Adult Dosing
Anaphylaxis
- Auto-injector
- 15-30 kg: 0.15 mg IM/SC
- >30 kg: 0.3 mg IM/SC
- Injection Solution
- 0.2-1 mg (mL) IM/SC; may repeat q10-15 minutes
- Alt: 0.1-0.25 mg IV over 5 minutes, q5-15 minutes PRN
Bronchial asthma
- 0.2-1 mg (mL) IM/SC; start with small dose and increase if required
- Alt: 0.1-0.25 mg IV over 5 minutes, q5-15 minutes PRN
Cardiac resuscitation
- 0.5 mg diluted in 10 mL sodium chloride IV/Intracardiac
- Alt: If patient is intubated inject 0.5 mg via the endotracheal tube directly into the bronchial tree
Regional anesthesia
- 0.3-0.4 mg (0.3-0.4 mL of 1:1000) mixed with spinal anesthetic agents
- 1:200,000 for infiltration injection, nerve block, caudal or other epidural blocks
Calcium Channel Blocker Overdose [Non-FDA Approved]
- 1-2 µg/min IV. Titrate to effect
Cardiac Arrest [Non-FDA approved]
- 1 mg IV in a concentration of 1:10,000 q3 to 5 minutes
Pediatric Dosing
Anaphylaxis, Bronchial asthma
- Auto-injector
- 15-30 kg: 0.15 mg IM/SC
- >30 kg: 0.3 mg IM/SC
- Injection Solution
- 0.01 mg/kg or 0.3 mg/m2 SC q4 hrs; max: 0.5 mg/dose
Note:
- Inject auto-injector only into the anterolateral aspect of the thigh
Calcium Channel Blocker Overdose [Non-FDA Approved]
- 0.1 µg/kg/min IV. Titrate to effect
Cardiac Arrest [Non-FDA approved]
- 0.01 mg/kg IV in a concentration of 1:10,000 q3 to 5 minutes
[Outline]
- Inject auto-injector epinephrine into the anterolateral aspect of the thigh only. Do not administer auto-injector into the hands or feet and buttock as it can result in loss of blood flow to the affected area. If there is an accidental injection into these areas, advise the patient to inform the healthcare provider [Auto-injector]
- Avoid intravascular administration of auto-injector, as large dose can result in cerebral hemorrhage due to a sharp rise in blood pressure. If there is such inadvertent intravascular administration, administer rapid acting vasodilators, as it can counteract the marked pressor effects of epinephrine [Auto-injector]
- Epinephrine auto injector contains sodium bisulfite, which itself can cause allergic-type reactions including anaphylactic symptoms. But the presence of a sulfite in this product should not deter administration of the drug for treatment of serious allergic or other emergency situations, even if the patient is sulfite-sensitive
- Use cautiously in cardiac arrhythmias, coronary artery or organic heart disease, or hypertension as epinephrine can precipitate or aggravate angina pectoris as well as produce ventricular arrhythmias in these patients
- Because of the peripheral constriction and cardiac stimulation produced by epinephrine, fatalities can result from pulmonary edema. Administer rapidly acting vasodilators, such as nitrites, or alpha blocking agents to counteract the marked pressor effects of epinephrine
- Potentially serious cardiac arrhythmias can occur in patients not suffering from heart disease and patients with organic heart disease or who are receiving drugs that sensitize the myocardium
- Paradoxical but transient lowering of blood pressure, bradycardia and apnea can occur immediately after epinephrine 1:1000 injection
Cautions: Use cautiously in
- Cardiovascular disease
- Hypertension
- Diabetes
- Hyperthyroidism
- Cerebrovascular diseases
- Long-standing bronchial asthma
- Emphysema
- Psychoneurotic patient
Pregnancy Category:C
Breastfeeding: No data available on the use of epinephrine during breastfeeding. It is unlikely to affect the infants due to its poor oral bio-availability and short half-life, however high IV dose may reduce milk production or milk letdown. This information is based on LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 18 April 2011). Manufacturer advises caution.
US Trade Name(s)
- Adrenalin
- Adrenaclick
- Twinject
- Epipen
- Epipen JR
- Auvi-Q
US Availability
epinephrine (generic)
- INJ: 1 mg/mL (30 mL vial)
Adrenalin
- INJ: 1mg/mL (Single-use vial)
Adrenaclick, Twinject
- INJ: 0.15 mg/0.15 mL (Prefilled auto injector)
- INJ: 0.3 mg/0.3 mL (Prefilled auto injector)
Epipen
- INJ: 0.3 mg/0.3 mL (Prefilled auto injector)
Epipen JR
- INJ: 0.15 mg/0.15 mL (Prefilled auto injector)
Auvi-Q
- INJ: 0.3 mg/delivery (Prefilled auto injector)
- INJ: 0.15 mg/delivery (Prefilled auto injector)
Canadian Trade Name(s)
- Anapen
- Anapen JR
- Epipen
- Epipen JR
- Twinject
Canadian Availability
epinephrine (generic)
adrenaline 1:1000 (generic)
Anapen
Anapen JR
Epipen
Epipen JR
Twinject
- INJ: 0.15 mg/0.15 mL (Prefilled auto injector)
- INJ: 0.3 mg/0.3 mL (Prefilled auto injector)
UK Trade Name(s)
UK Availability
adrenaline 1:1000 (generic)
epinephrine 1:10,000 (generic)
- INJ: 0.1 mg/mL (prefilled syringes)
Epipen
- INJ: 0.3 mg/0.3 mL (Prefilled auto injector)
Epipen JR
- INJ: 0.15 mg/0.3 mL (Prefilled auto injector)
Australian Trade Name(s)
- Anapen
- Anapen JR
- Epipen
- Epipen JR
Australian Availability
adrenaline 1:1000 (generic)
adrenaline 1:10,000 (generic)
Anapen
- INJ: 0.3 mg/0.3 mL (Prefilled auto injector)
Anapen JR
- INJ: 0.15 mg/0.3 mL (Prefilled auto injector)
Epipen
- INJ: 1 mg/0.3mL (Prefilled auto injector)
Epipen JR
- INJ: 0.5 mg/0.3mL (Prefilled auto injector)
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- EpiPen 2-Pak 0.3 MG/0.3ML (1:1000) DEVI [Package] (DEY LABS)
2 (1:1000) = $215.99
6 (1:1000) = $620.96 - Adrenaclick 0.3 MG/0.3ML DEVI [Pen] (SHIONOGI PHARMA)
1 0.3ml = $99.91
2 0.3ml = $189.83 - Adrenaclick 0.3 MG/0.3ML DEVI [Pen] (SHIONOGI PHARMA)
2 0.3ml = $179.84
4 0.3ml = $349.67 - EpiPen Jr 2-Pak 0.15 MG/0.3ML (1:2000) DEVI [Package] (DEY LABS)
2 (1:2000) = $215.99
6 (1:2000) = $616 - Twinject 0.15 MG/0.15ML DEVI [Box] (SHIONOGI PHARMA)
2 0.15ml = $299
6 0.15ml = $881.99 - Twinject 0.3 MG/0.3ML DEVI [Box] (SHIONOGI PHARMA)
2 0.3ml = $302.98
6 0.3ml = $892.99
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
