Emerphed 25mg/5ml Pf Syr Inj, 5ml
It is used to treat low blood pressure. It may be given to you for other reasons. Talk with the doctor.
Drug Class
Vasopressor; Bronchodilator
Pharmacologic Class
Sympathomimetic (alpha- and beta-adrenergic agonist)
Pregnancy Category
Category C
FDA Approved
Jan 1970
DEA Schedule
Not Controlled
Overview
What is this medicine?
Ephedrine is a medication given by injection to quickly raise blood pressure, especially during anesthesia, or to help open airways during breathing difficulties. It works by stimulating your body's natural 'fight or flight' response.
How to Use This Medicine
Taking Your Medication
To use this medication correctly, follow your doctor's instructions and read all the information provided to you. It is essential to follow the instructions carefully. This medication is administered intravenously over a specified period.
Storing and Disposing of Your Medication
If you need to store this medication at home, consult with your doctor, nurse, or pharmacist to determine the proper storage procedure.
Missing a Dose
If you miss a dose, contact your doctor to receive guidance on the next steps to take.
To use this medication correctly, follow your doctor's instructions and read all the information provided to you. It is essential to follow the instructions carefully. This medication is administered intravenously over a specified period.
Storing and Disposing of Your Medication
If you need to store this medication at home, consult with your doctor, nurse, or pharmacist to determine the proper storage procedure.
Missing a Dose
If you miss a dose, contact your doctor to receive guidance on the next steps to take.
Lifestyle & Tips
- Inform healthcare providers about all medications, supplements, and herbal products you are taking.
- Avoid consuming other stimulants (e.g., caffeine, decongestants) unless directed by a healthcare professional, as this can increase side effects.
- Report any unusual symptoms immediately, especially chest pain, severe headache, or difficulty breathing.
Available Forms & Alternatives
Dosing & Administration
Adult Dosing
Standard Dose:
Hypotension (spinal anesthesia): IV 5-10 mg, may repeat every 3-4 minutes as needed, max 50 mg. Bronchodilation: IM/SC 12.5-25 mg, may repeat every 4 hours as needed, max 150 mg/24 hours.
Dose Range:
5 - 50 mg
Condition-Specific Dosing:
hypotension_anesthesia:
IV 5-10 mg, repeat as needed, max 50 mg
bronchospasm:
IM/SC 12.5-25 mg, repeat every 4 hours, max 150 mg/24 hours
Pediatric Dosing
Neonatal:
Not established
Infant:
Hypotension: IV 0.1-0.2 mg/kg, repeat as needed. Bronchospasm: IM/SC 0.2-0.3 mg/kg every 4-6 hours.
Child:
Hypotension: IV 0.1-0.2 mg/kg, repeat as needed. Bronchospasm: IM/SC 0.2-0.3 mg/kg every 4-6 hours.
Adolescent:
Hypotension: IV 5-10 mg, may repeat every 3-4 minutes as needed, max 50 mg. Bronchospasm: IM/SC 12.5-25 mg, may repeat every 4 hours as needed, max 150 mg/24 hours.
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment recommended, monitor closely.
Moderate:
Consider lower initial doses and extend dosing intervals; monitor closely for adverse effects.
Severe:
Significant dose reduction required; monitor closely for adverse effects and accumulation. Avoid if possible.
Dialysis:
Ephedrine is dialyzable. Administer after dialysis or adjust dose based on clinical response.
Hepatic Impairment:
Mild:
No specific adjustment recommended.
Moderate:
No specific adjustment recommended, monitor for increased sensitivity.
Severe:
No specific adjustment recommended, monitor for increased sensitivity.
Pharmacology
Mechanism of Action
Ephedrine is a sympathomimetic amine that acts directly on alpha- and beta-adrenergic receptors and indirectly by causing the release of norepinephrine from sympathetic nerve endings. This results in increased heart rate, increased cardiac output, peripheral vasoconstriction (alpha-1), bronchodilation (beta-2), and central nervous system stimulation.
