ADRIN

Allergic reactions, Inflammatory response

Vasoconstrictor

The actions of epinephrine resemble the effects of stimulation of adrenergic nerves. It acts on both alpha and beta receptor sites of sympathetic effector cells. Its most prominent actions are on the beta receptors of the heart, vascular and other smooth muscle. When given by rapid intravenous injection, it produces a rapid rise in blood pressure, mainly systolic, by (1) direct stimulation of cardiac muscle which increases the strength of ventricular contraction, (2) increasing the heart rate and (3) constriction of the arterioles in the skin, mucosa and splanchnic areas of the circulation. When given by slow intravenous injection, epinephrine usually produces only a moderate rise in systolic and a fall in diastolic pressure. Although some increase in pulse pressure occurs, there is usually no great elevation in mean blood pressure. Accordingly, the compensatory reflex mechanisms that come into play with a pronounced increase in blood pressure do not antagonize the direct cardiac actions of epinephrine as much as with catecholamines that have a predominant action on alpha receptors.

Cardiopulmonary resuscitation BY INTRAVENOUS INJECTION Adult: 1 mg every 3-5 minutes as required, a 1 in 10000 (100 micrograms/mL) solution is recommended Acute hypotension BY CONTINUOUS INTRAVENOUS INFUSION Neonate: Initially 100 nanograms/kg/minute, adjusted according to response, higher doses up to 1.5 micrograms/kg/minute have been used in acute hypotension. Child: Initially 100 nanograms/kg/minute, adjusted according to response, higher doses up to 1.5 micrograms/kg/minute have been used in acute hypotension Emergency treatment of acute anaphylaxis (under expert supervision) | Angioedema (if laryngeal oedema is present) (under expert supervision) BY INTRAMUSCULAR INJECTION Child 1 month-5 years: 150 micrograms, doses may be repeated several times if necessary at 5 minute intervals according to blood pressure, pulse, and respiratory function, suitable syringe to be used for measuring small volume; injected preferably into the anterolateral aspect of the middle third of the thigh Child 6-11 years: 300 micrograms, doses may be repeated several times if necessary at 5 minute intervals according to blood pressure, pulse, and respiratory function, to be injected preferably into the anterolateral aspect of the middle third of the thigh Child 12-17 years: 500 micrograms, to be injected preferably into the anterolateral aspect of the middle third of the thigh, doses may be repeated several times if necessary at 5 minute intervals according to blood pressure, pulse, and respiratory function, 300 micrograms (0.3 mL) to be administered if child small or prepubertal Adult: 500 micrograms, to be injected preferably into the anterolateral aspect of the middle third of the thigh, doses may be repeated several times if necessary at 5 minute intervals according to blood pressure, pulse, and respiratory function Acute anaphylaxis when there is doubt as to the adequacy of the circulation (specialist use only) | Angioedema (if laryngeal oedema is present) (specialist use only) BY SLOW INTRAVENOUS INJECTION Adult: 50 micrograms, using 0.5mL of the dilute 1 in 10 000 adrenaline injection, dose to be repeated according to response, if multiple doses required, adrenaline should be given as a slow intravenous infusion stopping when a response has been obtained Control of bradycardia in patients with arrhythmias after myocardial infarction, if there is a risk of asystole, or if the patient is unstable and has failed to respond to atropine BY INTRAVENOUS INFUSION Adult: 2-10 micrograms/minute, adjusted according to response EMERADE- 150 MICROGRAMS Acute anaphylaxis (for self-administration) BY INTRAMUSCULAR INJECTION Child (body-weight up to 15 kg): 150 micrograms, then 150 micrograms after 5-15 minutes as required Child (body-weight 15-30 kg): 150 micrograms, then 150 micrograms after 5-15 minutes as required, on the basis of a dose of 10 micrograms/kg, 300 micrograms may be more appropriate for some children EMERADE- 300 MICROGRAMS Acute anaphylaxis (for self-administration) BY INTRAMUSCULAR INJECTION Child (body-weight 30 kg and above): 300 micrograms, then 300 micrograms after 5-15 minutes as required Adult (body-weight 30 kg and above): 300 micrograms, then 300 micrograms after 5-15 minutes as required EMERADE- 500 MICROGRAMS Acute anaphylaxis (for self-administration for patients at risk of severe anaphylaxis) BY INTRAMUSCULAR INJECTION Child 12-17 years: 500 micrograms, then 500 micrograms after 5-15 minutes as required Adult: 500 micrograms, then 500 micrograms after 5-15 minutes as required EPIPEN- AUTO-INJECTOR 0.3MG Acute anaphylaxis (for self-administration) BY INTRAMUSCULAR INJECTION Child (body-weight 30 kg and above): 300 micrograms, then 300 micrograms after 5-15 minutes as required Adult (body-weight 30 kg and above): 300 micrograms, then 300 micrograms after 5-15 minutes as required EPIPEN- JR AUTO-INJECTOR 0.15MG Acute anaphylaxis (for self-administration) BY INTRAMUSCULAR INJECTION Child (body-weight up to 15 kg): 150 micrograms, then 150 micrograms after 5-15 minutes as required Child (body-weight 15-30 kg): 150 micrograms, then 150 micrograms after 5-15 minutes as required, on the basis of a dose of 10 micrograms/kg, 300 micrograms may be more appropriate for some children JEXT- 150 MICROGRAMS Acute anaphylaxis (for self-administration) BY INTRAMUSCULAR INJECTION Child (body-weight up to 15 kg): 150 micrograms, then 150 micrograms after 5-15 minutes as required Child (body-weight 15-30 kg): 150 micrograms, then 150 micrograms after 5-15 minutes as required, on the basis of a dose of 10 micrograms/kg, 300 micrograms may be more appropriate for some children JEXT- 300 MICROGRAMS Acute anaphylaxis (for self-administration) BY INTRAMUSCULAR INJECTION Child (body-weight 30 kg and above): 300 micrograms, then 300 micrograms after 5-15 minutes as required Adult (body-weight 30 kg and above): 300 micrograms, then 300 micrograms after 5-15 minutes as required

