Names and pronunciation
(ep-i-nef′rin) Adrenalin, Adrenaclick , Allerjet , Auvi-Q, Anapen , Anapen Jr. , EpiPen, EpiPen Jr.
Source page 476
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Individual generic drug information
Extracted information for ePINEPHrine only.
(ep-i-nef′rin) Adrenalin, Adrenaclick , Allerjet , Auvi-Q, Anapen , Anapen Jr. , EpiPen, EpiPen Jr.
Source page 476
Func. class.: Bronchodilator nonse- lective adrenergic agonist, vasopressor
Source page 476
Chem. class.: Catecholamine
Source page 476
Do not confuse: EPINEPHrine/ePHEDrine/norepinephrine
Source page 476
ACTION: β1- and β2-agonist causing increased levels of cAMP, thereby pro- ducing bronchodilation, cardiac, and CNS stimulation; high doses cause vaso- constriction via alpha-receptors; low doses can cause vasodilation via β2-vascular receptors
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USES: Acute asthmatic attacks, hemo- stasis, bronchospasm, anaphylaxis, aller- gic reactions, cardiac arrest, adjunct in anesthesia, shock
Source page 476
Unlabeled uses: Bradycardia, chloro- quine overdose
Source page 476
Extracted information for ePINEPHrine only.
CONTRAINDICATIONS: Hyper- sensitivity to sympathomimetics, sul- fites, closed-angle glaucoma, nonana- phylactic shock during general anesthesia Precautions: Pregnancy, breastfeeding, cardiac disorders, hyperthyroidism, dia- betes mellitus, prostatic hypertrophy, hypertension, organic brain syndrome, local anesthesia of certain areas, labor, cardiac dilation, coronary insufficiency, cerebral arteriosclerosis, organic heart disease
Source pages 476, 477
SIDE EFFECTS CNS: Tremors, anxiety, insomnia, head- ache, dizziness, confusion, hallucina- tions, weakness, drowsiness CV: Palpitations, tachycardia, hyper- tension, dysrhythmias, increased T wave GI: Anorexia, nausea, vomiting MISC: Sweating, dry eyes RESP: Dyspnea, paradoxical broncho- spasm (inhalation) META: Hypoglycemia
Source page 478
INTERACTIONS • Do not use with MAOIs or tricyclics; hypertensive crisis may occur • Toxicity: other sympathomimetics Decrease: hypertensive effects—beta- adrenergic blockers, stop beta-blocker 3 days prior to starting product Increase: hypotension—alpha-blockers Increase: cardiac effects—antihista- mines, thyroid replacement hormones Increase: dysrhythmias—cardiac glycosides Drug/Herb • Increased stimulation: coffee, tea, guarana, yerba maté
Source page 479
TREATMENT OF OVERDOSE: Administer alpha-blocker and beta-blocker See Appendix B HIGH ALERT
Source page 479
Extracted information for ePINEPHrine only.
DOSAGE AND ROUTES Anaphylaxis/severe asthma exacerbation • Adult: IM/SUBCUT 0.3-0.5 mg, may repeat q10-15min (anaphylaxis) or q20min-4 hr (asthma) Severe anaphylaxis • Adult: IV 0.1-0.25 mg q5-15min, then 1-4 mcg/min continuous infusion if needed • Child: IV ≤0.1 mcg/kg/min, then 0.1 mcg/kg/min continuous infusion if needed Severe allergic reactions type I • Adult/child ≥30 kg: IM 0.3 mg (EpiPen/EpiPen 2-Pak) • Child <30 kg: IM 0.15 mg (EpiPen Jr/ EpiPen Jr 2-Pak) CPR (ACLS) • Adult: IV 1 mg q3-5min Bradycardia (ACLS) • Adult: IV 2-10 mcg/min Bradycardia/pulseless arrest (PALS) • Child: IV 0.01 mg/kg may repeat q3- 5min, may increase to 0.1-0.2 mg/kg if needed
Source page 477
Available forms: Nasal spray (solu- tion) 1 mg/mL; solution for injection 1 mg/mL (1:1000); 0.1 mg/mL (1:10,000); inhaled vapor (solution) 0.22 mg/actua- tion; pressurized inhalation (solution) 0.22 mg/actuation; solution for injection 0.15 mg/0.15 mL autoinjector, 0.3 mg/0.3 mL autoinjector, 0.15 mg/0.3 mL
Source page 477
Administer: • Increased dose of insulin for diabetic patients if glucose is elevated • Check for correct concentrations, route, dosage prior to administering • Give SUBCUT, IM, intraosseously, IV; suspensions are for SUBCUT use only; do not give IV • Visually inspect parenteral products for particulate matter and discoloration prior to use; do not use solutions that are pinkish to brownish or that contain a precipitate • Avoid extravasation during parenteral administration; if extravasation occurs, infiltrate the affected area with phentol- amine diluted in NS • Death has occurred from drug errors; make sure the right concentration is used E • Store reconstituted solution refriger- ated ≤24 hr Inhalation route • Place in nebulizer (10 drops of a 1% base solution) • Dilute racepinephrine 2.25% solution IM route • Give in the deltoid or anterior thigh (vastus lateralis); do not administer into the gluteal muscle, may give through clothing in emergency SUBCUT route • Inject, taking care not to inject intra- dermally; massage injection site well af- ter use to enhance absorption and to decrease local vasoconstriction; injection can cause tissue irritation Intraosseous INFUSION route (unla- beled) • During CPR, the same EPINEPHrine dosage may be given via the intraosse- ous route when IV access is not available Intracardiac route • Intracardiac route should be reserved for extreme emergencies; intracardiac injection should only be performed by properly trained medical personnel Endotracheal route • Per the ACLS or PALS guidelines, the EPINEPHrine parenteral product is ad- ministered via endotracheal (ET) route; ET administration should only be used if access to IV or intraosseous routes is not possible • Adult: Dilute dose in 5-10 mL of NS or sterile distilled water; administer via ET tube; endotracheal absorption of EPI- NEPHrine may be improved by diluting with water instead of NS • Child: After dose administration, flush the ET tube with a minimum of 5 mL NS Direct IV INJ route • 1:10,000 solution can be given directly without diluting: dilute 1:1000 (1 mg/0.9 mL) 0.9% NaCL (1:1000 solution) • Inject EPINEPHrine directly into a vein over 5-10 min for adults or 1-3 min for children; may be given IV push in cardiac arrest • In neonates, may administer via the umbilical vein During adult cardiopulmonary resusci- tation (CPR): • Resuscitation drugs may be given IV by bolus injection into a peripheral vein, followed by an injection of 20 mL IV fluid; elevate the extremity for 10-20 sec to facilitate drug delivery to the central circulation Continuous IV INFUSION route • Dilute 1 mg EPINEPHrine in 250 or 500 mL of a compatible IV infusion solution to provide a concentration of 4 or 2 mcg/mL, respectively; give into a large vein, if pos- sible; more concentrated solutions (16-32 mcg/mL) may be used in fluid-restricted patients when administered through a central line Y-site compatibilities: Alfentanil, amikacin, amiodarone, amphotericin B liposome, anidulafungin, ascorbic acid, atracurium, atropine, aztreonam, benztropine, bivaliru- din, bleomycin, bumetanide, buprenor- phine, butorphanol, calcium chloride/ gluconate, CARBOplatin, caspofungin, ceFAZolin, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chloramphenicol, chlorproMA- ZINE, cimetidine, cisatracurium, CISplatin, clindamycin, cyanocobalamin, cyclophos- phamide, cycloSPORINE, cytarabine, DACTI- Nomycin, DAPTOmycin, dexamethasone, dexmedetomidine, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, DOXOrubicin, doxy- cycline, enalaprilat, epirubicin, epoetin alfa, ertapenem, erythromycin, esmolol, etopo- side, etoposide phosphate, famotidine, fenoldopam, fentaNYL, fluconazole, fludara- bine, folic acid, furosemide, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hydrocortisone, HYDROmorphone, ifosfamide, imipenem-cilastatin, isoprotere- nol, ketorolac, labetalol, levofloxacin, lido- caine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, meperi- dine, metaraminol, methicillin, metho trexate, methoxamine, methyldopa, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, midazolam, milrinone, minocycline, mitoXANtrone, mor- phine, multiple vitamins, nafcillin, nalbu- phine, naloxone, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pancuronium, pantoprazole, PEMEtrexed, penicillin G potassium, pentamidine, pentazocine, phen- tolamine, phenylephrine, phytonadione, piperacillin/tazobactam, potassium chloride, procainamide, prochlorperazine, prometha- zine, propofol, propranolol, protamine, pyri- doxime, quinupristin/dalfopristin, ranitidine, remifentanil, ritodrine, rocuronium, sodium acetate, streptomycin, succinylcholine, SUFen tanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, trimethaphan, urokinase, vancomycin, vaso- pressin, vecuronium, verapamil, vinCRIStine, vinorelbine, vitamin B complex with C, vori- conazole, warfarin, zoledronic acid
Source pages 477, 478
Extracted information for ePINEPHrine only.
