ADRENALINE (EPINEPHRINE)

Indications & Dose:

Cardiac arrest, acute asthmatic attacks, nasal congestion, anaphylactic reactions

• BY INJECTION

* Volume of adrenaline 1 in 1000 (1mg/ml) in acute anaphylaxix by intramuscular injection: (preferably midpoint in anterolateral thigh) of 1 in 1000 (1mg/ml) solution

Adult and child over 12-18 : 500 microgram 0.5ml

Child over 6-12 : 300 microgram 0.3ml

Child under 6 year : 150 microgram 0.15ml the doses may be repeated several times , if necessary at 5-minute intervals according to blood pressure response, pulse and respiratory function.

Hypotension: IV INF 1-4 p,g/min

Cardiac arrest: 0.5-1mg (5-10ml of 1:10,000 soln.) Diluted to 10ml with NaCl administered i.v. or intracardiac to restore myocardial contractility. During a resusci-tation effort administer 0.5-1mg i.v. every 5 minutes.

If i.v. access is not available, the drug may be injected via the endotracheal tube. Perform 5 rapid insufflations, forcefully expel 10ml containing 1mg adrenaline (0.1mg/ml) directly into the tube, follow with 5 quick insufflations.

Hypersensitivity reactions, bronchial as-thma, urticaria, anaphylactic shock: use sc.

• Bronchodilator: SC 10 μg/kg (0.0.1 ml/kg of I : l 000), mix single dose 0.5 mg; susp (1:200) 0.005 ml/ kg/dose (0.025 mg/kg/dose) q6h, max 0.15 ml (0.75 mg)/dose; NEB 0.25-0.5 ml of 2.25% racemic epinephrine solution diluted in 3 ml NS q l -4h

Adults

i.v. 0.1-0.25mg injected slowly.

Neonates

0.01mg/kg.

Infants

0.05mg initial dose, repeated at 20-30 mins. intervals in the management of asthma attacks.

Concomitant administration with local anaesthetics: Adrenaline 1:200,000 is the usual concentration employed with local anaesthetics to delay absorption of drugs.

Intraspinal use: 0.2-0.4mg of 1:2000 solution added to anaesthetic spinal fluid mixture to prolong anaesthetic action by limiting absorption.

Dose for resuscitation of neonates, infants and children: 0.1ml/kg of 1:10000 dilution solution i.v

Contraindications:

Cardiac dysrhythmias, angle-closure glaucoma, local anesthesia of fingers and toes, general anesthesia with halogenated hydrocarbons or cyclopropane, organic brain damage, labor, coronary insufficiency

Side Effects:

Cautions:

Precautions:

Elderly, cardiovascular disease, hypertension, diabetes, hyperthyroidism, psychoneurotic individuals, thyrotoxicosis, parkinsonism

Interaction:

Drugs

ß-blockers: Noncardioselective ß-blockers enhance pressor response to epinephrine resulting in hypertension and bradycardia

Chlorpromazine, clozaril,thioridazine: Reversal of epinephrine pressor response

Cyclic antidepressants: Pressor response to IV epinephrine markedly enhanced

Warnings:

Adverse Effects:

Lactations:

Excreted into breast milk; use caution in nursing mothers

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Anxiety, dizziness, fear, headache, hemiplegia, restlessness, subarachnoid hemorrhage, tremor, weakness
CV: Anginal pain, dysrhythmias, hypertension, palpitations
GI: Nausea, vomiting
GU: Urinary retention
RESP: Respiratory difficulty
SKIN: Hemorrhage at inj site, pallor, urticaria, whelil 

Patient And Carer Advice: