used to treat bradycardias, severe left ventricular dysfunction or anaphylaxis
Stimulates alpha adrenergic receptors
used in profound hypotension or pulseless cardiac arrest to promote systemic perfusion pressure gradient
1 mg IV direct
Cardiac Arrest: repeat every 3 to 5 minutes until return of spontaneous circulation
1-4 mcg/min (beta dose) titrated to effect
>20 mcg/min dose titrated to effect (alpha dose)
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
increased myocardial oxygen consumption
increased blood glucose
acute kidney injury
extravasation of drug may cause severe tissue necrosis (Rx with 5-15 mg phentolamine in NS - see phentolamine monograph)
epinephrine + beta blockers = decreased contractility and blood pressure
epinephrine + other sympathomimetics = increased toxicity
epinephrine + inhaled anaesthetics = increased myocardial irritability and risk of arrhythmias
IV insertion site
continuous heart rate and rhythm
central or mixed venous oxygen saturation
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