When is epinephrine given

Here, learn to recognize the symptoms and what to do next. What is an epinephrine injection? Medically reviewed by Alan Carter, Pharm. About Uses Administration Other information Side effects Summary Epinephrine, also called adrenaline, is a hormone that the adrenal glands produce in the body.

Share on Pinterest An epinephrine injection can treat severe allergic reactions. Image credit: Tony Webster, How to administer. Share on Pinterest A doctor can give instructions on how to administer a certain auto-injector. Other information and tips. Side effects and risks. Share on Pinterest A headache is a common side effect of an epinephrine injection. Latest news Adolescent depression: Could school screening help? Exposure to air pollutants may amplify risk for depression in healthy individuals.

Related Coverage. What to know about allergy shots. Medically reviewed by Alana Biggers, M. What happens when you get an adrenaline rush? Medically reviewed by Daniel Murrell, MD. If the prefilled automatic injection device is dropped, check to see if it is broken or leaking. Dispose of any medication that is damaged or should otherwise not be used and be sure to have a replacement available.

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. It is important to keep all medication out of sight and reach of children as many containers such as weekly pill minders and those for eye drops, creams, patches, and inhalers are not child-resistant and young children can open them easily.

To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location — one that is up and away and out of their sight and reach. In case of overdose, call the poison control helpline at If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at Do not let anyone else take your medication.

If you use a prefilled automatic injection device, be sure to get a replacement right away. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription over-the-counter medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements.

You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. Generic alternatives may be available.

Epinephrine Injection pronounced as ep'' i nef' rin. Why is this medication prescribed? How should this medicine be used? Also, typically reserved for use in addition to standard therapy for asthma complicated by anaphylaxis or angioedema. Guidelines state there is no proven advantage of systemic therapy over inhaled short-acting beta-agonists. Some experts use 0. In general, improvement is seen within 10 to 30 minutes and lasts 2 hours after administration; closely observe patients for recurrence of symptoms for 2 to 3 hours after administration.

A continuous infusion of 0. Do not interrupt CPR to administer drug therapy. Higher doses of epinephrine are not recommended except when indicated for exceptional circumstances e. After administration, flush the IV line with 0. Higher doses of epinephrine are not recommended. Effectiveness of endotracheal epinephrine is controversial; drug absorption is unpredictable, and optimal doses are unknown. Animal studies suggest that the lower epinephrine blood concentrations attained after ET drug administration may result in transient beta-2 vasodilation, resulting in decreased blood pressure, lower coronary artery perfusion pressure and flow, and a reduced potential for return of spontaneous circulation.

Dilute dose in 5 to 10 mL of Sterile Water for Injection or 0. Max: 2. If CPR is in progress, stop chest compressions briefly to administer medication. Follow ET administration with saline flush or dilute the drug in isotonic saline 5 mL or more and deliver several consecutive positive-pressure ventilations.

Follow ET administration with saline flush or dilute the drug in isotonic saline 0. NOTE: Intracardiac administration should be reserved for use only during open cardiac massage or in extreme emergencies when other routes of administration are unavailable. The risks of intracardiac injection include myocardial puncture and cardiac tamponade, coronary artery rupture, pneumothorax, and the need to cease chest compression and ventilation.

Titrate to desired effect. There is great interpatient variability in response. In general, low-dose infusions less than 0. Instill 1 to 2 drops of 0. See manufacturer's product literature for specifics of dilution and use. Use with caution and only under prescriber supervision due to greater sensitivity to sympathomimetic effects in this population.

Must dilute prior to intraocular use. Use the irrigating solution as needed for the surgical procedure. After dilution in an ophthalmic irrigating fluid, the solution may also be injected intracamerally as a bolus dose of 0.

Effectiveness of endotracheal epinephrine is controversial; drug absorption is unpredictable and optimal doses are unknown.

Titrate by 0. Epinephrine may be useful in refractory septic shock patients with myocardial dysfunction. Titrate to clinical response. Initially, 0. Diazepam was continued for 2 to 4 additional days.

Eleven cases of acute chloroquine overdose total ingested dose ranged from 5 to 12 g were treated with epinephrine; 10 patients were discharged alive from the hospital. The 1 patient who died ingested the largest total dose 15 g of chloroquine.

Soak gauze or a cotton pledget in 0. Dependent on route of administration and indication for therapy. For CPR, 0. For anaphylaxis, 0. For bronchospasm, 0. For croup, 0. Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.

Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed. Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit.

Do not use solutions that are pinkish to brownish in color, cloudy, or contain a precipitate or particulate matter. Do not inject epinephrine in fingers, toes, nose, and genitalia because it can cause severe tissue necrosis due to vasoconstriction of small blood vessels. Also, avoid injection of epinephrine-containing local anesthetics into these areas. If extravasation or accidental injection occurs, infiltrate the affected ischemic area as soon as possible with phentolamine to counteract dermal vasoconstriction.

