articaine/epinephrine (Rx)

Local, Infiltrative, or Conductive Anesthesia in Dental Procedures

Infiltration: 0.5-2.5 mL injection of 4% solution; 20-100 mg total dose

Nerve block: 0.5-3.4 mL injection of 4% solution; 20-136 mg total dose

Oral surgery: 1-5.1 mL injection of 4% solution; 40-204 mg total dose

Not to exceed 7 mg/kg (0.175 mL/kg)  

Local, Infiltrative, or Conductive Anesthesia in Dental Procedures

<4 years: Safey and efficacy not established

4-16 years: Use lower end of dose range; 0.76-5.65 mg/kg used safely in simple procedures; 0.37-7.48 mg/kg used safely in complex procedures

Not to exceed 7 mg/kg (0.175 mL/kg)  

Storage

Storage: room temperature, protect from light, do not freeze

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 (66)

• 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.

• levoketoconazole

  epinephrine and levoketoconazole 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 (217)

• 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.

• hyaluronidase

  hyaluronidase, articaine. Other (see comment). Use Caution/Monitor. Comment: Hyaluronidase hastens the onset of local analgesia and reduces swelling, but increases systemic absorption of anesthetic. This decreases the duration of action and increases incidence of systemic reaction.

• 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, articaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Increased effects of epinephrine in anesthetic; risk of hypertension and bradycardia. Do NOT D/C chronic beta blocker Tx prior to anesthetic administration. Consider selective beta 1 blocker (e.g., metoprolol).
  
  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.

• pindolol

  pindolol, articaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Increased effects of epinephrine in anesthetic; risk of hypertension and bradycardia. Do NOT D/C chronic beta blocker Tx prior to anesthetic administration. Consider selective beta 1 blocker (e.g., metoprolol).

• 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.
  
  propranolol, articaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Increased effects of epinephrine in anesthetic; risk of hypertension and bradycardia. Do NOT D/C chronic beta blocker Tx prior to anesthetic administration. Consider selective beta 1 blocker (e.g., metoprolol).

• 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.

• timolol

  timolol, articaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Increased effects of epinephrine in anesthetic; risk of hypertension and bradycardia. Do NOT D/C chronic beta blocker Tx prior to anesthetic administration. Consider selective beta 1 blocker (e.g., metoprolol).

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.

• acebutolol

  Monitor Closely (2)acebutolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.
  
  acebutolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• aceclofenac

  Monitor Closely (1)aceclofenac increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• acemetacin

  Monitor Closely (1)acemetacin increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• albuterol

  Monitor Closely (3)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

  Monitor Closely (1)alfentanil increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• alprazolam

  Monitor Closely (1)alprazolam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• amiloride

  Monitor Closely (1)amiloride increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• amiodarone

  Serious - Use Alternative (1)epinephrine and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.

• amitriptyline

  Monitor Closely (2)amitriptyline increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.
  
  amitriptyline increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)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.

• amobarbital

  Monitor Closely (1)amobarbital increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• amoxapine

  Monitor Closely (2)amoxapine increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.
  
  amoxapine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)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.

• arformoterol

  Monitor Closely (3)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

  Monitor Closely (1)aripiprazole increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• armodafinil

  Monitor Closely (1)epinephrine and armodafinil both decrease sedation. Use Caution/Monitor.

• artemether/lumefantrine

  Serious - Use Alternative (1)epinephrine and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.

• aspirin

  Monitor Closely (1)aspirin increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• aspirin rectal

  Monitor Closely (1)aspirin rectal increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

• aspirin/citric acid/sodium bicarbonate

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• atenolol

  Monitor Closely (2)atenolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.
  
  atenolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• atomoxetine

  Monitor Closely (1)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

  Monitor Closely (1)azelastine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• azithromycin

  Monitor Closely (1)epinephrine and azithromycin both increase QTc interval. Use Caution/Monitor.

• belladonna and opium

  Monitor Closely (1)belladonna and opium increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• bendroflumethiazide

  Monitor Closely (1)epinephrine and bendroflumethiazide both decrease serum potassium. Use Caution/Monitor.Minor (1)epinephrine, bendroflumethiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• benperidol

  Monitor Closely (1)benperidol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• benzphetamine

  Monitor Closely (2)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

  Monitor Closely (2)betaxolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.
  
  betaxolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• bisoprolol

  Monitor Closely (2)bisoprolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.
  
  bisoprolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• bretylium

  Monitor Closely (1)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

  Monitor Closely (1)bromocriptine, epinephrine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Hypertension, V tach.

