Epinephrine (27 brand names, 6 dosage forms, 11 routes)
Available dosage forms: SOLUTION, INJECTABLE, AEROSOL, METERED, INJECTION, SPRAY, PATCH.
Routes of administration: INTRAMUSCULAR, SUBCUTANEOUS, INJECTION, INTRAMUSCULAR, INTRAMUSCULAR, INTRAVENOUS, SUBCUTANEOUS, INHALATION, INTRAVENOUS, INTRAOCULAR, INTRAMUSCULAR, SUBCUTANEOUS, SOLUTION,CONCENTRATE, NASAL, INTRAVENOUS, IONTOPHORESIS, TOPICAL, IONTOPHORESIS.
Brand Names
- ADRENACLICK
- ADRENALIN
- ALPHACAINE HYDROCHLORIDE W/ EPINEPHRINE
- AUVI-Q
- BRONKAID MIST
- BUPIVACAINE HYDROCHLORIDE AND EPINEPHRINE
- DURANEST
- EPI E Z PEN JR
- EPINEPHRINE
- EPINEPHRINE (AUTOINJECTOR)
- EPIPEN
- EPIPEN E Z PEN
- EPIPEN JR.
- IONTOCAINE
- LIDOCAINE HYDROCHLORIDE AND EPINEPHRINE
- LIDOCAINE HYDROCHLORIDE W/ EPINEPHRINE
- LIDOCATON
- LIDOSITE TOPICAL SYSTEM KIT
- NEFFY
- OCTOCAINE …and 7 more
Contraindications
None.
Drug Interactions
Drugs antagonizing pressor effects of epinephrine α-blockers, such as phentolamine Vasodilators, such as nitrates Diuretics Antihypertensives Ergot alkaloids Drugs potentiating pressor effects of epinephrine • Sympathomimetics• β-blockers, such as propranolol• Tricyclic anti-depressants• Monoamine oxidase (MAO) inhibitors• Catechol-O-methyl transferase (COMT) inhibitors, such as entacapone• Clonidine• Doxapram• Oxytocin• Drugs potentiating arrhythmogenic effects of epinephrine. Patients who are concomitantly receiving any of the following drugs should be observed carefully for the development of cardiac arrhythmias [see Warnings and Precautions (5.6) and Adverse Reactions (6)].• β-blockers, such as propranolol• Cyclopropane or halogenated hydrocarbon anesthetics, such as halothane• Antihistamines• Thyroid hormones• Diuretics• Cardiac glycosides, such as digitalis glycosides• Quinidine Drugs potentiating arrhythmogenic effects of epinephrine. Patients who are concomitantly receiving any of the following drugs should be observed carefully for the development of cardiac arrhythmias [see Warnings and Precautions (5.6)and Adverse Reactions (6)]. β-blockers, such as propranolol Cyclopropane or halogenated hydrocarbon anesthetics, such as halothane Antihistamines Thyroid hormones Diuretics Cardiac glycosides, such as digitalis glycosides Quinidine Drugs potentiating hypokalemic effects of epinephrine • Potassium depleting diuretics• Corticosteroids• Theophylline Epinephrine should not be used to counteract circulatory collapse or hypotension caused by phenothiazines, as a reversal of the pressor effects of epinephrine may result in further lowering of blood pressure. Epinephrine may antagonize the neuronal blockade produced by guanethidine resulting in decreased antihypertensive effect and requiring increased dosage of the latter.
Mechanism of Action
Epinephrine acts on both alpha (α)- and beta (β)-adrenergic receptors. The mechanism of the rise in blood pressure is 3-fold: a direct myocardial stimulation that increases the strength of ventricular contraction (positive inotropic action), an increased heart rate (positive chronotropic action), and peripheral vasoconstriction.
Overdosage
Overdosage of epinephrine may produce extremely elevated arterial pressure, which may result in cerebrovascular hemorrhage, particularly in elderly patients. Overdosage may also result in pulmonary edema because of peripheral vascular constriction together with cardiac stimulation. Epinephrine overdosage may also cause transient bradycardia followed by tachycardia and these may be accompanied by potentially fatal cardiac arrhythmias. Premature ventricular contractions may appear within one minute after injection and may be followed by multifocal ventricular tachycardia (prefibrillation rhythm). Subsidence of the ventricular effects may be followed by atrial tachycardia and occasionally by atrioventricular block. Myocardial ischemia and infarction, cardiomyopathy, extreme pallor and coldness of the skin, metabolic acidosis due to elevated blood lactic acid levels, and renal insufficiency and failure have also been reported. Epinephrine is rapidly inactivated in the body and treatment following overdose is primarily supportive. Treatment of pulmonary edema consists of a rapidly acting alpha-adrenergic blocking drug (such as phentolamine mesylate) and respiratory support. Treatment of arrhythmias consists of administration of a beta-adrenergic blocking drug (such as propranolol). If necessary, pressor effects may be counteracted by rapidly acting vasodilators (such as nitrites) or alpha-adrenergic blocking drugs. If prolonged hypotension follows such measures, it may be necessary to administer another pressor drug.