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
  • IV direct:
    • 1 mg IV direct
    • Cardiac Arrest: repeat every 3 to 5 minutes until return of spontaneous circulation
  • IV infusion:
    • 1-4 mcg/min (beta dose) titrated to effect
    • >20 mcg/min dose titrated to effect (alpha dose)
  • Endotracheal:
    • 2-2.5 mg
Administration: IV Infusion:
8 mg/250 mL dextrose 5%, sodium chloride 0.9% or Ringer's Lactate
  • protect from light
  • should be weaned off
  • hypovolemia, hypoxemia and acidosis should be corrected concurrently with initiation of therapy
  • monitor venous oxygen saturation and lactate to guide optimal dose; higher doses associated with lactic acidosis and increased myocardia oxygen demand
Adverse Effects:
  • tachycardias
  • arrhythmias
  • hypertension
  • increased myocardial oxygen consumption
  • increased blood glucose
  • acute kidney injury
  • mesenteric ischemia
  • extravasation of drug may cause severe tissue necrosis (Rx with 5-15 mg phentolamine in NS - see phentolamine monograph)
Drug Interactions:
  • epinephrine + beta blockers = decreased contractility and blood pressure
  • epinephrine + other sympathomimetics = increased toxicity
  • epinephrine + inhaled anaesthetics = increased myocardial irritability and risk of arrhythmias
Monitoring Therapy:
  • IV insertion site
  • continuous heart rate and rhythm
  • blood pressure
  • central or mixed venous oxygen saturation
  • lactate
  • blood gases
  • urine output
  • blood glucose
  • urea, creatinine
  • electrolytes
  • changes in skin temperature or color
Adult Critical Care Protocol:
  • May be administered IV direct, by IV infusion or by endotracheal tube by a nurse in Adult Critical Care with an order.
  • May be titrated by a nurse in Adult Critical Care.
  • May be administered IV direct or by endotracheal tube by Medical Directive for pulseless ventricular tachycardia or ventricular fibrillation by an ACLS certified nurse or RRT.
  • Must be administered via central venous access device; in emergency situations may be temporarily infused through a peripheral vasuclar access device until a central venous line can be established.
  • Patient requires placement of an arterial line to monitor BP.
  • Continuous infusions must be administered by infusion device and the pump library must be enabled.
  • Should not be infused via the proximal injectate port (blue) of a pulmonary artery catheter. If this is the only available central venous line, it may be administered through the proximal injectate port but thermodilution cardiac output measurements must not be measured during infusion).

Lynne Kelly, Pharmacist, CCTC
Brenda Morgan, Clinical Nurse Specialist, CCTC
Last Update: January 12, 2017, updated September 17, 2018