• brompheniramine

  Monitor Closely (1)brompheniramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• bumetanide

  Monitor Closely (1)epinephrine and bumetanide both decrease serum potassium. Use Caution/Monitor.Minor (1)epinephrine, bumetanide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• buprenorphine buccal

  Monitor Closely (1)buprenorphine buccal increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• butabarbital

  Monitor Closely (1)butabarbital increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• butalbital

  Monitor Closely (1)butalbital increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• butorphanol

  Monitor Closely (1)butorphanol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• cabergoline

  Serious - Use Alternative (1)cabergoline, epinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

• caffeine

  Monitor Closely (1)epinephrine and caffeine both decrease sedation. Use Caution/Monitor.

• carbenoxolone

  Monitor Closely (1)epinephrine and carbenoxolone both decrease serum potassium. Use Caution/Monitor.

• carbinoxamine

  Monitor Closely (1)carbinoxamine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• carvedilol

  Monitor Closely (2)carvedilol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.
  
  carvedilol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• celecoxib

  Monitor Closely (1)celecoxib increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• celiprolol

  Monitor Closely (2)celiprolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.
  
  celiprolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• chloral hydrate

  Monitor Closely (1)chloral hydrate increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• chlordiazepoxide

  Monitor Closely (1)chlordiazepoxide increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• chlorothiazide

  Monitor Closely (1)epinephrine and chlorothiazide both decrease serum potassium. Use Caution/Monitor.Minor (1)epinephrine, chlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• chlorpheniramine

  Monitor Closely (1)chlorpheniramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• chlorpromazine

  Monitor Closely (3)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.
  
  chlorpromazine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)epinephrine and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.

• chlorthalidone

  Monitor Closely (1)epinephrine and chlorthalidone both decrease serum potassium. Use Caution/Monitor.Minor (1)epinephrine, chlorthalidone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• choline magnesium trisalicylate

  Monitor Closely (1)choline magnesium trisalicylate increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

• cinnarizine

  Monitor Closely (1)cinnarizine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• clarithromycin

  Serious - Use Alternative (1)epinephrine and clarithromycin both increase QTc interval. Avoid or Use Alternate Drug.

• clemastine

  Monitor Closely (1)clemastine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• clomipramine

  Monitor Closely (2)clomipramine increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.
  
  clomipramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)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.

• clonazepam

  Monitor Closely (1)clonazepam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• clorazepate

  Monitor Closely (1)clorazepate increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• clozapine

  Monitor Closely (2)clozapine decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. Block pressor response to epinephrine, which may result in severe hypotension and tachycardia.
  
  clozapine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• codeine

  Monitor Closely (1)codeine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• cyclizine

  Monitor Closely (1)cyclizine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• cyclopenthiazide

  Monitor Closely (1)epinephrine and cyclopenthiazide both decrease serum potassium. Use Caution/Monitor.Minor (1)epinephrine, cyclopenthiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• cyproheptadine

  Monitor Closely (1)cyproheptadine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• deflazacort

  Monitor Closely (1)epinephrine and deflazacort both decrease serum potassium. Use Caution/Monitor.

• desflurane

  Serious - Use Alternative (2)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

  Monitor Closely (2)desipramine increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.
  
  desipramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)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.

• desmopressin

  Minor (1)desmopressin increases effects of epinephrine by pharmacodynamic synergism. Minor/Significance Unknown.

• dexchlorpheniramine

  Monitor Closely (1)dexchlorpheniramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dexfenfluramine

  Monitor Closely (2)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

  Monitor Closely (1)dexmedetomidine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dexmethylphenidate

  Monitor Closely (2)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

  Monitor Closely (2)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

  Monitor Closely (1)dextromoramide increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• diamorphine

  Monitor Closely (1)diamorphine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dichlorphenamide

  Monitor Closely (2)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

  Monitor Closely (1)diclofenac increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• diethylpropion

  Monitor Closely (2)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

  Monitor Closely (1)difenoxin hcl increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• diflunisal

  Monitor Closely (1)diflunisal increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• digoxin

  Monitor Closely (1)digoxin increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dihydroergotamine

  Serious - Use Alternative (1)dihydroergotamine, epinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

• dihydroergotamine intranasal

  Serious - Use Alternative (1)dihydroergotamine intranasal, epinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

• dimenhydrinate

  Monitor Closely (1)dimenhydrinate increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• diphenhydramine

  Monitor Closely (1)diphenhydramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• diphenoxylate hcl

  Monitor Closely (1)diphenoxylate hcl increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dipipanone

  Monitor Closely (1)dipipanone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• disopyramide

  Contraindicated (1)epinephrine and disopyramide both increase QTc interval. Contraindicated.