Pharmacokinetics
Absorption:
Bioavailability:
100% (IV)
Tmax:
IV: immediate; IM: 10-20 minutes; SC: 20-60 minutes
FoodEffect:
Not applicable for injection
Distribution:
Vd:
Not precisely quantified, but widely distributed
ProteinBinding:
Not extensively protein bound
CnssPenetration:
Yes
Elimination:
HalfLife:
3-6 hours (highly dependent on urine pH; shorter in acidic urine, longer in alkaline urine)
Clearance:
Primarily renal
ExcretionRoute:
Renal
Unchanged:
Approximately 77% (in acidic urine); 22-35% (in alkaline urine)
Pharmacodynamics
OnsetOfAction:
IV: immediate; IM: 10 minutes; SC: 10-20 minutes
PeakEffect:
IV: 2-5 minutes; IM: 20-30 minutes; SC: 30-60 minutes
DurationOfAction:
IV: 10-20 minutes; IM/SC: 30-60 minutes (up to 4 hours for bronchodilation)
Confidence:
Medium
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of high blood pressure, including:
+ Severe headache
+ Dizziness
+ Passing out
+ Changes in eyesight
Chest pain or pressure
Abnormal heartbeat (fast, slow, or irregular)
Weakness on one side of the body
Trouble speaking or thinking
Changes in balance
Drooping on one side of the face
Blurred eyesight
Difficulty urinating
Shortness of breath
Seizures
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other unusual symptoms, contact your doctor for advice:
Dizziness
Headache
Feeling nervous and excitable
Trouble sleeping
Upset stomach or vomiting
Decreased appetite
Restlessness
Excessive sweating
Reporting Side Effects
This list is not exhaustive, and you may experience other side effects. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of high blood pressure, including:
+ Severe headache
+ Dizziness
+ Passing out
+ Changes in eyesight
Chest pain or pressure
Abnormal heartbeat (fast, slow, or irregular)
Weakness on one side of the body
Trouble speaking or thinking
Changes in balance
Drooping on one side of the face
Blurred eyesight
Difficulty urinating
Shortness of breath
Seizures
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other unusual symptoms, contact your doctor for advice:
Dizziness
Headache
Feeling nervous and excitable
Trouble sleeping
Upset stomach or vomiting
Decreased appetite
Restlessness
Excessive sweating
Reporting Side Effects
This list is not exhaustive, and you may experience other side effects. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe headache
- Chest pain or tightness
- Rapid or irregular heartbeat (palpitations)
- Difficulty breathing or shortness of breath
- Sudden weakness or numbness
- Confusion or extreme anxiety
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
If you have taken certain medications for depression or Parkinson's disease within the last 14 days, including isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline, as this may increase the risk of very high blood pressure.
If you are currently taking linezolid or methylene blue, as these medications can interact with this drug.
If you are taking any other medications for conditions such as nose stuffiness, weight loss, or attention deficit hyperactivity disorder (ADHD).
This list is not exhaustive, and it is crucial to disclose all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, as well as any health problems you may have. Your doctor and pharmacist need this information to ensure it is safe for you to take this medication with your other medications and health conditions. Never start, stop, or change the dose of any medication without first consulting your doctor.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
If you have taken certain medications for depression or Parkinson's disease within the last 14 days, including isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline, as this may increase the risk of very high blood pressure.
If you are currently taking linezolid or methylene blue, as these medications can interact with this drug.
If you are taking any other medications for conditions such as nose stuffiness, weight loss, or attention deficit hyperactivity disorder (ADHD).
This list is not exhaustive, and it is crucial to disclose all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, as well as any health problems you may have. Your doctor and pharmacist need this information to ensure it is safe for you to take this medication with your other medications and health conditions. Never start, stop, or change the dose of any medication without first consulting your doctor.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
Using this drug may cause high blood pressure or a rapid heartbeat, which can increase the risk of a heart attack or stroke, potentially leading to fatal outcomes. If you have any concerns or questions, consult your doctor.
