Epinephrine

Epinephrine is a prescription medication used to treat low blood pressure, wheezing, severe skin itching, hives, and other symptoms of severe allergic reactions.

• Epinephrine is available under the following different brand names: Akovaz, Corphedra, Emerphed, Rezipres

Dosages of Epinephrine:

Adult dosage

Injectable solution, as sulfate

• 50mg/mL (Akovaz, Corphedra, generics)
• 50mg/10mL (5mg/mL) (Emerphed): equivalent to ephedrine base 3.8 mg/mL

Injectable solutions, as hydrochloride (Rezipres)

• 47mg/mL: equivalent to ephedrine base 38mg/mL
• 47mg/5mL (9.4mg/mL): equivalent to ephedrine base 7.7 mg/mL
• 23.5 mg/5mL (4.7mg/mL): equivalent to ephedrine base 3.8mg/mL

Hypotension

Akovaz, Corphedra, Emerphed, generics

• Initial dose: 5-10 mg IV bolus

Rezipres

• Initial dose: 4.7-9.4 mg IV bolus

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”.

Common side effects of Epinephrine include:

• breathing problems, 
• fast, irregular, or pounding heartbeats, 
• pale skin, 
• sweating, 
• nausea, 
• vomiting, 
• dizziness, 
• weakness, 
• tremors, 
• headache, 
• restlessness, 
• feeling fearful, 
• nervousness, 
• anxiousness, and 
• excitement 

Serious side effects of Epinephrine include:

• hives, 
• difficulty breathing, 
• swelling of the face, lips, tongue, or throat, and
• pain, swelling, warmth, redness, or other signs of infection at the injection site

Rare side effects of Epinephrine include:

• none 

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them.  Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first

• Epinephrine has severe interactions with the following drugs:
  • iobenguane I 123
  • isocarboxazid
  • linezolid
  • pheneizine
  • procarbazine
  • rasagiline
  • selegiline
  • selegiline transdermal
  • tranylcypromine
• Epinephrine has serious interactions with at least 28 other drugs. 
• Epinephrine has moderate interactions with at least 249 other drugs.
• Epinephrine has minor interactions with at least 16 other drugs.

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drugs interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use.  Keep a list of all your medications with you, and share this information with your doctor and pharmacist.  Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns.

Contraindications

• None

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Epinephrine?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Epinephrine?”

Cautions

• Serious postpartum hypertension and stroke reported with coadministration of a vasopressor (ie, methoxamine, phenylephrine, ephedrine) and an oxytocic (ie, methylergonovine, ergonovine); monitor BP if the patient has received both ephedrine and an oxytocic
• Repeated administration may cause tachyphylaxis; an alternative vasopressor may be needed to mitigate unresponsiveness to treatment
• An increased incidence of hypertension has occurred when used for prevention compared with the treatment of hypotension

Drug interaction overview

• Oxytocin and oxytocic drugs
  • Carefully monitor BP
  • Coadministration of a vasopressor and an oxytocic cause serious postpartum hypertension; some patients experienced a stroke
• Drugs that augment vasopressor effects of ephedrine
  • Carefully monitor BP
  • Clonidine, propofol, monoamine oxidase inhibitors (MAOIs), atropine may augment the vasopressor effects of ephedrine
• Drugs that antagonize vasopressor effects of ephedrine
  • Carefully monitor BP
  • Alpha-adrenergic antagonists, beta-adrenergic receptor antagonists, reserpine, or quinidine may antagonize the vasopressor effects of ephedrine
• Rocuronium
  • Be aware of the interaction
  • Ephedrine may reduce the onset time of neuromuscular blockade when used for intubation with rocuronium if administered simultaneously with anesthetic induction
• Epidural anesthesia
  • Monitor and treat according to clinical practice
  • Ephedrine may decrease the efficacy of epidural blockage by hastening the regression of sensory analgesia
• Theophylline
  • Monitor for worsening symptoms and manage symptoms according to clinical practice
  • Ephedrine may increase the frequency of nausea, nervousness, and insomnia
• Cardiac glycosides
  • Carefully monitor
  • Coadministration with a cardiac glycoside (eg, digoxin) may increase the risk of arrhythmias

Pregnancy and Lactation

• Available data of use in pregnant females have not identified a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes
• Untreated hypotension associated with spinal anesthesia for cesarean section is associated with an increase in maternal nausea and vomiting
• Decreased uterine blood flow due to maternal hypotension may result in fetal bradycardia and acidosis
• Fetal/neonatal adverse reactions
  • Cases of potential metabolic acidosis in newborns at delivery with maternal ephedrine exposure have been reported in the literature
  • These reports describe umbilical artery pH of less than or 7.2 at the time of delivery
  • Monitor newborn for signs and symptoms of metabolic acidosis
• A single published case report indicates that ephedrine is present in human milk
• No information is available on its effects on breastfed infants or milk production