• dobutamine

  Monitor Closely (3)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.

• dofetilide

  Serious - Use Alternative (1)epinephrine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.

• dolasetron

  Monitor Closely (1)epinephrine and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

• dopamine

  Monitor Closely (2)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

  Monitor Closely (4)dopexamine, epinephrine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.
  
  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.

• dosulepin

  Serious - Use Alternative (1)epinephrine and dosulepin both increase QTc interval. Avoid or Use Alternate Drug.

• doxapram

  Serious - Use Alternative (1)doxapram increases effects of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

• doxepin

  Monitor Closely (2)doxepin increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.
  
  doxepin increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)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

  Serious - Use Alternative (1)epinephrine and dronedarone both increase QTc interval. Avoid or Use Alternate Drug.

• droperidol

  Monitor Closely (1)droperidol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)epinephrine and droperidol both increase QTc interval. Avoid or Use Alternate Drug.

• drospirenone

  Monitor Closely (1)drospirenone increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• droxidopa

  Monitor Closely (1)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

  Monitor Closely (1)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

  Monitor Closely (4)ephedrine, epinephrine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.
  
  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.

• epinephrine inhaled

  Monitor Closely (1)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

  Monitor Closely (4)epinephrine, epinephrine racemic. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely.
  
  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.

• ergoloid mesylates

  Serious - Use Alternative (1)ergoloid mesylates, epinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

• ergotamine

  Serious - Use Alternative (1)ergotamine, epinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

• erythromycin base

  Serious - Use Alternative (1)epinephrine and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin ethylsuccinate

  Serious - Use Alternative (1)epinephrine and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin lactobionate

  Serious - Use Alternative (1)epinephrine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin stearate

  Serious - Use Alternative (1)epinephrine and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.

• esmolol

  Monitor Closely (2)esmolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.
  
  esmolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• estazolam

  Monitor Closely (1)estazolam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ethacrynic acid

  Monitor Closely (1)epinephrine and ethacrynic acid both decrease serum potassium. Use Caution/Monitor.Minor (1)epinephrine, ethacrynic acid. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• ethanol

  Monitor Closely (1)ethanol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ether

  Serious - Use Alternative (1)ether increases toxicity of epinephrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

• etodolac

  Monitor Closely (1)etodolac increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• etomidate

  Serious - Use Alternative (1)etomidate increases levels of epinephrine by decreasing metabolism. Contraindicated.

• eucalyptus

  Minor (1)eucalyptus increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• fenfluramine

  Monitor Closely (2)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

  Monitor Closely (1)fenoprofen increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• flecainide

  Monitor Closely (1)epinephrine and flecainide both increase QTc interval. Modify Therapy/Monitor Closely.

• fluconazole

  Serious - Use Alternative (1)epinephrine and fluconazole both increase QTc interval. Avoid or Use Alternate Drug.

• fluoxetine

  Monitor Closely (1)epinephrine and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.

• fluphenazine

  Monitor Closely (3)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.
  
  fluphenazine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)epinephrine and fluphenazine both increase QTc interval. Avoid or Use Alternate Drug.

• flurazepam

  Monitor Closely (1)flurazepam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• flurbiprofen

  Monitor Closely (1)flurbiprofen increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• fluvoxamine

  Monitor Closely (1)fluvoxamine and epinephrine both increase QTc interval. Modify Therapy/Monitor Closely.

• formoterol

  Monitor Closely (3)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.Serious - Use Alternative (1)epinephrine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

• foscarnet

  Monitor Closely (1)epinephrine and foscarnet both increase QTc interval. Modify Therapy/Monitor Closely.

• furosemide

  Monitor Closely (1)epinephrine and furosemide both decrease serum potassium. Use Caution/Monitor.Minor (1)epinephrine, furosemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• gentamicin

  Monitor Closely (1)epinephrine and gentamicin both decrease serum potassium. Use Caution/Monitor.

• green tea

  Monitor Closely (1)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

  Monitor Closely (1)haloperidol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)epinephrine and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.

• hyaluronidase

  Monitor Closely (1)hyaluronidase, articaine. Other (see comment). Use Caution/Monitor. Comment: Hyaluronidase hastens the onset of local analgesia and reduces swelling, but increases systemic absorption of anesthetic. This decreases the duration of action and increases incidence of systemic reaction.

• hydralazine

  Monitor Closely (1)hydralazine, epinephrine. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.

• hydrochlorothiazide

  Monitor Closely (1)epinephrine and hydrochlorothiazide both decrease serum potassium. Use Caution/Monitor.Minor (1)epinephrine, hydrochlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• hydromorphone

  Monitor Closely (1)hydromorphone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• hydroxyzine

  Monitor Closely (1)hydroxyzine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ibuprofen

  Monitor Closely (1)ibuprofen increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ibuprofen IV

  Monitor Closely (1)ibuprofen IV increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ibutilide

  Contraindicated (1)epinephrine and ibutilide both increase QTc interval. Contraindicated.

• iloperidone

  Monitor Closely (2)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

  Monitor Closely (2)imipramine increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.
  
  imipramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)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.

• indacaterol, inhaled

  Monitor Closely (1)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

  Contraindicated (1)epinephrine and indapamide both increase QTc interval. Contraindicated.Monitor Closely (1)epinephrine and indapamide both decrease serum potassium. Use Caution/Monitor.Minor (1)epinephrine, indapamide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• indomethacin

  Monitor Closely (1)indomethacin increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• insulin degludec

  Monitor Closely (1)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

  Monitor Closely (1)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

  Monitor Closely (1)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.

• iobenguane I 123

  Contraindicated (1)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.

• iobenguane I 131

  Serious - Use Alternative (1)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.

• isocarboxazid

  Contraindicated (1)isocarboxazid increases effects of epinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

• isoflurane

  Serious - Use Alternative (1)isoflurane increases toxicity of epinephrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

• isoproterenol

  Monitor Closely (3)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.

• ketamine

  Serious - Use Alternative (1)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

  Serious - Use Alternative (1)epinephrine and ketoconazole both increase QTc interval. Avoid or Use Alternate Drug.

• ketoprofen

  Monitor Closely (1)ketoprofen increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ketorolac

  Monitor Closely (1)ketorolac increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ketorolac intranasal

  Monitor Closely (1)ketorolac intranasal increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

• ketotifen, ophthalmic

  Monitor Closely (1)ketotifen, ophthalmic increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• labetalol

  Monitor Closely (2)labetalol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.
  
  labetalol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• levalbuterol

  Monitor Closely (3)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

  Monitor Closely (1)epinephrine and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

• levoketoconazole

  Serious - Use Alternative (1)epinephrine and levoketoconazole both increase QTc interval. Avoid or Use Alternate Drug.

• levomilnacipran

  Serious - Use Alternative (1)levomilnacipran increases levels of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of paroxysmal HTN, arrhythmia.

• levorphanol

  Monitor Closely (1)levorphanol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• levothyroxine

  Monitor Closely (1)levothyroxine will increase the level or effect of epinephrine by unspecified interaction mechanism. Use Caution/Monitor.

• linezolid

  Contraindicated (1)linezolid increases effects of epinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

• lisdexamfetamine

  Monitor Closely (2)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

  Monitor Closely (2)lofepramine increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.
  
  lofepramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)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.

• lofexidine

  Monitor Closely (1)lofexidine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• loprazolam

  Monitor Closely (1)loprazolam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• lorazepam

  Monitor Closely (1)lorazepam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• lormetazepam

  Monitor Closely (1)lormetazepam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• lornoxicam

  Monitor Closely (1)lornoxicam increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• loxapine

  Monitor Closely (1)loxapine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• loxapine inhaled

  Monitor Closely (1)loxapine inhaled increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• lumefantrine

  Serious - Use Alternative (1)epinephrine and lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.

• lurasidone

  Contraindicated (1)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.

• maprotiline

  Monitor Closely (2)maprotiline increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.
  
  maprotiline increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)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.