This period should be as short as possible, and for a maximum of 2 hours at room temperature or 4 hours when refrigerated. In-use time is defined as the maximum amount of time allowed to elapse between penetration of a closed-container system or after reconstitution of a lyophilized drug before patient administration.

Though central IV access is preferred, epinephrine may be administered peripherally. In neonates, epinephrine may be administered via the umbilical vein. Avoid extravasation into the tissues to prevent local necrosis. If blanching along the course of the infused vein occurs, consider changing the infusion site at intervals to allow the effects of local vasoconstriction to subside. Do not interrupt CPR to administer epinephrine.

Epinephrine should be administered during chest compressions; however, the timing of drug administration is less important than the need to minimize chest compression interruption. After medication administration, flush with 0. Although FDA-approved labeling recommends dilution in dextrose-containing solutions to protect against significant loss of potency by oxidation, dilution in 0. Avoid veins of the leg in elderly patients or those with occlusive vascular disease.

Use a syringe with a fine hypodermic needle and liberally infiltrate throughout the ischemic area which is easily identified by its cold, hard, and pallid appearance. Inject epinephrine into the anterolateral aspect of the thigh, through clothing if necessary. Do NOT inject into the buttock, digits, hands, or feet. Avoid administration into or near smaller muscles, such as the deltoid muscle, due to differences in absorption observed with this use. Avoid repeated injections at the same site because resulting vasoconstriction can lead to tissue necrosis.

Device failure has been reported with epinephrine auto-injectors. Device failure may result from spontaneous activation caused by using a sideways force to remove the blue safety release, inadvertent or spontaneous activation due to a raised blue safety release, or difficulty removing the device from the carrier tube. Review appropriate use instructions with patients and their caregivers.

Prior to dispensing or using, ensure that the auto-injector slides out of the carrier tube and that the blue safety release is not raised. If the blue safety release is raised, the auto-injector should not be used because the device could activate by accident. Do not try to push the blue safety release back down. A device that has been activated by accident cannot be used for a patient in an emergency. Recommended "hold times" may vary among devices.

Subcutaneous epinephrine is not routinely recommended in the treatment of anaphylaxis due to delayed absorption. Inject epinephrine subcutaneously taking care not to inject intradermally.

Massage injection site well after administration to enhance absorption and to decrease local vasoconstriction. Injection can cause tissue irritation. If administering to a young child who may be uncooperative, hold the leg firmly in place and limit movement prior to and during the injection.

Avoid repeated injections at the same site, as resulting vasoconstriction may lead to tissue necrosis. During cardiopulmonary resuscitation, the same epinephrine dosage may be given via the intraosseous route when IV access is not available.

Of note, intraosseous lines are not commonly used in neonates because of the availability of the umbilical vein, the fragility of small bones, and the small intraosseous space available. After injection, flush with saline to promote medication entry into the central circulation. Intracardiac epinephrine administration should be reserved for extreme emergencies.

Intracardiac injection should only be performed by properly trained medical personnel. Before using the inhaler for the first time, activate the new inhaler by removing the red cap, shaking well, and then spraying into the air 4 separate times. Shake well before each use. Remove the red cap. Have the patient exhale completely. Place mouthpiece in patient's mouth with their lips closed around the opening.

The patient should inhale deeply while pressing down on the top of inhaler, then continue the deep breath. Hold breath as long as possible. Release finger and remove inhaler from mouth then exhale slowly. Wait at least 1 minute. If symptoms are not relieved, take a second inhalation by repeating the steps above. Do not exceed recommended daily dosage. Wash inhaler after each day of use by running water through the mouthpiece for 30 seconds.

Contents are under pressure; do not expose to heat, flame, or puncture as this may cause injury. Instruct patient on the proper technique for administering epinephrine nasal solution.

To avoid the spread of infection, do not use the container for more than one person. Epinephrine injection MUST be diluted prior to intraocular use. Visually inspect for particulate matter and discoloration prior to administration. Use as an irrigating solution as needed for surgical procedure. Inject a bolus dose of 0. ET administration is associated with lower drug concentrations compared to IV administration and may be less effective. Animal studies suggest that the lower epinephrine blood concentrations attained after ET drug administration may result in transient beta2-adrenergic effects with potential for hypotension.

Administer via ET tube. Endotracheal absorption of epinephrine may be improved by diluting with water instead of 0.

Generic: - Discard product if it contains particulate matter, is cloudy, or discolored - Discard unused portion. Do not store for later use.