Assess: • Asthma: auscultate lungs, pulse, B/P, respirations, sputum (color, character); monitor pulmonary function studies be- fore and during treatment • Vasopressor: ECG during adminis- tration continuously; if B/P increases, decrease dose; B/P, pulse q5min after parenteral route; CVP, ISVR, PCWP during infusion if possible; inadver- tent high arterial B/P can result in angina, aortic rupture, cerebral hem- orrhage • Injection site: tissue sloughing; ad- minister phentolamine with NS • Sulfite sensitivity; may be life- threatening • Cardiac status, I&O; blood glucose in diabetes • Allergic reactions, bronchospasms (swelling of face/lips/eyelids, rash, diffi- culty breathing): withhold dose, notify prescriber
Source page 479
Evaluate: • Therapeutic response: increased B/P with stabilization or ease of breathing, relief of bronchospasm
Source page 479
CLINICAL CONSIDERATIONS
Source page 479
Patient and caregiver information: • About the reason for product adminis- tration • Inhalation: to rinse mouth after use to prevent dryness after inhalation, not to spray near eyes, teach correct use • To take exactly as prescribed. If on scheduled regimen, take missed dose as soon as remembered. Space remaining doses evenly. Do not double doses. To contact prescriber immediately if short- ness of breath is not relieved or diapho- resis, dizziness, or chest pain occurs • To consult prescriber prior to taking any OTC, Rx medications, supplements or herbals • To use bronchodilator prior to using other products E • To maintain adequate fluid intake (2000- 3000 mL/day) to help liquefy secretions • To notify prescriber if pregnancy is planned or suspected or if breast feeding • Autoinjector: how to use for anaphy- laxis; remove cap, place injector end tip on thigh at 90-degree angle, hold 10 sec, remove • Pregnancy/breastfeeding: identify if pregnancy is planned or suspected or if breastfeeding
Source page 479
Extracted information for ePINEPHrine only.
PHARMACOKINETICS Crosses placenta, metabolized in liver IM: 6-10 min, duration 1-4 hr SUBCUT: Onset 5-10 min, duration 20 min-4 hr IV: Onset immediate, peak 20 min, dura- tion 1-4 hr INH: Onset 1-5 min, duration 1-3 hr
Source page 478
Filter the extracted dose blocks for this individual drug.
Anaphylaxis/severe asthma exacerbation
• Adult: IM/SUBCUT 0.3-0.5 mg, may repeat q10-15min (anaphylaxis) or q20min-4 hr (asthma) Severe anaphylaxis
Candidate age grouping · source page 477
Anaphylaxis/severe asthma exacerbation
• Adult: IV 0.1-0.25 mg q5-15min, then 1-4 mcg/min continuous infusion if needed
Candidate age grouping · source page 477
Anaphylaxis/severe asthma exacerbation
• Child: IV ≤0.1 mcg/kg/min, then 0.1 mcg/kg/min continuous infusion if needed Severe allergic reactions type I
Candidate age grouping · source page 477
Anaphylaxis/severe asthma exacerbation
• Adult/child ≥30 kg: IM 0.3 mg (EpiPen/EpiPen 2-Pak)
Candidate age grouping · source page 477
Anaphylaxis/severe asthma exacerbation
• Child <30 kg: IM 0.15 mg (EpiPen Jr/ EpiPen Jr 2-Pak) CPR (ACLS)
Candidate age grouping · source page 477
Anaphylaxis/severe asthma exacerbation
• Adult: IV 1 mg q3-5min Bradycardia (ACLS)
Candidate age grouping · source page 477
Anaphylaxis/severe asthma exacerbation
• Adult: IV 2-10 mcg/min Bradycardia/pulseless arrest (PALS)
Candidate age grouping · source page 477
Anaphylaxis/severe asthma exacerbation
• Child: IV 0.01 mg/kg may repeat q3- 5min, may increase to 0.1-0.2 mg/kg if needed
Candidate age grouping · source page 477