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|Epinephrine |
Drugs search, click the first letter of a drug name: | A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z | 1 | 2 | 3 | 4 | 5 | 6 | 8 | 9 Home EpinephrinePronouncation: (epp-ih-NEFF-rin)Class: Arylalkylamines, Sympathomimetic, Vasopressor used in shock Trade Names: Trade Names: Trade Names: Trade Names: Trade Names: Trade Names: Vaponefrin (Canada) Mechanism of ActionPharmacologyStimulates alpha- and beta-receptors (alpha-receptors at high doses; beta 1 - and beta 2 -receptors at moderate doses) within sympathetic nervous system. Relaxes smooth muscle of bronchi and iris and is antagonist of histamine. PharmacokineticsMetabolismInactivated by enzymatic transformation to metabephrine or normetanephrine; these are subsequently conjugated and excreted in the urine. EliminationMostly excreted in urine as inactive metabolites; remainder excreted as unchanged drug or conjugated. Onset5 to 10 minutes (subcutaneous), 1 to 5 minutes (inhalation). Duration4 to 6 hr (subcutaneous), 1 to 4 hr (IM), 1 to 3 hr (inhalation). Indications and UsageTreatment and prophylaxis of cardiac arrest and attacks of transitory AV heart block; treatment of Adams-Stokes syndrome; treatment of hay fever; relief of bronchial asthma; treatment of syncope caused by heart block or carotid sinus hypersensitivity; symptomatic relief of serum sickness, urticaria, and angioedema; relaxation of uterine musculature; anaphylaxis; allergic reactions (eg, bronchospasm, urticaria, pruritus, angioneurotic edema, swelling of the lips, eyelids, tongue, and nasal mucosa) because of anaphylactic shock caused by stinging insects (primarily of the order Hymenoptera , which includes bees, wasps, hornets, yellow jackets, bumble bees, and fire ants); severe allergic or anaphylactoid reactions caused by allergy injections; exposures to pollens, dusts molds, foods, drugs; exercise; unknown substances (so-called idiopathic anaphylaxis); severe, life-threatening asthma attacks characterized by wheezing, dyspnea, and inability to breathe. Nasal solutionTreatment of nasal congestion; relief of eustachian tube congestion. InhalationTemporary relief from acute paroxysms of bronchial asthma and other states; treatment of postintubation and infectious croup. ContraindicationsHypersensitivity to epinephrine; narrow-angle glaucoma; concomitant use during general anesthesia with halogenated hydrocarbons or cyclopropane; cerebral arteriosclerosis or organic brain damage; use with anesthesia for fingers and toes; use during labor; phenothiazine-induced circulatory collapse; MAO inhibitor therapy; nonanaphylactic shock during general anesthesia with halogenated hydrocarbons or cyclopropane; organic heart disease; cardiac dilation and coronary insufficiency. Dosage and AdministrationCardiac ArrestAdults IV/Intracardiac 0.5 to 1 mg (5 to 10 mL of 1:10,000 solution) q 5 minute as needed. Myocardial injection usually given in left ventricular chamber by trained personnel at dose of 0.3 to 0.5 mg. Other IV UsesAdults IV 1 mg in 250 mL of D5W (4 mcg/mL) for infusion at 1 to 4 mcg/min (15 to 60 mL/hr). Intraspinal UseAdults Intraspinal 0.2 to 0.4 mL of 1:1,000 solution added to anesthetic spinal fluid mixture. Epinephrine 1:100,000 to 1:200,000 is usual concentration employed with local anesthetics. Allergic EmergenciesAdults IM ( Epipen ) Usual dose is 0.3 mg. ChildrenIM ( Epipen or Epipen Jr ) 0.01 mg/kg is recommended. Nasal CongestionAdults and Children 6 yr of age and older Nasal Apply as drops, spray, or with sterile swab as required. AsthmaAdults and Children 4 yr of age and older Inhalation Hand pump nebulizer : Place 0.5 mL (approximately 8 to 10 drops) of racemic epinephrine into nebulizer reservoir. Squeeze bulb 1 to 3 times in partially opened mouth. If relief does not occur within 2 to 3 minutes, administer 2 to 3 additional inhalations. Do not administer more often than q 3 hr. Aerosol-nebulizer : Add 0.5 mL (approximately 10 drops) racemic epinephrine to 3 mL of diluent or 0.2 to 0.4 mL (approximately 4 to 8 drops) of MicroNefrin to 4.6 to 4.8 mL water. Administer for 15 minutes q 3 to 4 hr. Aerosol : Start with 1 inhalation, then wait at least 1 