Epinephrine

Epinephrine Brand Names

Adrenaclick | Adrenalin | Auvi-Q | Epifrin | EpiPen | Primatene Mist | SYMJEPI | Twinject

What is Epinephrine

Epinephrine is a parenteral, topical, and oral inhalant non-selective alpha and beta-adrenergic receptor agonist indicated for emergency treatment of allergic reactions, including anaphylaxis, to increase mean arterial blood pressure in patients with hypotension associated with septic shock, for induction and maintenance of mydriasis during intraocular surgery, for temporary relief of mild symptoms of intermittent asthma, and for nasal congestion.

It is an endogenous sympathomimetic catecholamine produced primarily from norepinephrine in the adrenal medulla.

The adrenergic effects of exogenous epinephrine are dose-dependent with beta-adrenergic effects (e.g., inotropy, vasodilation) more pronounced at low doses and alpha-adrenergic effects (e.g., vasoconstriction) at high doses.

Epinephrine is utilized during cardiopulmonary resuscitation for ventricular fibrillation, pulseless electrical activity, asystole, and bradycardia. High-dose epinephrine is no longer recommended during cardiac arrest except for exceptional circumstances (e.g., beta-blocker overdosage).

In patients with sinus node dysfunction or second- or third-degree atrioventricular block associated with symptoms of hemodynamic compromise who are at a low likelihood of coronary ischemia, epinephrine may be considered to increase heart rate, improve atrioventricular conduction, increase ventricular rate, and improve symptoms.

Epinephrine is the drug of choice for anaphylaxis; prompt administration at the onset of symptoms is essential, and the use of intramuscular auto-injector devices in patients with a history of severe allergic reactions is widely accepted.

Epinephrine administered by metered-dose inhaler (MDI) is available without a prescription for treatment of mild, intermittent asthma and is approved only for those who are 12 years and older who have been diagnosed with asthma by a healthcare provider; it is not a replacement for prescription treatments.

Inhaled epinephrine is recommended in addition to standard therapy for acute asthma exacerbation associated with anaphylaxis and angioedema, but is not recommended for routine asthma management or treatment.

Indications

1. acute bronchospasm
2. anaphylactic shock
3. anaphylaxis
4. angioedema
5. asthma
6. bradycardia
7. bronchospasm prophylaxis
8. cardiac arrest
9. cardiogenic shock
10. cardiopulmonary resuscitation
11. chloroquine overdose
12. glaucoma
13. hypotension
14. laryngotracheobronchitis (croup)
15. mydriasis induction
16. nasal congestion
17. pulseless electrical activity
18. septic shock
19. surgical bleeding
20. urticaria
21. ventricular asystole
22. ventricular fibrillation

Side Effects

1. agitation
2. angina
3. anxiety
4. apnea
5. arrhythmia exacerbation
6. cardiomyopathy
7. chest pain (unspecified)
8. corneal edema
9. diaphoresis
10. dizziness
11. drowsiness
12. dyspnea
13. ecchymosis
14. erythema
15. excitability
16. headache
17. hyperactivity
18. hyperglycemia
19. hypertension
20. hypoesthesia
21. hypoglycemia
22. hypokalemia
23. infection
24. injection site reaction
25. insulin resistance
26. lactic acidosis
27. memory impairment
28. metabolic acidosis
29. myocardial infarction
30. nausea
31. necrotizing fasciitis
32. oliguria
33. pallor
34. palpitations
35. paresthesias
36. peripheral vasoconstriction
37. premature ventricular contractions (PVCs)
38. pulmonary edema
39. restlessness
40. sinus tachycardia
41. skin discoloration
42. skin laceration
43. stroke
44. supraventricular tachycardia (SVT)
45. tissue necrosis
46. tremor
47. ventricular fibrillation
48. ventricular tachycardia
49. vomiting
50. weakness

Monitoring Parameters

• blood pressure
• heart rate
• pulmonary function tests (PFTs)

Contraindications

• breast-feeding
• cardiac disease
• cardiomyopathy
• cerebrovascular disease
• children
• closed-angle glaucoma
• coronary artery disease
• diabetes mellitus
• extravasation
• hypertension
• hyperthyroidism
• hypovolemia
• infants
• infection
• intraarterial administration
• labor
• obstetric delivery
• ophthalmic administration
• organic brain syndrome
• Parkinson’s disease
• pheochromocytoma
• pregnancy
• renal disease
• shock
• sulfite hypersensitivity
• thyroid disease
• thyrotoxicosis

