** Information provided here is not comprehensive but includes what Nursing Unraveled considers as the more pertinent information relevant to nursing. **
** See references for links to articles that detail comprehensive drug information.**
Names
Generic
Epinephrine
Brand
EpiPen, Auvi-Q, Adrenaclick, Adrenalin
Indications and Dosing
Epinephrine is available in two different concentrations:
1 mg/mL for intramuscular (IM) administration
0.1 mg/mL for intravenous (IV) administration
When given as an IV infusion (IV drip) the 1 mg / mL concentration should be diluted.
Dilution will be dependent upon patient condition and hospital policies.
Cardiac Arrest
Cardiac Arrest Benefit:
Cardiac myocyte excitation causing increases in:
heart rate
contractility
coronary perfusion pressure
Route:
Intravenous (IV) or Intraosseous (IO)
In cardiac arrest Epi is always given via IV or IO access.
Endotracheal Tube (ETT) Administration
In emergency situations where IV or IO access is non-existent, Epi may be administered through an ETT to be absorbed through the alveoli.
IV or IO access should ALWAYS be the priority due to lack of data regarding medication administration through ETT.
Dosing:
Pediatric Weight Based Formula:
sssssssssssssPediatric IV: 0.01 mg/kg of the 0.1mg/mL solution
sssssssssssssPediatric ETT: 0.01 mg/kg of the 0.1mg/mL solution
Common Dosages:
sssssssssssssPediatrics: 0.01 mg/kg every 3 to 5 minutes
sssssssssssssAdults: 1mg every 3 to 5 minutes
Anaphylaxis
Anaphylaxis Benefit:
Bronchodilation leading to improved ventilation
Route:
Intramuscular (IM)
Injection to be given in a large muscle with a considerable amount of blood flow.
This is most often given in the side of the thigh muscle (vastus lateralis).
This injection may be given through clothes due to the emergent nature of administering it.
Intravenous (IV)
In certain circumstances Epi may be given IV for anaphylaxis.
Consult your hospital policies for instructions and dosing.
Dosing:
Pediatric Weight Based Formula:
sssssssssssssPediatric IM: 0.01 mg/kg of the 1mg/mL concentration
sssssssssssssPediatric IV: 0.01 mg/kg of the 0.1mg/mL concentration
Adult Dosage Ranges:
sssssssssssssAdult IM: 0.2 – 0.5 mg of the 1mg/mL concentration
sssssssssssssAdult IV: 0.1–0.25 mg of the 0.1mg/mL concentration
Common Dosages:
sssssssssssss0.3 mg for patients weighing ≥30 kg
sssssssssssss0.15 mg for patients weighing 15–30 kg
Other Indications
Pupil dilation (mydriasis) during intraocular surgeries
Hypotension during septic and anaphylactic shock
Croup via nebulization
Severe asthma exacerbation’s via nebulization
Local anesthetic block
Contraindications
Precaution: Geriatric
Precaution: Pediatrics
Precaution: Pregnancy
Precaution: Labor and Delivery
Shock unless shock is caused by anaphylaxis or sepsis
Hypersensitivity
Class: Adrenergic
These medications are considered to be “sympathomimetic”, meaning they mimic functions of the sympathetic nervous system.
Adrenergic medications bind to adrenergic receptors throughout the body.
These receptors include: alpha-1, alpha-2, beta-1, beta-2, and beta-3 receptors.
Each receptor controls different bodily functions, which are:
Pharmacodynamics
Pharmacodynamics is the study of what a drug does to the body.
Here Mechanism of Action and Toxicity will be covered.
Mechanism of Action
Acts upon adrenergic receptors throughout the body including alpha-1, alpha-2, beta-1, beta-2, and beta-3 receptors.
Effects include:
Increased heart rate
Increased myocardial contractility
Vasoconstriction
Bronchodilation
Smooth muscle contraction
Increased renin production
Tocolysis
Increased aqueous humor production
Toxicity
Vesicant
ssssss Extravasation protocols should be used in the event of IV infiltration.
Drug induced liver injury
ssssss May cause liver injury due to liver involvement in metabolism
Pharmacokinetics
Pharmacokinetics is the study of what the body does to the drug.
Here Absorption, Metabolism, Half-Life, and Excretion will be covered.
Absorption
IV:
ssss Rapid onset due to direct distribution into blood stream.
IM:
ssss Effects begin within 5 to 10 minutes
Metabolism
Mostly metabolized by the liver by a combination of reactions involving the enzymes catechol-O-methyltransferase (COMT) and monoamine oxidase (MAO)
Half-Life
2 to 3 minutes once it enters the blood stream
Since IM injections take longer to enter the blood stream half-life will be increased due to the increased time of absorption.
Excretion
Excreted through urine after being metabolized
Adverse Effects
*Tachycardia
Depending upon the condition this is expected.
In anaphylaxis it is not uncommon for the patient to wind up tachy which is expected and should be monitored.
Hypertension
Dysrhythmias
Angina
Tremors
Anxiety
Medication Interactions
Alpha-adrenergic blockers (decreased pressor effect)
Antihypertensives (decreases pressor effect)
Vasodilators (decreases pressor effect)
Diuretics (decreases pressor effect)
Beta Blockers (increases pressor effect)
MAO inhibitors (increases pressor effect)
COMT inhibitors (increases pressor effect)
References
American Society of Health-System Pharmacists. (2022, March 2). Epinephrine monograph for professionals. Drugs.com. https://www.drugs.com/monograph/epinephrine.html
Dalal, R., & Grujic, D. (2023, May 1). Epinephrine. statpearls. Retrieved February 5, 2024 from https://www.ncbi.nlm.nih.gov/books/NBK482160/
National Center for Biotechnology Information (2024). PubChem Compound Summary for CID 5816, Epinephrine. Retrieved February 6, 2024 from https://pubchem.ncbi.nlm.nih.gov/compound/Epinephrine.