April 28, 2017
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"The American Academy of Pediatrics (AAP) confirms in a new report that epinephrine is the medication of choice for the first-aid treatment of anaphylaxis and updates a 2007 report on how it should be used most effectively.

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In general, the most common uses of epinephrine are to relieve respiratory distress due to bron-chospasm, to provide rapid relief of hypersensitivity reactions to drugs and other allergens, and to prolong the action of infiltration anesthetics. Its cardiac effects may be of use in restoring cardiac rhythm in cardiac arrest due to various causes, but it is not used in cardiac failure or in hemorrhagic, traumatic, or cardiogenic shock.

Epinephrine is used as a hemostatic agent. It is also used in treating mucosal congestion of hay fever, rhinitis, and acute sinusitis; to relieve bronchial asthmatic paroxysms; in syncope due to complete heart block or carotid sinus hypersensitivity; for symptomatic relief of serum sickness, urticaria, angioneurotic edema; for resuscitation in cardiac arrest following anesthetic accidents; in simple (open angle) glaucoma; for relaxation of uterine musculature and to inhibit uterine contractions. Epinephrine injection can be utilized to prolong the action of intraspinal and local anesthetics (see CONTRAINDICATIONS section).


Parenteral drug products should be inspected visually for particulate matter and discoloration whenever solution and container permit.

Vial and contents must be discarded 30 days after initial use.

Subcutaneously or intramuscularly - 0.2 to 1 mL (mg). Start with a small dose and increase if required.

Note: The subcutaneous is the preferred route of administration. If given intramuscularly, injection into the buttocks should be avoided.

For bronchial asthma and certain allergic manifestations, e.g., angioedema, urticaria, serum sickness, anaphylactic shock, use epinephrine subcutaneously. For bronchial asthma in pediatric patients, administer 0.01 mg/kg or 0.3 mg/m2 to a maximum of 0.5 mg subcutaneously, repeated every four hours if required.

For cardiac resuscitation - A dose of 0.5 mL (0.5 mg) diluted to 10 mL with sodium chloride injection can be administered intravenously or intracardially to restore myocardial contrac-tility. External cardiac massage should follow intracardial administration to permit the drug to enter coronary circulation. The drug should be used secondarily to unsuccessful attempts with physical or electromechanical methods.

Ophthalmologic use (for producing conjunctival decongestion, to control hemorrhage, produce mydriasis and reduce intraocular pressure)—Use a concentration of 1:10,000 (0.1 mg/mL) to 1:1,000 (1 mg/mL).

Intraspinal use (Amp 88) - Usual dose is 0.2 to 0.4 mL (0.2 to 0.4 mg) added to anesthetic spinal fluid mixture (may prolong anesthetic action by limiting absorption). For use with local anesthetic—Epinephrine 1:100,000 (0.01 mg/mL) to 1:20,000 (0.05 mg/mL) is the usual concentration employed with local anesthetics.


NDC 61570-418-81 (Amp 88) Sterile solution containing 1 mg Adrenalin (epinephrine) as the hydrochloride in each 1-mL ampoule (1:1000). For intramuscular or subcutaneous use. When diluted, it may also be administered intracardially, intravenously, or intraspinally. Supplied in packages of ten.

NDC 61570-401-11 (S.V. 11) Sterile solution containing 1 mg Adrenalin (epinephrine) as the hydrochloride (1:1000). For intramuscular or subcutaneous use. When diluted, it may also be administered intracardially or intravenously. Supplied in a 30-mL Steri-Vial® (rubber-diaphragm-capped vial).

Store between 15° and 25°C (59° and 77°F).

Protect from light and freezing.

Manufactured for: Monarch Pharmaceuticals, Inc., Bristol, TN 37620. By: Parkedale Pharmaceuticals, Inc., Rochester, MI 48307. FDA rev date: n/a

This monograph has been modified to include the generic and brand name in many instances.

Last reviewed on RxList: 12/29/2008

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