• marijuana

  Monitor Closely (1)marijuana increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• meclofenamate

  Monitor Closely (1)meclofenamate increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• mefenamic acid

  Monitor Closely (1)mefenamic acid increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• melatonin

  Monitor Closely (1)melatonin increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• meloxicam

  Monitor Closely (1)meloxicam increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• meperidine

  Monitor Closely (1)meperidine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• meprobamate

  Monitor Closely (1)meprobamate increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• metaproterenol

  Monitor Closely (3)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

  Monitor Closely (2)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

  Monitor Closely (2)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.

• methoxyflurane

  Serious - Use Alternative (1)methoxyflurane increases toxicity of epinephrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

• methyclothiazide

  Monitor Closely (1)epinephrine and methyclothiazide both decrease serum potassium. Use Caution/Monitor.Minor (1)epinephrine, methyclothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• methyldopa

  Monitor Closely (1)methyldopa increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.

• methylenedioxymethamphetamine

  Monitor Closely (2)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.

• methylergonovine

  Serious - Use Alternative (1)methylergonovine, epinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

• methylphenidate

  Monitor Closely (1)epinephrine and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• metolazone

  Monitor Closely (1)epinephrine and metolazone both decrease serum potassium. Use Caution/Monitor.Minor (1)epinephrine, metolazone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• metoprolol

  Monitor Closely (2)metoprolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.
  
  metoprolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• midazolam

  Monitor Closely (1)midazolam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• midodrine

  Monitor Closely (2)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.

• milnacipran

  Serious - Use Alternative (1)milnacipran increases levels of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of paroxysmal HTN, arrhythmia.

• mirtazapine

  Monitor Closely (1)mirtazapine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• modafinil

  Monitor Closely (1)epinephrine and modafinil both decrease sedation. Use Caution/Monitor.

• morphine

  Monitor Closely (1)morphine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• motherwort

  Monitor Closely (1)motherwort increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• moxifloxacin

  Serious - Use Alternative (1)epinephrine and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.

• moxonidine

  Monitor Closely (1)moxonidine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• nabilone

  Monitor Closely (1)nabilone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• nabumetone

  Monitor Closely (1)nabumetone increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• nadolol

  Monitor Closely (3)nadolol, articaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Increased effects of epinephrine in anesthetic; risk of hypertension and bradycardia. Do NOT D/C chronic beta blocker Tx prior to anesthetic administration. Consider selective beta 1 blocker (e.g., metoprolol).
  
  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.Serious - Use Alternative (1)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).

• nalbuphine

  Monitor Closely (1)nalbuphine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• naproxen

  Monitor Closely (1)naproxen increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• nateglinide

  Monitor Closely (1)epinephrine decreases effects of nateglinide by pharmacodynamic antagonism. Use Caution/Monitor. Coadministration may reduce nateglinide's hypoglycemic action.

• nebivolol

  Monitor Closely (2)nebivolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.
  
  nebivolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• noni juice

  Minor (1)noni juice increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• norepinephrine

  Monitor Closely (3)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

  Monitor Closely (2)nortriptyline increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.
  
  nortriptyline increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)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

  Serious - Use Alternative (1)epinephrine and octreotide both increase QTc interval. Avoid or Use Alternate Drug.

• octreotide (Antidote)

  Serious - Use Alternative (1)epinephrine and octreotide (Antidote) both increase QTc interval. Avoid or Use Alternate Drug.

• ofloxacin

  Monitor Closely (1)epinephrine and ofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

• olanzapine

  Monitor Closely (1)olanzapine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• olodaterol inhaled

  Monitor Closely (1)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

  Monitor Closely (1)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

  Monitor Closely (1)opium tincture increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• oxaprozin

  Monitor Closely (1)oxaprozin increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• oxazepam

  Monitor Closely (1)oxazepam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• oxycodone

  Monitor Closely (1)oxycodone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• oxymetazoline topical

  Monitor Closely (1)oxymetazoline topical and epinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• oxymorphone

  Monitor Closely (1)oxymorphone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• oxytocin

  Monitor Closely (1)oxytocin increases effects of epinephrine by pharmacodynamic synergism. Use Caution/Monitor.

• ozanimod

  Serious - Use Alternative (1)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.

• paliperidone

  Monitor Closely (2)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

  Monitor Closely (1)papaveretum increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• parecoxib

  Monitor Closely (1)parecoxib increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• paroxetine

  Monitor Closely (1)epinephrine and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.

