Name: EPINEPHRINE (AdrenalinR)
Classification: sympathomimetic
  • Stimulates beta adrenergic receptors
    • increases myocardial contractility, positive chronotrope, positive dromotrope, bronchodilator
    • used to treat bradycardias, severe left ventricular dysfunction or anaphylaxis
  • Stimulates alpha adrenergic receptors 
    • vasoconstriction
    • used in profound hypotension or pulseless cardiac arrest to promote systemic perfusion pressure gradient
Dose:
  • Bolus dose:
    • 1 mg IV direct (single IV doses of up to 10 mg have been used in EMD, ventricular fibrillation)
  • Infusion dose:
    • 1-4 mcg/min (beta dose) titrated to effect
    • >20 mcg/min dose titrated to effect (alpha dose)
Administration: IV Infusion:
8 mg/250 mL D5W, NS, RL
  • Protect from light
  • Should be weaned off
  • Hypovolemia, hypoxemia and acidosis should be corrected concurrently with initiation of therapy
Adverse Effects:
  • tachycardias
  • arrhythmias
  • hypertension
  • increased myocardial oxygen consumption
  • increased blood glucose
  • renal failure
  • decreased mesenteric ischemia
  • extravasation of drug may cause tissue necrosis (Rx with 5-15 mg phentolamine in NS - see phentolamine monograph)
Drug Interactions:
  • epinephrine + propranolol = increased BP, decreased HR --->may be fatal; OR propranolol may make patients resistant to epinephrine effects
  • epinephrine + other sympathomimetics = increased toxicity
  • epinephrine + inhaled anaesthetics = increased myocardial irritability and risk of arrhythmias
Monitoring Therapy:
  • HR, ECG
  • BP
  • cardiac index
  • PWP 
  • SVRI
  • urine output
  • blood glucose
  • BUN, creatinine
  • electrolytes
  • arterial lactate
  • changes in skin temperature or color
CCTC Protocol:
  • May be administered as 1mg IV direct without a physician's order by a certified nurse in the CCTC for pulseless ventricular tachycardia or ventricular fibrillation.
  • May be titrated by an approved nurse in the CCTC.
  • Must be administered via central line.
  • Continous infusion must be administered via an infusion pump.
  • Should not be infused via the proximal injectate port (blue) of the Swan Ganz catheter.
  • Patient requires placement of an arterial line to monitor BP.


Lynne Kelly, Pharmacist, CCTC
Brenda Morgan, Clinical Nurse Specialist, CCTC
Last Update: January 12, 2017

LHSCHealth Professionals

Last Updated January 12, 2017 | © 2007, LHSC, London Ontario Canada