Interactions

• Acarbose
• Acebutolol
• Acetaminophen; Aspirin, ASA; Caffeine
• Acetaminophen; Butalbital; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
• Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
• Acetaminophen; Dextromethorphan; Phenylephrine
• Acetaminophen; Guaifenesin; Phenylephrine
• Aclidinium; Formoterol
• Albiglutide
• Albuterol
• Albuterol; Ipratropium
• Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
• Aliskiren; Hydrochlorothiazide, HCTZ
• Alogliptin; Pioglitazone
• Alpha-blockers
• Alpha-glucosidase Inhibitors
• Ambrisentan
• Amiloride; Hydrochlorothiazide, HCTZ
• Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
• Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
• Amobarbital
• Amoxapine
• Arformoterol
• Aspirin, ASA; Butalbital; Caffeine
• Aspirin, ASA; Butalbital; Caffeine; Codeine
• Aspirin, ASA; Caffeine; Dihydrocodeine
• Aspirin, ASA; Caffeine; Orphenadrine
• Atenolol
• Atenolol; Chlorthalidone
• Atomoxetine
• Azilsartan; Chlorthalidone
• Belladonna Alkaloids; Ergotamine; Phenobarbital
• Benazepril; Hydrochlorothiazide, HCTZ
• Bendroflumethiazide; Nadolol
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• Brompheniramine; Dextromethorphan; Phenylephrine
• Budesonide; Formoterol
• Butyrophenone
• Caffeine
• Caffeine; Ergotamine
• Canagliflozin
• Canagliflozin; Metformin
• Candesartan; Hydrochlorothiazide, HCTZ
• Captopril; Hydrochlorothiazide, HCTZ
• Carbetapentane; Chlorpheniramine; Phenylephrine
• Carbetapentane; Diphenhydramine; Phenylephrine
• Carbetapentane; Guaifenesin; Phenylephrine
• Carbetapentane; Phenylephrine
• Carbetapentane; Phenylephrine; Pyrilamine
• Carbidopa; Levodopa; Entacapone
• Carbinoxamine; Hydrocodone; Phenylephrine
• Carbinoxamine; Phenylephrine
• Cardiac glycosides
• Carteolol
• Carvedilol
• Chlophedianol; Guaifenesin; Phenylephrine
• Chlorothiazide
• Chlorpheniramine; Dextromethorphan; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Phenylephrine
• Chlorpheniramine; Hydrocodone; Phenylephrine
• Chlorpheniramine; Phenylephrine
• Chlorpromazine
• Chlorthalidone
• Chlorthalidone; Clonidine
• Clonidine
• Clozapine
• Cocaine
• Codeine; Phenylephrine; Promethazine
• Codeine; Promethazine
• Colchicine
• Colchicine; Probenecid
• COMT inhibitors
• Dapagliflozin
• Dapagliflozin; Metformin
• Dapagliflozin; Saxagliptin
• Desmopressin
• Dextromethorphan; Diphenhydramine; Phenylephrine
• Dextromethorphan; Guaifenesin; Phenylephrine
• Dextromethorphan; Promethazine
• Dichlorphenamide
• Digitoxin
• Digoxin
• Dihydroergotamine
• Dinoprostone, Prostaglandin E2
• Dipeptidyl Peptidase-4 Inhibitors
• Diphenhydramine; Hydrocodone; Phenylephrine
• Diphenhydramine; Phenylephrine
• Dopamine
• Dorzolamide; Timolol
• Doxazosin
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• Droxidopa
• Dulaglutide
• Dyphylline
• Dyphylline; Guaifenesin
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• Enalapril; Hydrochlorothiazide, HCTZ
• Enflurane
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• Esmolol
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• Fluticasone; Vilanterol
• food
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• Ginger, Zingiber officinale
• Glimepiride; Pioglitazone
• Glimepiride; Rosiglitazone
• Glycopyrrolate; Formoterol
• Green Tea
• Guaifenesin; Phenylephrine
• Guanabenz
• Halothane
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• Hydrochlorothiazide, HCTZ
• Hydrochlorothiazide, HCTZ; Irbesartan
• Hydrochlorothiazide, HCTZ; Lisinopril
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• Hydrochlorothiazide, HCTZ; Propranolol
• Hydrochlorothiazide, HCTZ; Quinapril
• Hydrochlorothiazide, HCTZ; Spironolactone
• Hydrochlorothiazide, HCTZ; Telmisartan
• Hydrochlorothiazide, HCTZ; Triamterene
• Hydrochlorothiazide, HCTZ; Valsartan
• Hydrocodone; Phenylephrine
• Iloprost
• Incretin Mimetics
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• Indapamide
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