As directed, regularly monitor your blood pressure to ensure it remains within a safe range.
In some cases, individuals who received this medication in combination with other drugs, such as ergonovine and methylergonovine, after childbirth have experienced severely high blood pressure, which has led to strokes in certain instances. If you have any questions or concerns, discuss them with your doctor.
If you are pregnant, planning to become pregnant, or are breastfeeding, notify your doctor. It is crucial to discuss the potential benefits and risks of this medication to both you and your baby to make an informed decision.
Using this drug may cause high blood pressure or a rapid heartbeat, which can increase the risk of a heart attack or stroke, potentially leading to fatal outcomes. If you have any concerns or questions, consult your doctor.
As directed, regularly monitor your blood pressure to ensure it remains within a safe range.
In some cases, individuals who received this medication in combination with other drugs, such as ergonovine and methylergonovine, after childbirth have experienced severely high blood pressure, which has led to strokes in certain instances. If you have any questions or concerns, discuss them with your doctor.
If you are pregnant, planning to become pregnant, or are breastfeeding, notify your doctor. It is crucial to discuss the potential benefits and risks of this medication to both you and your baby to make an informed decision.
Overdose Information
Overdose Symptoms:
- Severe hypertension (high blood pressure)
- Tachycardia (rapid heart rate)
- Arrhythmias (irregular heartbeats)
- Myocardial infarction (heart attack)
- Cerebral hemorrhage (bleeding in the brain)
- Seizures
- Coma
- Respiratory depression or arrest
What to Do:
Seek immediate medical attention. Call 911 or your local emergency number. For poison control, call 1-800-222-1222.
Drug Interactions
Contraindicated Interactions
- Monoamine Oxidase Inhibitors (MAOIs) - risk of hypertensive crisis
- Cyclopropane, Halothane, or other halogenated anesthetics - risk of cardiac arrhythmias
Major Interactions
- Other sympathomimetics (e.g., pseudoephedrine, phenylephrine) - additive cardiovascular effects
- Tricyclic Antidepressants (TCAs) - potentiate pressor effects
- Oxytocin - severe persistent hypertension
- Digoxin - increased risk of arrhythmias
- Ergot alkaloids - increased vasoconstriction
Moderate Interactions
- Beta-blockers (non-selective) - may antagonize bronchodilator effects and lead to unopposed alpha-adrenergic effects (hypertension)
- Diuretics (e.g., furosemide, thiazides) - may reduce pressor response
- Alpha-adrenergic blockers (e.g., phentolamine) - may reduce pressor response
- Antihypertensives - reduced antihypertensive effect
Minor Interactions
- Corticosteroids - may increase risk of hypokalemia (rare)
Monitoring
Baseline Monitoring
Blood Pressure (BP)
Rationale: To establish baseline and guide dosing for hypotensive states.
Timing: Prior to administration
Heart Rate (HR)
Rationale: To establish baseline and monitor for tachycardia/arrhythmias.
Timing: Prior to administration
Electrocardiogram (ECG)
Rationale: To assess for pre-existing cardiac abnormalities, especially in patients with cardiac risk factors.
Timing: Prior to administration, if clinically indicated
Routine Monitoring
Blood Pressure (BP)
Frequency: Every 2-5 minutes initially, then as clinically indicated (e.g., every 5-15 minutes) until stable, then less frequently.
Target: Maintain systolic BP within desired range (e.g., >90 mmHg or within 20% of baseline).
Action Threshold: Hypotension or hypertension outside target range; adjust dose or consider alternative.
Heart Rate (HR)
Frequency: Every 2-5 minutes initially, then as clinically indicated.
Target: Maintain within acceptable physiological limits (e.g., <120 bpm).
Action Threshold: Significant tachycardia or bradycardia; assess for arrhythmias.
