Drug Summary

Epinephrine Hydrochloride (1:1,000)

Pharmacologic properties:

Epinephrine is a sympathomimetic which stimulates both alpha and beta adrenergic receptors. Its effects are to increase systemic vascular resistance, arterial blood pressure, coronary and cerebral blood flow, heart rate and contractility. The alpha-adrenergic effect increases vascular resistance and coronary blood flow, which may make the fibrillating myocardium more susceptible to counter-shock. The beta adrenergic effect increases heart rate and cardiac output, and induces bronchodilation.

Indications:

  • Anaphylaxis and acute allergic reactions associated with severe systemic symptoms (BP < 90 mmHg, stridor, severe respiratory distress) in adults and pediatrics
  • Bronchospasm (wheezing) with severe respiratory distress during asthma or COPD exacerbation
  • Cardiac arrest in pediatrics (via endotracheal tube, diluted)

Contraindications:

  • Known hypersensitivity

Precautions:

  • Presence of hypertension
  • History of heart disease
  • Age over 50 years
  • Epinephrine is inactivated by alkaline solutions and should not be mixed with Sodium Bicarbonate
  • Epinephrine 1:1,000 cannot be given intravenously in non-cardiac arrest patients

Adverse Reactions:

  • Anxiety
  • Headache
  • Cerebral hemorrhage
  • Tachycardia
  • Ventricular dysrhythmias
  • Hypertension
  • Angina
  • Nausea and vomiting

Dosage and administration:

  • Adult
    • 0.3 mg IM
  • Pediatric
    • Bronchospasm / Acute allergic reaction
      • 0.01 mg/kg (max 0.3 mg) IM
      • May repeat every 15 minutes as needed X 2 additional doses (3 total)
    • Cardiac Arrest (no IV/IO available)
      • 0.1 mg/kg (max 10 mg) diluted in 5 mL NaCl via endotracheal tube