Although there are no absolute contraindications to the use of parenteral epinephrine when used in acute, life-threatening situations, some product labeling states epinephrine is contraindicated in patients with known hypersensitivity to sympathomimetic amines, such as epinephrine. Epinephrine may induce cardiac arrhythmias, myocardial ischemia, and angina pectoris in patients, especially patients with coronary artery disease, cardiomyopathy, organic cardiac disease, high blood pressure, or patients receiving drugs that sensitize the myocardium.

Correct hypovolemia as fully as possible before any vasopressor is administered. When, as an emergency measure, intraaortic pressures must be maintained to prevent cerebral or coronary artery ischemia, epinephrine can be administered before and concurrently with blood volume replacement.

Some epinephrine preparations contain sodium metabisulfite and should not be used in patients with sulfite hypersensitivity unless the patient is being treated for an emergent condition such as anaphylaxis or cardiac arrest. Epinephrine is the preferred treatment for anaphylaxis, and the alternatives to using epinephrine in anaphylaxis may not be satisfactory. The presence of sulfite in epinephrine emergency kits or syringes should not deter administration of the drug for emergent treatment of anaphylaxis, even if the patient is sulfite-sensitive.

Although there are no absolute contraindications to the use of parenteral epinephrine when used in acute, life-threatening situations, some product labeling states epinephrine is contraindicated in closed-angle glaucoma because it can exacerbate this condition. Epinephrine is a potent vasoconstrictor; inadvertent digital or intraarterial administration can lead to vasoconstriction, vasospasm, thrombosis, and subsequent tissue necrosis.

Epinephrine and epinephrine-containing products e. Do not administer repeated injections at the same site. Infusion sites should be checked frequently for free flow. If inadvertent digital injection or extravasation occurs, the affected area should be infiltrated as soon as possible with a 0. The ischemic area may be identified by a cool, hard, and pallid appearance. Sympathetic blockade with phentolamine causes immediate and noticeable local hyperemic changes if the area is infiltrated within 12 hours of extravasation.

When used for anaphylaxis, epinephrine should be administered into the anterolateral aspect of the thigh vastus lateralis muscle because of its location, size, and available blood flow. Injection into the buttock may not be effective for anaphylaxis and has been associated with the development of gas gangrene; cleansing with alcohol does not kill bacterial spores and does not lower the risk.

Advise patients to seek medical care if they develop signs or symptoms of infection at the injection site e. Avoid the use of epinephrine, if possible, in patients with organic brain syndrome or cerebrovascular disease due to the risk of cerebral hemorrhage caused by a sharp rise in blood pressure associated with the intravenous administration of epinephrine. Patients with cerebrovascular disease are at risk for epinephrine-induced cardiac arrhythmias and angina.

Use epinephrine with great caution in patients with hypertension, as dangerously high blood pressure may occur. Increases in blood pressure can put patients with hypertension at risk for cardiac arrhythmias. When administered intravenously, monitor vital signs during infusion titration; invasive arterial blood pressure and central venous pressure monitoring are recommended.

Patients receiving monoamine oxidase inhibitors MAOI or antidepressants of the triptyline or imipramine types may experience severe, prolonged hypertension when given epinephrine. Epinephrine should be used with caution in patients with thyroid disease such as hyperthyroidism or thyrotoxicosis as well as those with pheochromocytoma; these patients may experience a greater sensitivity to the adverse effects of epinephrine. This is typically not of concern in acute, life-threatening situations.

Epinephrine should be administered with caution to patients with diabetes mellitus. Diabetic patients may experience transient increases in blood glucose. Epinephrine can cause hyperglycemia due to increased glycogenolysis in the liver, decreased tissue uptake of glucose, and decreased insulin release from the pancreas. This is typically not of concern when diluted for admixture with local anesthetics to reduce absorption and prolong the action of the anesthetic or in acute, life-threatening situations.

Prolonged experience with epinephrine use during human pregnancy does not identify a drug associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. However, there are risks to the mother and fetus associated with epinephrine use during labor and obstetric delivery.

In animal studies, subcutaneous epinephrine resulted in adverse developmental effects e. Life-sustaining therapy for the pregnant woman should not be withheld due to potential concerns regarding the effects of epinephrine on the fetus. Delaying treatment in pregnant women with hypotension associated with septic shock may increase the risk of maternal and fetal morbidity and mortality.

Avoid use during the second stage of labor; epinephrine may cause a prolonged period of uterine atony with hemorrhage at dosages sufficient to reduce uterine contractions. There is no information regarding the presence of epinephrine in human milk or its effects on the breastfed infant or milk production.

Epinephrine exposure is expected to be very low in the breastfed infant due to poor bioavailability and short half-life. According to the recommendations of the National Asthma Education and Prevention Program for managing asthma during pregnancy, there is no contraindication for the use of short-acting inhaled beta2-agonists, including albuterol, during lactation. Epinephrine injection must be diluted prior to intraocular use. Use epinephrine with caution in patients with Parkinson's disease.