• penbutolol

  Monitor Closely (2)penbutolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.
  
  penbutolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pentamidine

  Contraindicated (1)epinephrine and pentamidine both increase QTc interval. Contraindicated.

• pentazocine

  Monitor Closely (1)pentazocine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pentobarbital

  Monitor Closely (1)pentobarbital increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• perphenazine

  Monitor Closely (3)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.
  
  perphenazine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)epinephrine and perphenazine both increase QTc interval. Avoid or Use Alternate Drug.

• phendimetrazine

  Monitor Closely (2)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.

• phenelzine

  Contraindicated (1)phenelzine increases effects of epinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

• phenobarbital

  Monitor Closely (1)phenobarbital increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenoxybenzamine

  Monitor Closely (1)phenoxybenzamine, epinephrine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Hypotension, tachycardia.

• phentermine

  Monitor Closely (2)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

  Monitor Closely (1)phentolamine, epinephrine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Hypotension, tachycardia.

• phenylephrine

  Monitor Closely (2)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

  Monitor Closely (2)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

  Monitor Closely (1)pholcodine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pimozide

  Contraindicated (1)epinephrine and pimozide both increase QTc interval. Contraindicated.Monitor Closely (1)pimozide increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pindolol

  Monitor Closely (3)pindolol, articaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Increased effects of epinephrine in anesthetic; risk of hypertension and bradycardia. Do NOT D/C chronic beta blocker Tx prior to anesthetic administration. Consider selective beta 1 blocker (e.g., metoprolol).
  
  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.Serious - Use Alternative (1)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).

• pirbuterol

  Monitor Closely (3)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

  Monitor Closely (1)piroxicam increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• posaconazole

  Monitor Closely (1)epinephrine and posaconazole both increase QTc interval. Modify Therapy/Monitor Closely.

• potassium acid phosphate

  Monitor Closely (1)potassium acid phosphate increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• potassium chloride

  Monitor Closely (1)potassium chloride increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• potassium citrate

  Monitor Closely (1)potassium citrate increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• primidone

  Monitor Closely (1)primidone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• procainamide

  Contraindicated (1)epinephrine and procainamide both increase QTc interval. Contraindicated.

• procarbazine

  Serious - Use Alternative (1)procarbazine increases effects of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of acute hypertensive episode.

• prochlorperazine

  Monitor Closely (3)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.
  
  prochlorperazine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)epinephrine and prochlorperazine both increase QTc interval. Avoid or Use Alternate Drug.

• promazine

  Monitor Closely (2)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.Serious - Use Alternative (1)epinephrine and promazine both increase QTc interval. Avoid or Use Alternate Drug.

• promethazine

  Monitor Closely (3)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.
  
  promethazine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)epinephrine and promethazine both increase QTc interval. Avoid or Use Alternate Drug.

• propofol

  Serious - Use Alternative (1)propofol increases levels of epinephrine by unknown mechanism. Avoid or Use Alternate Drug.

• propranolol

  Monitor Closely (3)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.
  
  propranolol, articaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Increased effects of epinephrine in anesthetic; risk of hypertension and bradycardia. Do NOT D/C chronic beta blocker Tx prior to anesthetic administration. Consider selective beta 1 blocker (e.g., metoprolol).Serious - Use Alternative (1)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).

• propylhexedrine

  Monitor Closely (2)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

  Monitor Closely (2)protriptyline increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.
  
  protriptyline increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)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.

• pseudoephedrine

  Monitor Closely (1)epinephrine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• quazepam

  Monitor Closely (1)quazepam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• quetiapine

  Monitor Closely (1)quetiapine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• quinidine

  Contraindicated (1)epinephrine and quinidine both increase QTc interval. Contraindicated.

• ranolazine

  Monitor Closely (1)epinephrine and ranolazine both increase QTc interval. Modify Therapy/Monitor Closely.

• rasagiline

  Monitor Closely (1)rasagiline increases effects of epinephrine by pharmacodynamic synergism. Use Caution/Monitor. Avoid concomitant use if possible. Caution is advised.

• risperidone

  Monitor Closely (2)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

  Monitor Closely (1)sacubitril/valsartan increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• sage

  Minor (1)sage increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• salicylates (non-asa)

  Monitor Closely (1)salicylates (non-asa) increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• salmeterol

  Monitor Closely (3)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

  Monitor Closely (1)salsalate increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• scullcap

  Monitor Closely (1)scullcap increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• secobarbital

  Monitor Closely (1)secobarbital increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• selegiline

  Monitor Closely (1)selegiline increases effects of epinephrine by pharmacodynamic synergism. Use Caution/Monitor. Avoid concomitant use if possible. Caution is advised.

