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What is the best-known trade name for epinephrine?
Adrenalin
Epinephrine is known as "adrenaline" in most of the world but the term is not used in the US due to its similarity to the trademarked "Adrenalin".
What is the functional class of epinephrine?
Sympathomimetic
In the human body, the most abundant catecholamines (which all have sympathomimetic effects) are epinephrine, norepinephrine and dopamine.
What is the mechanism of action of epinephrine?
A naturally-occurring catecholamine that acts directly on the alpha- and beta- (more profound) adrenergic receptors. This causes positive inotropic, dromotropic, and chronotropic effects as well as increased systemic vascular resistance and BP.
- Inotropic - increased contractility
- Dromotropic - increased conduction velocity
- Chronotropic - increased rate
What are the listed indications for epinephrine?
- Cardiac arrest: asystole, VF, pulseless VT, PEA
- Symptomatic bradycardia
- Anaphylaxis
- Severe reactive airway disease
Epinephrine is also used as a local vasoconstrictor in local anesthetics and in ointments to stop bleeding in contact sports such as boxing.
What are the listed contraindications for epinephrine?
Hypersensitivity to sympathomimetic amines
Some sources state that epinephrine is contraindicated for patients on nonselective β-blockers because severe hypertension may result as only the α-adrenergic effects will be produced.
What are the listed precautions for epinephrine?
- Protect from light
- Can be deactivated by sodium bicarbonate, therefore flush IV line between administration of epinephrine and sodium bicarbonate.
- Effects can be intensified by antidepressants
Furosemide (Lasix) can also block the effects of epinephrine.
What are the listed side effects for epinephrine?
- Increases myocardial oxygen demand
- Can cause palpitations, anxiety, headache, CVA, syncope, HTN, tachydysrhythmias
- Tissue necrosis with repeated injections or extravasation of IV
Some sources add acute pulmonary edema as a side effect of epinephrine.
What are the listed interactions for epinephrine?
- May increase hypotension caused by phenothiazines, alpha and beta blockers
- Can be deactivated in alkaline solutions or sodium bicarbonate
Tricyclic antidepressants can potentiate epinephrine by inhibition of norepinephrine reuptake.
What is the dosage and route of epinephrine for cardiac arrest?
Adult:
- 1.0mg of 1:10,000 IVP q 3 - 5 minutes or
2.0 - 2.5mg of 1:1,000 ET q 3 - 5 minutes (diluted to 10mL)

Pedi:
- 0.01mg/kg of 1:10,000 IV/IO or
0.1mg/kg of 1:1,000 ET q 3 - 5 minutes (diluted to 3 - 5mL)
Note that the differing routes use differing concentrations. High-dose epinephrine is ET (as it is being diluted), low-dose is IV/IO.
What is the dosage and route of epinephrine for severe anaphylaxis/asthma?
Adult:
- 0.3 - 0.5mg of 1:1,000 SQ q 5 - 15 minutes,
- If ineffective give 0.1 - 0.5mg of 1:10,000 IVP q 5 - 15 minutes

Pedi:
- 0.01mg/kg of 1:1,000 SQ
- If ineffective give 0.01mg/kg of 1:10,000 IVP q 5 - 15 minutes
First dose is high-dose SQ, second dose is low-dose IVP.
What is the dosage and route of epinephrine for symptomatic bradycardia (as an infusion)?
Preparation: 1 mg of 1:1,000 in 250mL NS

Adult:
- 2 - 10mcg/min

Pedi:
- 0.1 - 1mcg/kg/min
This is high-dose epinephrine as it is being diluted for infusion.

NH EMS protocols do not include epinephrine infusion for pediatric patients.
What are the pharmacokinetics of epinephrine?
None listed.
One source states:

Onset: 5 - 10 min SQ, 1 - 2 min IV
Duration: 5 - 10 min