ep-i-NEF-rin
Therapeutic Classification: antiasthmatics, bronchodilators, vasopressors
Pharmacologic Classification: adrenergics
High Alert
Local/Spinal
IV, Intracardiac, Intratracheal, Intraosseous (part of advanced cardiac life support [ACLS] and pediatric advanced life support [PALS] guidelines)
Absorption: IV administration results in complete bioavailability; well absorbed following SUBQ administration; some absorption may occur following repeated inhalation of large doses.
Distribution: Does not cross the blood-brain barrier; crosses the placenta and enters breast milk.
Half-Life: Unknown.
(bronchodilation)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| Inhaln | 1 min | unknown | 1–3 hr |
| SUBQ | 5–10 min | 20 min | <1–4 hr |
| IM | 6–12 min | unknown | <1–4 hr |
| IV | rapid | 20 min | 20–30 min |
Contraindicated in:
Use Cautiously in:
CV: angina, arrhythmias, hypertension, tachycardia
Derm: skin and soft tissue infections (including necrotizing fasciitis and myonecrosis)
Endo: hyperglycemia
GU: renal impairment
Neuro: nervousness, restlessness, tremor, headache, insomnia
Resp: PARADOXICAL BRONCHOSPASM (WITH EXCESSIVE USE OF INHALERS), pulmonary edema
Drug-drug:
Drug-Natural Products:
Inhaln
(Adults ): Inhalation solution: 1 inhalation of 1% solution; may be repeated after 1–2 min; additional doses may be given every 3 hr; Racepinephrine: Via hand nebulizer, 2–3 inhalations of 2.25% solution; may repeat in 5 min with 2–3 more inhalations, up to 4–6 times daily.Inhaln
(Children >1 mo): 0.25–0.5 mL of 2.25% racemic epinephrine solution diluted in 3 mL normal saline.Inhaln
(Adults and Children ≥12 yr): Over-the-counter inhaler: 1–2 inhalations every 4 hr as needed (max = 8 inhalations/day).Endotracheal
(Adults ): Cardiopulmonary resuscitation (ACLS guidelines): 2–2.5 mg.Intraspinal
(Adults and Children ): 0.2–0.4 mL of 1:1000 solution.With Local Anesthetics
(Adults and Children ): Use 1:200,000 solution with local anesthetic.Lab Test Considerations:
Toxicity and Overdose:
Patient harm or fatalities have occurred from medication errors with epinephrine. Epinephrine is available in various concentrations, strengths, and percentages and used for different purposes. Packaging labels may be confused or products incorrectly diluted. Dilutions should be prepared by a pharmacist. IV doses should be expressed in milligrams not ampules, concentration, or volume. Prior to administration, have second practitioner independently check original order, dose calculations, concentration, route of administration, and infusion pump settings.
IV Administration:
NDC Code