• selegiline transdermal

  Contraindicated (1)selegiline transdermal increases effects of epinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

• serdexmethylphenidate/dexmethylphenidate

  Monitor Closely (1)epinephrine and serdexmethylphenidate/dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• sevoflurane

  Serious - Use Alternative (1)sevoflurane increases toxicity of epinephrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

• shepherd's purse

  Monitor Closely (1)shepherd's purse increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol

  Monitor Closely (1)epinephrine and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

• solriamfetol

  Monitor Closely (1)epinephrine and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• sotalol

  Contraindicated (1)epinephrine and sotalol both increase QTc interval. Contraindicated.Monitor Closely (2)sotalol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.
  
  sotalol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• spironolactone

  Monitor Closely (1)spironolactone increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• succinylcholine

  Monitor Closely (1)succinylcholine increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• sufentanil

  Monitor Closely (1)sufentanil increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• sulfamethoxazole

  Monitor Closely (1)epinephrine and sulfamethoxazole both increase QTc interval. Modify Therapy/Monitor Closely.

• sulfasalazine

  Monitor Closely (1)sulfasalazine increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• sulindac

  Monitor Closely (1)sulindac increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• tapentadol

  Monitor Closely (1)tapentadol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• telavancin

  Monitor Closely (1)epinephrine and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.

• temazepam

  Monitor Closely (1)temazepam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• terbutaline

  Monitor Closely (3)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

  Monitor Closely (3)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.
  
  thioridazine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)epinephrine and thioridazine both increase QTc interval. Avoid or Use Alternate Drug.

• thiothixene

  Monitor Closely (1)thiothixene increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Minor (1)thiothixene decreases effects of epinephrine by pharmacodynamic antagonism. Minor/Significance Unknown.

• timolol

  Monitor Closely (3)timolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.
  
  timolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  timolol, articaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Increased effects of epinephrine in anesthetic; risk of hypertension and bradycardia. Do NOT D/C chronic beta blocker Tx prior to anesthetic administration. Consider selective beta 1 blocker (e.g., metoprolol).Serious - Use Alternative (1)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).

• tolcapone

  Monitor Closely (1)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

  Monitor Closely (1)tolfenamic acid increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• tolmetin

  Monitor Closely (1)tolmetin increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• tolvaptan

  Monitor Closely (1)tolvaptan increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• topiramate

  Monitor Closely (1)topiramate increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• torsemide

  Monitor Closely (1)epinephrine and torsemide both decrease serum potassium. Use Caution/Monitor.Minor (1)epinephrine, torsemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

• tramadol

  Monitor Closely (1)tramadol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• tranylcypromine

  Contraindicated (1)tranylcypromine increases effects of epinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

• trazodone

  Monitor Closely (2)trazodone increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.
  
  trazodone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)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.

• triamterene

  Monitor Closely (1)triamterene increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

• triazolam

  Monitor Closely (1)triazolam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• triclofos

  Monitor Closely (1)triclofos increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• trifluoperazine

  Monitor Closely (3)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.
  
  trifluoperazine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)epinephrine and trifluoperazine both increase QTc interval. Avoid or Use Alternate Drug.

• trimethoprim

  Monitor Closely (1)epinephrine and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.

• trimipramine

  Monitor Closely (2)trimipramine increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.
  
  trimipramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)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.

• triprolidine

  Monitor Closely (1)triprolidine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• tropisetron

  Monitor Closely (1)epinephrine and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.

• vasopressin

  Minor (1)epinephrine decreases effects of vasopressin by pharmacodynamic antagonism. Minor/Significance Unknown.

• venlafaxine

  Monitor Closely (1)epinephrine and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.

• voriconazole

  Monitor Closely (1)epinephrine and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.

• xylometazoline

  Monitor Closely (2)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.

• yohimbe

  Serious - Use Alternative (1)yohimbe, epinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

• yohimbine

  Monitor Closely (2)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

  Monitor Closely (1)ziconotide increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ziprasidone

  Monitor Closely (1)ziprasidone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)epinephrine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.