Use of Adrenaline with excessive doses of digitalis, mercurial diuretics or other drugs that sensitize the heart to arrhythmias is not recommended. The adverse effects of Adrenaline may be potentiated by tricyclic antidepressants; certain antihistamines; e.g, Diphenhydramine, Tripelennamine, Chlorpheniramine and L-thyroxine Sodium.

Arteriosclerosis (in adults) . arrhythmias . cerebrovascular disease . cor pulmonale . diabetes mellitus . elderly . hypercalcaemia . hyperreflexia . hypertension . hyperthyroidism . hypokalaemia . ischaemic heart disease . obstructive cardiomyopathy . occlusive vascular disease . organic brain damage . phaeochromocytoma . prostate disorders . psychoneurosis . severe angina . susceptibility to angle-closure glaucoma

Angina . angle-closure glaucoma . anorexia . anxiety . arrhythmias . cold extremities . confusion . difficulty in micturition . dizziness . dry mouth . dyspnoea . headache . hyperglycaemia . hypersalivation . hypertension (risk of cerebral haemorrhage) . hypokalaemia . insomnia . metabolic acidosis . mydriasis . myocardial infarction . nausea . pallor . palpitation . psychosis . pulmonary oedema (on excessive dosage or extreme sensitivity) . restlessness . sweating . tachycardia . tissue necrosis at injection site . tissue necrosis of bowel . tissue necrosis of extremities . tissue necrosis of kidneys . tissue necrosis of liver . tremor . urinary retention . vomiting . weakness

PREGNANCY May reduce placental perfusion and cause tachycardia, cardiac irregularities, and extrasystoles in fetus. Can delay second stage of labour. Manufacturers advise use only if benefit outweighs risk. BREAST FEEDING Present in milk but unlikely to be harmful as poor oral bioavailability.

Cardiac arrhythmia leading to ventricular fibrillation, severe hypertension leading to pulmonary edema and cerebral hemorrhage. Combined alpha and beta-adrenergic blocking agents such as Labetalol may counteract the effects of adrenaline, or a beta-blocking agent may be used to treat any supraventricular arrhythmias and Phentolamine to control the alpha-mediated effects on the peripheral circulation. Rapidly acting vasodilators such as nitrates and Sodium Nitroprusside may also be helpful. Immediate resuscitation support must be available.

Store below 25°C. Protect from light. Keep out of the reach of children.