EPINEPHRINE = EPN = ADRENALINE injectable

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    Last updated: April 2024

     

    Prescription under medical supervision

     

     
    Check the route of administration indicated on the ampoule. 
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    IV route should only be used by well trained personnel in well-equipped hospitals.
     

     

    Therapeutic action    

    • Sympathomimetic

    Indications

    • Severe anaphylactic reaction
    • Acute hypotension despite fluid therapy in shock

    Forms and strengths, route of administration

    • 1 mg in 1 ml ampoule (1 mg/ml) for IM injection only
    • 1 mg in 1 ml ampoule (1 mg/ml) for IV injection or infusion only

     

    Dosage

    Severe anaphylactic reaction 

    • Administer undiluted solution by IM route (anterolateral part of the thigh) using a 1 ml syringe graduated in 0.01 ml:
      • Child under 6 months: 0.1 to 0.15 ml 
      • Child 6 months to 5 years: 0.15 ml
      • Child 6 to 12 years: 0.3 ml 
      • Child over 12 years and adult: 0.5 ml (0.3 ml if small or prepubertal child)
    • Repeat after 5 minutes if no or poor clinical improvement (up to a total of 3 IM injections).  

     

    Acute hypotension despite fluid therapy or anaphylactic reaction unresponsive to epinephrine IM

    • Use diluted solution in 0.9% sodium chloride (NaCl 0.9%) or 5% glucose (G5%) or Ringer lactate (RL):
      • Child under 40 kg: add 2 ml of EPN (2 amp. of 1 mg/ml for IV route) to 38 ml of NaCl 0.9%, G5% or RL to obtain a 0.05 mg/ml (50 micrograms/ml) solution.
      • Child 40 kg and over and adult: add 4 ml of EPN (4 amp. of 1 mg/ml for IV route) to 36 ml of NaCl 0.9%, G5% or RL to obtain a 0.1 mg/ml (100 micrograms/ml) solution.
    • Administer by continuous IV infusion using an infusion or syringe pump:
      • Child and adult: 0.1 microgram/kg/min, increase if necessary by 0.05 micrograms/kg/min every 10 min for the first hour, then every hour (max. 1 microgram/kg/min)

      • Once desired response is achieved, discontinue gradually, in decrements of 0.05 micrograms/kg/min every hour. Do not discontinue abruptly.

    • The infusion rate is calculated as follows: [desired dose (microgram/kg/min) x weight (kg) x 60 min]/concentration (microgram/ml).

    Example, for a child 20 kg, dose 0.1 microgram/kg/min, solution concentration 50 micrograms/ml:

    EPN dose (microgram/kg/min)

    0.1

    0.15

    0.2

    0.25

    0.3

    0.35

    0.4

    0.45

    0.5

    Infusion rate (ml/hour)

    2.4

    3.6

    4.8

    6

    7.2

    8.4

    9.6

    10.8

    12

     

    Contra-indications, adverse effects, precautions

    • Administer with caution to patients with hypertension, angina, ischaemic heart disease, hyperthyroidism and to older patients.
    • May cause: arrhythmia, hypertension, agitation, headache; tissue necrosis following extravasation (use a large vein for IV administration).
    • Pregnancy and breast-feeding: no contra-indication

    Remarks

    • In anaphylaxis, use IV treatment only if no or poor improvement after 3 IM injections or if there is a circulatory collapse.
    • Epinephrine can be used via nebulizer in the management of croup: 0.5 mg/kg (max. 5 mg) to be repeated every 20 minutes if necessary.
    • Epinephrine is colourless: discard any ampoules with a pink or brownish colour.
    • Also comes in 0.15 mg/0.3 ml and 0.3 mg/0.3 ml pre-filled auto-injector.

    Storage

     
    –  Below 25 °C