Dosing & Uses
Dosage Forms & Strengths
articaine/epinephrine
injectable solution
- 4% (40mg/mL)/1:100,000 (0.01mg/mL)
- 4% (40 mg/mL)/1:200,000 (0.005mg/mL)
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
Dosage Forms & Strengths
articaine/epinephrine
injectable solution
- 4%(40mg/mL)/1:100,000(0.01mg/mL)
- 4%(40 mg/mL)/1:200,000(0.005mg/mL)
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
Interactions
Interaction Checker
No Results

Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor

Contraindicated (15)
- disopyramide
epinephrine and disopyramide both increase QTc interval. Contraindicated.
- ibutilide
epinephrine and ibutilide both increase QTc interval. Contraindicated.
- indapamide
epinephrine and indapamide both increase QTc interval. Contraindicated.
- iobenguane I 123
epinephrine decreases effects of iobenguane I 123 by receptor binding competition. Contraindicated. If clinically appropriate, discontinue drugs that compete for NE receptor sites for at least 5 half-lives; may cause false-negative imaging results.
- isocarboxazid
isocarboxazid increases effects of epinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- linezolid
linezolid increases effects of epinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- lurasidone
epinephrine increases toxicity of lurasidone by pharmacodynamic synergism. Contraindicated. Interaction applies only in setting of acute lurasidone overdose. Epinephrine may enhance hypotensive effects of lurasidone in overdose setting.
- pentamidine
epinephrine and pentamidine both increase QTc interval. Contraindicated.
- phenelzine
phenelzine increases effects of epinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- pimozide
epinephrine and pimozide both increase QTc interval. Contraindicated.
- procainamide
epinephrine and procainamide both increase QTc interval. Contraindicated.
- quinidine
epinephrine and quinidine both increase QTc interval. Contraindicated.
- selegiline transdermal
selegiline transdermal increases effects of epinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- sotalol
epinephrine and sotalol both increase QTc interval. Contraindicated.
- tranylcypromine
tranylcypromine increases effects of epinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
Serious - Use Alternative (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.
Adverse Effects
1-10%
Facial edema
Headache
Pain
Paresthesia
Sleepiness
Gingivitis
Nausea
Vomiting
Infection
Frequency Not Defined
Systemic absorption of significant concentrations of local anesthetic can produce myocardial depression, cardiac conduction changes, CNS excitation, convulsions, and cardiorespiratory arrest, facial paralysis, hemorrhage, hyperesthesia, methemoglobinemia
Warnings
Contraindications
Hyperensitivity to amide-type local anesthetics, sulfites
Cautions
Vasoconstrictor epinephrine, will promote local hemostasis, decrease systemic absorption, increase duration of action
Local anesthetics may produce cardiovascular effects when absorbed
Risk of methemoglobinemia and sudden respiratory arrest
CNS toxicity may occur; monitor state of consciousness, drowsiness, restlessness, anxiety, tinnitus, tremors, blurred vision following local injections of the anesthetic
Avoid IV use
Methemoglobinemia
- Use of local anesthetics may cause methemoglobinemia, a serious condition that must be treated promptly; patients with glucose-6-phosphate dehydrogenase deficiency, congenital or idiopathic methemoglobinemia, cardiac or pulmonary compromise, infants under 6 months of age, and concurrent exposure to oxidizing agents or their metabolites are more susceptible to developing clinical manifestations of the condition
- Advise patients or caregivers to seek immediate medical attention if patient experiences the following signs or symptoms: pale, gray, or blue colored skin (cyanosis); headache; rapid heart rate; shortness of breath; lightheadedness; or fatigue; discontinue Bicillin C-R and any other oxidizing agents; depending on severity of signs and symptoms, patients may respond to supportive care, including oxygen therapy and hydration; a more severe clinical presentation may require treatment with methylene blue, exchange transfusion, or hyperbaric oxygen
Pregnancy & Lactation
Pregnancy Category: C
Lactation: excretion in milk unknown; use with caution
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Local anesthetics prevent generation/conduction of nerve impulses by reducing sodium permeability and increasing action potential threshold
Pharmacokinetics
Half-Life: 44 min
Peak Plasma Time: 25-48 min
Protein Bound: 60-80%
Metabolism: primarily through plasma carboxyesterase to inactive articainic acid
Excretion: urine (2% unchanged)
Images
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.