EPINEPHRINE

Adverse reactions include transient, moderate anxiety, apprehensiveness, restlessness, tremor, weakness, dizziness, sweating, palpitations, pallor, nausea and vomiting, headache, and respiratory difficulties. These symptoms occur in some persons receiving therapeutic doses of epinephrine, but are more likely to occur, or to occur in exaggerated form, in those with hypertension or hyperthyroidism. Excessive doses cause acute hypertension. Arrhythmias, including fatal ventricular fibrillation, have been reported, particularly in patients with underlying cardiac disease or those receiving certain drugs (see DRUG INTERACTIONS).

Rapid rises in blood pressure have produced cerebral hemorrhage, particularly in elderly patients with cerebrovascular disease. Angina may occur in patients with coronary artery disease.

CHLO-AMINE®

Drowsiness, dizziness, blurred vision, dry mouth and gastrointestinal upsets may occur. Patients should not drive or operate machinery after taking the drug. Large doses produce central nervous system depression and occasionally tremors or convulsions. Reports of hematological disorders are rare.

Caution is indicated in patients receiving cardiac glycosides or mercurial diuretics, since these agents may sensitize the myocardium to beta-adrenergic stimulation and make cardiac arrhythmias more likely.

The effects of epinephrine may be potentiated by tricyclic antidepressants, sodium levothyroxine, and certain antihistamines, notably chlorpheniramine, tripelennamine, and diphenhydramine. The cardiostimulating and bronchodilating effects of epinephrine are antagonized by beta-adrenergic blocking drugs, such as propranolol. The vasoconstricting and hypertensive effects are antagonized by alpha-adrenergic blocking drugs, such as phentolamine. Ergot alkaloids and phenothiazines may also reverse the pressor effects of epinephrine.

Diabetic patients receiving epinephrine may require an increased dose of insulin or oral hypoglycemic drugs.

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