- SC IM (Adults and Children ≥30 kg): Severe anaphylaxis: 0.3–0.5 mg (not to exceed 0.5 mg/dose); may repeat every 10–15 min as needed.
- SC (Children <30 kg): Severe anaphylaxis: 0.01 mg/kg (not to exceed 0.3 mg/dose); may repeat every 10–15 min as needed; Auvi-Q or Symjepi (15–30 kg): 0.15 mg; may repeat if anaphylactic symptoms persist; Auvi-Q (7.5–15 kg): 0.1 mg; may repeat if anaphylactic symptoms persist.
- IV (Adults ): Severe anaphylaxis: 0.1–0.25 mg every 5–15 min; may be followed by 1–4 mcg/min continuous infusion; Cardiopulmonary resuscitation (ACLS guidelines): 1 mg every 3–5 min; Bradycardia (ACLS guidelines): 2–10 mcg/min continuous infusion; Hypotension associated with septic shock: 0.05–2 mcg/kg/min continuous infusion; titrate every 10–15 min by 0.05–0.2 mcg/kg/min to achieve desired mean arterial pressure.
- IV (Children ): Severe anaphylaxis: 0.1 mg (less in younger children); may be followed by 0.1 mcg/kg/min continuous infusion (may ↑ up to 1.5 mcg/kg/min); Symptomatic bradycardia/pulseless arrest (PALS guidelines): 0.01 mg/kg; may repeat every 3–5 min; higher doses (up to 0.1–0.2 mg/kg) may be considered; may also be given by the intraosseous route. May also be given by the endotracheal route in doses of 0.1–0.2 mg/kg diluted to a volume of 3–5 mL with normal saline followed by several positive pressure ventilations.
- Inhaln (Adults ): Inhalation solution: 1 inhalation of 1% solution; may repeat 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 (Adults and Children ≥12 yr): Over-the-counter inhaler: 1–2 inhalations every 4 hr as needed (max = 8 inhalations/day).
- Inhaln (Children >1 mo): 0.25–0.5 mL of 2.25% racemic epinephrine solution diluted in 3 mL normal saline.
- (Adults and Children ≥4 yr and ≥30 kg): One spray (2 mg) administered into one nostril; if no clinical improvement in 5 min, may administer another spray (2 mg) in same nostril.
- (Adults and Children ≥4 yr and 15–<30 kg): One spray (1 mg) administered into one nostril; if no clinical improvement in 5 min, may administer another spray (1 mg) in same nostril.
- IV Intratracheal (Neonates ): 0.01–0.03 mg/kg every 3–5 min as needed.
- Intracardiac (Adults ): 0.3–0.5 mg.
- Endotracheal(Adults ): Cardiopulmonary resuscitation (ACLS guidelines): 2–2.5 mg.
- (Adults and Children ≥6 yr): Nasal decongestant: Apply 1% solution as drops, spray, or with a swab.
- 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.
