- restore cardiac rhythm in cardiac arrest, improve myocardial status and facilitate defibrillation
- epinephrine is the final product in catecholamine biosynthesis
- at low doses, epinephrine acts on the beta2 receptors to produce vasodilation in skeletal muscle (as well as relaxation of bronchial smooth muscle)
- stimulates both alpha1 and beta2 and beta2 adrenergic receptors and on the beta1 adrenergic receptors in the heart to produce a positive chronotropic and inotropic effect; systolic blood pressure may be slightly increased as a result of the increased cardiac output; diastolic blood pressure may be decreased because of vasodilation
- at higher doses, epinephrine acts on alpha1 receptors in peripheral blood vessels to produce vasoconstriction and result in an increase in both systolic and diastolic blood pressure
- vomiting, respiratory distress, hypertension, tachycardia, bronchial and pulmonary edema, arrhythmias
- repeated injections may cause tissue necrosis as a result of vasoconstriction at the injection site
- over dose can be fatal; check type of solution prescribed, concentration, dosage and route
- protect epinephrine from light
- NEVER GIVE IM in neonates
- monitor BP and heart rate continuously
- overdose: treatment is mainly supportive; the pressor effects may be counteracted by an alpha adrenergic blocking drug such as phentolamine; however, prolonged hypotension may follow, which may require a pressor agent such as norepinephrine; arrhythmias, if they occur, may be treated with a beta adrenergic blocking drug, such as propranolol; kidney failure, metabolic acidosis, and cold, white skin may occur
- local: blanching, tissue ischemia or necrosis may occur with extravasation. Use phentolamine (see phentolamine monograph) if this occurs.
- Do NOT administer a high dose intravenously.
- 0.1 to 0.3 mL/kg of a 1:10,000 solution, direct IV push over 1 to 3 minutes, given by a physician
- 0.3 to 1 mL/kg of a 1:10,000 solution given via ENDOTRACHEAL TUBE, given by a physician
- may be repeated every 5 minutes
- if administered via Endotracheal Tube and volume is <0.3 mL, dilute solution 1:1 with normal saline to aid delivery of the drug
- our clinical experience during resuscitation in the case room is that there is almost an immediate effect when epinephrine is given via the Endotracheal tube
- may also be given intracardiac (0.1 mL/kg of a 1:10,000 (0.1 mg/mL) solution) by a physician
Continuous IV Infusion
- 0.05 to 1 mcg/kg/min
- Pharmacy to supply all infusions, as standard concentrations:
- Patients 1kg or less: 8mcg/mL solution supplied as 400mcg or 0.4mg in total volume of 50mL of IV fluid specified
- patients over 1kg but less than 3kg: 16mcg/mL solution supplied as 800mcg or 0.8mg in total volume of 50mL of IV fluid specified
- patients over 3kg: 32mcg/mL solution supplied as 1600mcg or 1.6mg in total volume of 50mL of IV fluid specified
|For the indication "to improve upper airway obstruction", L-epinephrine may be used in place of Racemic Epinephrine Inhalation Solution (a mixture of D- and L- isomers of epinephrine). The route of administration is via nebulizer. Pharmacy to send as patient specific medication; this product no longer in Pyxis.
0.25 mL Racemic epinephrine (2.25%) = 2.5 mL L-epinephrine (1 : 1,000)
0.5 mL Racemic epinephrine (2.25%) = 5 mL L-epinephrine (1 : 1,000)
- L-epinephrine : 1:10,000 (0.1 mg/mL), 10 mL vial
- Supplied by Pharmacy as patient specific syringes of standard concentrations (see above)
- protect vial and ampoules from light: DO NOT use if the solution is coloured (brown) or contains a precipitate; the infusion solution, dextrose or sodium chloride, is stable for 24 hours and does not have to be protected from light
- McEvoy G K (ed): AHFS Drug Information, American Society of Hospital Pharmacists, 1991.
- Roberts, RJ: Drug Therapy in Infants, W.B. Saunders, Toronto, 1984.
- Fanaroff AA and Martin RJ (eds): Neonatal-Perinatal Medicine, Mosley, Toronto, 1992.
- Gomella TL (Ed): Neonatology - Management, Procedures, On-Call Problems, Diseases, Drugs, 1992, Appleton and Lange, Norwalk, Connecticut.
- Bhatt DR, Furman GI, Reber DJ et al: Neonatal Drug Formulary, 1990-1991, 2nd Edition, Fontana, California 92334.
- Taketomo CK, Hodding JH and Kraus DM: Pediatric Dosage Handbook, Lexi-Comp Inc., Cleveland, 1992.
- Fraser BD : Nebulized levo-epinephrine as an alternative to racemic epinephrine in pediatrics, The Canadian Journal of Hospital Pharmacy 1995; 48: 303-304.
- Waisman Y, Klein BL, Boenning DA et al : Prospective double-blind study comparing L-epinephrine and racemic epinephrine in the treatment of laryngotracheitis, Pediatrics 1992; 89 : 302-306.
- Remington S and Meakin G : Nebolised adrenaline 1:1,000 in the treatment of croup, Anaesthesia 1986; 41 : 923-926.
- Newton DW, Fung EYY, Williams DA : Stability of five catecholamines and terbutaline sulfate in 5% dextrose injection in the absence and presence of aminophylline. American Journal of Hospital Pharmacy 1981;38:1314-1319.
- Summary of Major Changes to the 2005 AAP / AHA Emergency Cardiovaxcular care Guidelines for neonatal resuscitation. Vol 15 No 2. fall / Winter 2005.
Updated: December 9, 2005