Respiratory Rate/Effort
Frequency: Continuously or frequently, especially if used for bronchodilation.
Target: Normal respiratory rate and effort.
Action Threshold: Increased work of breathing, wheezing, or respiratory distress.
Urine Output
Frequency: Hourly, if patient is critically ill or hypotensive.
Target: >0.5 mL/kg/hr
Action Threshold: Oliguria or anuria; indicates inadequate renal perfusion.
Symptom Monitoring
- Chest pain or discomfort
- Palpitations or irregular heartbeat
- Headache (severe)
- Dizziness or lightheadedness
- Nausea or vomiting
- Anxiety or restlessness
- Tremor
- Difficulty breathing or shortness of breath
Special Patient Groups
Pregnancy
Category C. Use only if the potential benefit justifies the potential risk to the fetus. Ephedrine crosses the placenta and can cause fetal tachycardia and arrhythmias. Prolonged use during pregnancy may lead to fetal growth restriction.
Trimester-Specific Risks:
First Trimester:
Potential for fetal cardiac effects; limited human data.
Second Trimester:
Potential for fetal cardiac effects; monitor fetal heart rate.
Third Trimester:
Can cause fetal tachycardia and arrhythmias; may inhibit uterine contractions. Avoid close to term if possible.
Lactation
Ephedrine is excreted into breast milk. Caution should be exercised when ephedrine is administered to a nursing mother. Monitor the infant for irritability, sleep disturbances, and feeding difficulties.
Infant Risk:
Low to moderate risk. Potential for irritability, sleep disturbances, and tachycardia in the infant. Observe infant closely.
Pediatric Use
Dosing must be carefully calculated based on weight. Pediatric patients may be more sensitive to the effects of sympathomimetics. Close monitoring of vital signs is essential.
Geriatric Use
Elderly patients may be more susceptible to the pressor and CNS effects of ephedrine, including hypertension, tachycardia, and anxiety. Lower initial doses and careful titration are recommended. Monitor for cardiovascular and CNS adverse effects.
Clinical Information
Clinical Pearls
- Ephedrine has both direct and indirect sympathomimetic effects, making its response potentially less predictable than pure direct agonists.
- The duration of action is relatively short, requiring frequent redosing for sustained effects.
- Urine pH significantly affects ephedrine's half-life; acidic urine increases excretion.
- Often used in the operating room for hypotension secondary to spinal or epidural anesthesia.
- Tolerance (tachyphylaxis) can develop with repeated doses, especially for bronchodilation.
- Careful titration is crucial to avoid excessive hypertension or tachycardia.
Alternative Therapies
- Phenylephrine (pure alpha-agonist for hypotension)
- Norepinephrine (for severe hypotension/shock)
- Dopamine (for hypotension/shock)
- Epinephrine (for anaphylaxis, severe bronchospasm, cardiac arrest)
- Albuterol (for bronchodilation)
Cost & Coverage
Average Cost:
Price varies, typically low for generic injection per 5ml vial
Generic Available:
Yes
Insurance Coverage:
Tier 1 or 2 (Generic)
General Drug Facts
If your symptoms or health problems do not improve or worsen over time, it is essential to contact your doctor for further guidance. To ensure safe use, never share your medication with others, and do not take medication prescribed to someone else. Store all medications in a secure location, out of reach of children and pets, to prevent accidental ingestion. Properly dispose of unused or expired medications by throwing them away. However, do not flush them down the toilet or pour them down the drain unless specifically instructed to do so by a healthcare professional or pharmacist. If you are unsure about the correct disposal method, consult with your pharmacist, who can also inform you about potential drug take-back programs in your area. Additionally, some medications may come with a separate patient information leaflet, which your pharmacist can provide. If you have any questions or concerns about your medication, discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. Be prepared to provide information about the medication taken, the amount, and the time it occurred, as this will aid in receiving appropriate treatment.