Patients with Parkinson's disease may experience psychomotor agitation or a temporary worsening of symptoms.

Use epinephrine cautiously in patients with renal disease. When administered intravenously, epinephrine may initially constrict the renal blood vessels resulting in a decrease in urine production.

Renal insufficiency has been associated with intravenous infusion. Lacerations, bent needles, and embedded needles have been reported when epinephrine has been injected into the thigh of infants or young children who are uncooperative and kick or move during an injection. To minimize the risk of injury, caregivers should be instructed to hold the leg of young children firmly in place and limit movement prior to and during injection.

Safety and efficacy of non-prescription epinephrine for oral inhalation e. Acarbose: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Monitor for loss of glycemic control when pseudoephedrine, phenylephrine, and other sympathomimetics are administered to patients taking antidiabetic agents. Epinephrine and other sympathomimetics, through stimulation of alpha- and beta- receptors, increase hepatic glucose production and glycogenolysis and inhibit insulin secretion.

Also, adrenergic medications may decrease glucose uptake by muscle cells. For treatment of cold symptoms, nasal decongestants may be preferable for short term, limited use 1 to 3 days as an alternative to systemic decongestants in patients taking medications for diabetes. Acebutolol: Minor Close monitoring of blood pressure or the selection of alternative therapeutic agents to the sympathomimetic agent may be needed in patients receiving a beta-blocker.

Sympathomimetics, such as amphetamines, phentermine, and decongestants e. Concurrent use increases the risk of unopposed alpha-adrenergic activity. Increased blood pressure, bradycardia, or heart block may occur due to excessive alpha-adrenergic receptor stimulation. Acetaminophen; Caffeine: Moderate Caffeine is a CNS-stimulant and such actions are expected to be additive when coadministered with other CNS stimulants or psychostimulants.

Acetaminophen; Caffeine; Dihydrocodeine: Moderate Caffeine is a CNS-stimulant and such actions are expected to be additive when coadministered with other CNS stimulants or psychostimulants. Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide: Moderate Caffeine is a CNS-stimulant and such actions are expected to be additive when coadministered with other CNS stimulants or psychostimulants.

Acetaminophen; Chlorpheniramine: Moderate Chlorpheniramine may potentiate the arrhythmogenic effects of epinephrine.

Acetaminophen; Chlorpheniramine; Dextromethorphan: Moderate Chlorpheniramine may potentiate the arrhythmogenic effects of epinephrine.

Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: Moderate Chlorpheniramine may potentiate the arrhythmogenic effects of epinephrine. Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: Major Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity. Although no data are available, pseudoephedrine should be used cautiously in patients using significant quantities of other sympathomimetics.

Moderate Chlorpheniramine may potentiate the arrhythmogenic effects of epinephrine. Acetaminophen; Chlorpheniramine; Phenylephrine : Moderate Chlorpheniramine may potentiate the arrhythmogenic effects of epinephrine. Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine: Moderate Chlorpheniramine may potentiate the arrhythmogenic effects of epinephrine.

Acetaminophen; Dextromethorphan; Guaifenesin; Pseudoephedrine: Major Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity. Acetaminophen; Dextromethorphan; Pseudoephedrine: Major Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity.

Acetaminophen; Diphenhydramine: Moderate Diphenhydramine may potentiate the arrhythmogenic effects of epinephrine. Acetaminophen; Pseudoephedrine: Major Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity.

Aclidinium; Formoterol: Moderate Caution and close observation should be used when formoterol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects. Acrivastine; Pseudoephedrine: Major Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity.

Albiglutide: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Albuterol: Moderate Caution and close observation should be used when albuterol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects.

Aliskiren: Moderate Antihypertensives, including aliskiren, antagonize the vasopressor effects of parenteral epinephrine. Aliskiren; Amlodipine: Moderate Antihypertensives, including aliskiren, antagonize the vasopressor effects of parenteral epinephrine. Call your pharmacist for a new prescription. Symptoms of an epinephrine overdose may include numbness or weakness, severe headache, blurred vision, pounding in your neck or ears, sweating, chills, chest pain, fast or slow heartbeats, severe shortness of breath, or cough with foamy mucus.

Do not inject epinephrine into a vein or into the muscles of your buttocks, or it may not work as well. Inject it only into the fleshy outer portion of the thigh. Accidentally injecting epinephrine into your hands or feet may result in a loss of blood flow to those areas, and resulting numbness.

Call your doctor at once if you notice pain, swelling, warmth, redness, or other signs of infection around the area where you gave an injection. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. Other drugs may affect epinephrine, including prescription and over-the-counter medicines, vitamins, and herbal products.

Tell your doctor about all your current medicines and any medicine you start or stop using. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

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