Treatment of bronchospasms, anaphylactic reactions, cardiac arrest, management of open-angle (chronic simple) glaucoma

Use with caution in elderly patients, patients with diabetes mellitus, cardiovascular diseases (angina, tachycardia, myocardial infarction), thyroid disease, or cerebral arteriosclerosis, Parkinson’s; some products contain sulfites as preservatives. Rapid I.V. infusion may cause death from cerebrovascular hemorrhage or cardiac arrhythmias. Oral inhalation of epinephrine is not the preferred route of administration.

Hypersensitivity to epinephrine or any component; cardiac arrhythmias, angle-closure glaucoma.

>10%: Cardiovascular: Tachycardia (parenteral), pounding heartbeat Central nervous system: Nervousness, restlessness. 1% to 10%: Cardiovascular: Flushing, hypertension Central nervous system: Headache, dizziness, lightheadedness, insomnia Gastrointestinal: Nausea, vomiting Neuromuscular & skeletal: Weakness, trembling Miscellaneous: Diaphoresis (increased)

<1%: Pallor, tachycardia, chest pain, increased myocardial oxygen consumption, cardiac arrhythmias, sudden death, anxiety, xerostomia, dry throat, decreased renal and splanchnic blood flow, acute urinary retention in patients with bladder outflow obstruction, precipitation of or exacerbation of narrow-angle glaucoma, wheezing

Increased toxicity: Increased cardiac irritability if administered concurrently with halogenated inhalational anesthetics, beta-blocking agents, alpha-blocking agents

Hypertension which may result in subarachnoid hemorrhage and hemiplegia; symptoms of overdose include arrhythmias, unusually large pupils, pulmonary edema, renal failure, metabolic acidosis. There is no specific antidote for epinephrine intoxication and the bulk of the treatment is supportive.

Hyperactivity and agitation usually respond to reduced sensory input; however, with extreme agitation, haloperidol (2-5 mg I.M. for adults) may be required. Hyperthermia is best treated with external cooling measures; or when severe or unresponsive, muscle paralysis with pancuronium may be needed. Hypertension is usually transient and generally does not require treatment unless severe. For diasNeonates: Cardiac arrest: I.V.: Intratracheal: 0.01-0.03 mg/kg (0.1-0.3 mL/kg of 1:10,000 solution) every 3-5 minutes as needed; dilute intratracheal doses to 1-2 mL with normal saline

Infants and Children: Bronchodilator: S.C.: 10 mcg/kg (0.01 mL/kg of 1:1000) (single doses not to exceed 0.5 mg) or suspension (1:200): 0.005 mL/kg/dose (0.025 mg/kg/dose) to a maximum of 0.15 mL (0.75 mg for single dose) every 8-12 hours
Bradycardia: I.V.: 0.01 mg/kg (0.1 mL/kg of 1:10,000 solution) every 3-5 minutes as needed (maximum: 1 mg/10 mL)

Intratracheal: 0.1 mg/kg (0.1 mL/kg of 1:1000 solution every 3-5 minutes); doses as high as 0.2 mg/kg may be effective
Asystole or pulseless arrest: I.V. or intraosseous: First dose: 0.01 mg/kg (0.1 mL/kg of a 1:10,000 solution); subsequent doses: 0.1 mg/kg (0.1 mL/kg of a 1:1000 solution); doses as high as 0.2 mg/kg may be effective; repeat every 3-5 minutes
Intratracheal: 0.1 mg/kg (0.1 mL/kg of a 1:1000 solution); doses as high as 0.2 mg/kg may be effective Hypersensitivity reaction: S.C.: 0.01 mg/kg every 15 minutes for 2 doses then every 4 hours as needed (single doses not to exceed 0.5 mg)
Refractory hypotension (refractory to dopamine/dobutamine): Continuous I.V. infusions of 0.1-1 mcg/kg/minute; titrate dosage to desired effect
Nebulization: 0.25-0.5 mL of 2.25% racemic epinephrine solution diluted in 3 mL normal saline, or L-epinephrine at an equivalent dose; racemic epinephrine 10 mg = 5 mg L-epinephrine; use lower end of dosing range for younger infants
Intranasal: Children > or =6 years and Adults: Apply locally as drops or spray or with sterile swab Adults: Asystole: I.V.: 1 mg every 3-5 minutes; if this approach fails, alternative regimens include: Intermediate: 2-5 mg every 3-5 minutes
Escalating: 1 mg, 3 mg, 5 mg at 3-minute intervals High: 0.1 mg/kg every 3-5 minutes
Intratracheal: 1 mg (although optimal dose is unknown, doses of 2-2.5 times the I.V. dose may be needed)
Bronchodilator: I.M., S.C. (1:1000): 0.1-0.5 mg every 10-15 minutes to 4 hours
Hypersensitivity reaction: I.M., S.C.: 0.2-0.5 mg every 20 minutes to 4 hours (single dose maximum: 1 mg)
Refractory hypotension (refractory to dopamine/dobutamine): Continuous I.V. infusion 1 mcg/minute (range: 1-10 mcg/minute); titrate dosage to desired effect; severe cardiac dysfunction may require doses >10 mcg/minute (up to 0.1 mcg/kg/minute)
Nebulization: Instill 8-15 drops into nebulizer reservoirs; administer 1-3 inhalations 4-6 times/day Ophthalmic: Instill 1-2 drops in eye(s) once or twice daily; when treating open-angle glaucoma, the concentration and dosage must be adjusted to the response of the patient.

Use this medication exactly as directed; do not take more than recommended dosage. Avoid other stimulant prescriptive or OTC medications to avoid serious overdose reactions. You may experience dizziness, blurred vision, restlessness (use caution when driving or engaging in tasks requiring alertness until response to drug is known);

or difficulty urinating (empty bladder immediately before taking this medication). Report excessive nervousness or excitation, inability to sleep, facial flushing, pounding heartbeat, muscle tremors or weakness, chest pain or palpitations, bronchial irritation or coughing, or increased sweating.