EPINEPHRINE = EPN = ADRENALINE injectable

Prescription under medical supervision

Therapeutic action

– Sympathomimetic

Indications

– Severe anaphylactic reaction
– Cardiopulmonary arrest

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 only after dilution in 0.9% sodium chloride to obtain a solution containing 0.1 mg/ml
Before administration, check concentration and route of administration indicated on the ampoule.

Dosage

– Severe anaphylactic reaction
IM epinephrine is the first line treatment (anterolateral part of the thigh), however use IV epinephrine in patients with circulatory collapse or those who deteriorate despite receiving two IM injections of epinephrine.

  • IM treatment
    Use undiluted solution (1 mg/ml = 1:1000) and a 1 ml syringe graduated in 0.01 ml:
    Child under 6 years: 0.15 ml
    Child from 6 to 12 years: 0.3 ml
    Child over 12 years and adult: 0.5 ml
    In children, if 1 ml syringe is not available, use a diluted solution, i.e. add 1 mg EPN to 9 ml of 0.9% sodium chloride to obtain a 0.1 mg/ml solution (1:10 000):
    Child under 6 years: 1.5 ml
    Child from 6 to 12 years: 3 ml
    Repeat after 5 minutes if there is no clinical improvement.
  • IV treatment
    Use a diluted solution, i.e. add 1 mg EPN to 9 ml of 0.9% sodium chloride to obtain a 0.1 mg/ml solution (1:10 000):
    Child: 0.1 ml/kg (0.01 mg/kg) administered over several minutes
    Adult: 1 to 2 ml (0.1 to 0.2 mg), to be repeated every 1 to 2 minutes, until improvement occurs

– Cardiopulmonary arrest
Use a diluted solution by IV route, i.e. add 1 mg EPN to 9 ml of 0.9% sodium chloride to obtain a 0.1 mg/ml solution (1:10 000):
Child: 0.1 ml/kg (0.01 mg/kg), to be repeated every 3 to 5 minutes, until improvement occurs
Adult: 10 ml (1 mg), to be repeated every 3 to 5 minutes, until improvement occurs

Contra-indications, adverse effects, precautions

– Administer with caution to patients with hypertension, angina, ischaemic heart disease, hyperthyroidism and to elderly patients.
– Do not exceed indicated dose: risk of arrhythmia.
– Pregnancy and breast-feeding: no contra-indication

Remarks

– Epinephrine is colourless: discard any ampoules with a pink or brownish colour.
– Also comes in 0.1 mg/ml (1:10 000 solution) ampoules.
– Storage