minute; repeat once more if needed. Do not use again for at least 3 hr. AdultsSubcutaneous/IM Solution (1:1,000) : 0.2 to 1 mL (0.2 to 1 mg); repeat q 4 hr. IV Solution (1:10,000) : 0.1 to 0.25 mg (1 to 2.5 mL) injected slowly. Infants and childrenSubcutaneous Solution (1:1,000) : 0.01 mL/kg or 0.3 mL/m 2 (0.01 mg/kg or 0.3 mg/m 2 ); repeat q 20 minutes to 4 hr. Do not exceed 0.5 mL (0.5 mg) in single dose. IV Solution (1:10,000) : 0.01 mg/kg to 0.05 mg repeated at 20 to 30 minute intervals. General AdviceMultiple concentrations and dosage forms are available. Ensure the proper concentration and dose form is being used. Injection
Storage/StabilityStore inhalation solution and inhalation aerosol at controlled room temperature (68° to 77°F). Store all other dose forms at controlled room temperature (59° to 86°F). Protect from light, extreme heat, and freezing. Do not remove ampules or syringes from carton until ready to use. Drug InteractionsAlpha-adrenergic blockers (eg, phentolamine)Vasoconstricting and hypertensive effects are antagonized. AntihistaminesEpinephrine effects may be potentiated. Beta-blocking agentsMay decrease effects of these agents, resulting in hypertension. DiureticsVascular response may be decreased. Ergot alkaloids, phenothiazines, nitratesPressor effects of epinephrine may be reversed. Furazolidone, methyldopa, Rauwolfia alkaloidsMay cause hypertension. General anesthetics (eg, halothane, cyclopropane), cardiac glycosidesThe potential for the myocardium to be sensitized to the effects of sympathomimetic amines is increased. Arrhythmias may result with coadministration and may respond to beta-blockers. GuanethidineMay increase pressor response. LevothyroxineEpinephrine effects may be potentiated. Oxytoxic drugsMay cause severe persistent hypertension. Tricyclic antidepressantsMay potentiate epinephrine"s vasopressive effects. IncompatibilityEpinephrine is unstable in alkaline solutions (eg, sodium bicarbonate); avoid admixture. Laboratory Test InteractionsNone well documented. Adverse ReactionsCardiovascularCardiac arrhythmias and excessive hypertension; palpitations (especially in hyperthyroid and hypertensive patients); tachycardia; anginal pain in predisposed patients; cerebral and subarachnoid hemorrhage; flushing. CNSAnxiety; headache; restlessness; tremor; weakness; hemiplegia; dizziness; insomnia. EENTNasal use: Local irritation; sneezing; rebound congestion. GINausea; vomiting. GenitourinaryDecreased urine formation with initial parenteral use. RespiratoryShortness of breath. MiscellaneousSevere metabolic acidosis; pallor; urticaria; wheal and hemorrhage at site of injection; necrosis at injection site following repeated injections; sweating; transient elevations of blood glucose; elevated serum lactic acid. Precautions
PregnancyCategory C . LactationExcreted in breast milk. ChildrenAdminister drug with caution. Syncope has occurred in asthmatic children. Labor and DeliveryDo not use when maternal BP exceeds 130/80 mm Hg; may delay second stage or induce uterine atony. Special Risk PatientsUse drug with caution in elderly patients, patients with CV disease, pulmonary edema, hypertension, hyperthyroidism, diabetes, psychoneurotic illness, asthma, prefibrillatory rhythm, or anesthetic cardiac accidents. Sulfite SensitivitySome products contain sulfites; use drug with caution in sulfite-sensitive individuals. Bronchial asthma/EmphysemaAdminister with extreme caution to patients with long-standing bronchial asthma and emphysema who develop degenerative heart disease. Cerebrovascular hemorrhageMay result from overdosage or inadvertent IV injection. FatalitiesDeath may result from pulmonary edema because of peripheral constriction and cardiac stimulation produced. Pulmonary edemaMay cause fatalities because of peripheral constriction or cardiac stimulation. OverdosageSymptomsPrecordial distress, vomiting, headache, shortness of breath, unusually elevated BP, cerebrovascular hemorrhage, pulmonary arterial hypertension, pulmonary edema, ventricular hyperirritability, bradycardia, tachycardia, arrhythmias, extreme pallor, cold skin, metabolic acidosis, kidney failure. Patient Information
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