Drug Cards

Epinephrine

Epinephrine 1:10,000 (Adrenalin)
Class:
Sympathominetic, endogenous catecholamine.
Mechanism of Action:
Direct acting alpha and beta agonist.
Alpha: vascular bronchial, cutaneous, renal and visceral arteiolar vasoconstriction.
Beta 1: positive inotropic, dromotropic and chronotropic actions, increases automaticity.
Beta 2: bronchial smooth muscle relaxant and dilation of skeletal vasculature.
Blocks histamine release.
Indications:
  • Cardiac arrest: Asystole, PEA, VF and pulsless VT unresponsive to defibrillation
  • Severe bronchospasm, asthma, bronchiolitis.
  • Anaphylaxis, acute allergic reactions. Could be infused in severe anaphylaxis.
  • Given as an infusion in refractory bradycardia or post arrest pressor support.
Contraindications:
Hypertension, hypothermia, hyperthyroidism, VT from cocaine OD, hypovolemic shock, pulmonary edema.
No condraindications in cardiac arrest.
Adverse reactions:
Hypertension, dysrythmias, pulmonary edema, coronary insufficiency, hypovolemia.
Adult Dosage and Administration
  • Cardiac Arrest: Asystole, PEA, VF and Pulseless VT unresponsive to defibrillation:
    1 mg IVP q 3-5min IV / IO 1:10.000.
  • Anaphylaxis:
    0.3 mg 1:1000 IM or 0.1 - 0.5 mg 1:10,000 IV
  • Severe bronchospasm:
    0.1 - 0.5 mg IV or IO (rarely used).
  • Symptomatic bradycardia refreactory to other care:
    2-10 mcg/ min of infusion which is mixed 1mg 1:1000 in 250 ml of NS which gives 4 mcg/ml.
  • Post ROSC hypotension / cardiac support:
    2 - 10 mcg/min infusion. Maintenance 0.1 - 0.5 mcg/kg/min.
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Pediatric Dosage and Administration:
  • Cardiac Arrest: Asystole, PEA, VF and pulseless VT unresponsive to defibrillation:
    0.01mg/kg 1:10,000 q 3-5 min IV / IO.
  • Allergic reactions and asthma:
    0.01 mgkg 1:1000 IM (max 0.5 mg).
  • Infusion:
    0.1-1.0 mcg/kg/min IV/IO use an infusion pump.
Duration of Action:
  • Onset: Immediate.
  • Peak effect: Minutes.
  • Duration: Several minutes.
Special Considerations:
Pregnancy safety: Category C