redness that doesn't go away, warmth, swelling, or pain).Get medical help right away if you have any very serious side effects, including: chest pain, fainting, vision changes, seizures, confusion.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before using this medication, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.This product may contain sulfites. However, if you have a sulfite allergy, this should not be a reason for avoiding use of this medication during an emergency. Since epinephrine can be life-saving, using it is more important than avoiding any sulfite-related problems you may experience.Before using this medication, tell your doctor or pharmacist your medical history, especially of: heart conditions (e.g., coronary artery disease, arrhythmias), high blood pressure, thyroid disease, diabetes.This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Older adults may be more sensitive to the side effects of this drug, especially a rapid rise in blood pressure.Tell your doctor if you are pregnant or breastfeeding before using this medication.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (such as prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug are: beta-blockers (such as propranolol).
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include irregular heartbeat, fainting, vision changes, confusion, seizures.
NOTES: Do not share this medication with others.
MISSED DOSE: Not applicable.
STORAGE: Store this product in the carrying case/original packaging at room temperature away from light and moisture. Avoid extreme heat and cold. Do not store this medication in your vehicle or in the bathroom. Do not refrigerate or freeze.From time to time, check the expiration date, and also check this product visually for particles or discoloration. Replace the unit before it expires or if particles/discoloration are present. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this medication when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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.
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.
