ephedrine

Therapeutic Classification: vasopressors

Pharmacologic Classification: adrenergics

Indications ⬆ ⬇

REMS

Hypotension occurring in setting of anesthesia.

Action ⬆ ⬇

Acts as an agonist at both alpha- and beta-receptors; also indirectly stimulates release of norepinephrine, which results in vasoconstriction and increased cardiac output.

Therapeutic effects:

Increased BP.

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Unknown.

Metabolism/Excretion: Metabolized into norephedrine. Primarily excreted as unchanged drug and metabolite in urine.

Half-Life: 6 hr.

Time/Action Profile ⬆ ⬇

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
IV	unknown	unknown	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

None.

Use Cautiously in:

Renal impairment;
OB: May risk of metabolic acidosis in neonates; use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Safety and effectiveness not established in children;
Geri: Initiate therapy in older adults at lowest dose due to age-related decline in cardiac, hepatic, and renal function.

Adv. Reactions/Side Effects ⬆ ⬇

CV: bradycardia, hypertension, palpitations, tachycardia

GI: nausea, vomiting

Neuro: dizziness, restlessness

Misc: tolerance

Interactions ⬆ ⬇

Drug-drug:

Concurrent use with oxytocic drugs, including methylergonovine or ergonovine may ↑ risk of postpartum hypertension.
Clonidine, propofol, and MAO inhibitors may potential vasopressor effects.
-blockers, -blockers, and quinidine may ↓ effectiveness.
May ↓ the onset time of neuromuscular blockade with rocuronium.
May ↓ the effectiveness of epidural analgesics.
May ↑ risk of toxicity of theophylline.
May ↑ risk of arrhythmias when given concurrently with digoxin.

Route/Dosage ⬆ ⬇

IV (Adults ): 5–10 mg initially as IV bolus; may administer additional boluses, as needed, to maintain BP (max total cumulative dose = 50 mg). Rezipres: 4.7–9.4 mg initially as IV bolus; may administer additional boluses, as needed, to maintain BP (max total cumulative dose = 47 mg)

Availability ⬆ ⬇

(Generic available)

Solution for injection: 5 mg/mL; 50 mg/mL
Solution for injection (Rezipres): 4.7 mg/mL

Assessment ⬆ ⬇

Monitor heart rate and BP during therapy. May cause hypertension and tachyphylaxis.

Lab Test Considerations:

If used during delivery, monitor acid-base balance in newborn; may cause metabolic acidosis.

Implementation ⬆ ⬇

Do not confuse ephedrine with epinephrine.

IV Administration:

Rezipres 4.7 mg/mLSolution is premixed; do not dilute. Solution is clear and colorless; do not administer solutions that are cloudy, discolored, or contain particulate matter.

Patient/Family Teaching ⬆ ⬇

Explain purpose of ephedrine to patient.
Rep: Postdelivery, inform patient that newborn may be affected by previous administration. Monitor newborn for signs and symptoms of metabolic acidosis. Monitoring of infant’s acid-base status is warranted to ensure that an episode of acidosis is acute and reversible. Advise patient to notify health care professional immediately if hyperventilation in the newborn occurs.

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Pronunciation ⬇

Classifications ⬆ ⬇