Epinephrine 0.1mg/ml Inj, 10ml
It is used to treat an allergic reaction.It is used during eye surgery.It is used when the heart is not beating.It may be given to you for other reasons. Talk with the doctor.
Drug Class
Vasopressor; Bronchodilator; Antiallergic
Pharmacologic Class
Alpha- and Beta-adrenergic Agonist
Pregnancy Category
C
FDA Approved
Jan 1939
DEA Schedule
Not Controlled
Overview
What is this medicine?
Epinephrine is a powerful medicine used in emergencies to treat very serious allergic reactions (anaphylaxis), severe asthma attacks, or to help restart the heart during cardiac arrest. It works by quickly opening up airways, raising blood pressure, and stimulating the heart.
How to Use This Medicine
Taking Your Medication Correctly
To use this medication safely and effectively, follow your doctor's instructions carefully. Read all the information provided to you and adhere to the instructions closely.
Administration Methods
For allergic reactions, this medication is administered via injection into a muscle or the fatty layer of the skin. For other conditions, your doctor will administer the medication.
Storage and Disposal
If you need to store this medication at home, consult with your doctor, nurse, or pharmacist to determine the proper storage procedure.
Missed Dose
If you miss a dose, seek medical attention immediately.
To use this medication safely and effectively, follow your doctor's instructions carefully. Read all the information provided to you and adhere to the instructions closely.
Administration Methods
For allergic reactions, this medication is administered via injection into a muscle or the fatty layer of the skin. For other conditions, your doctor will administer the medication.
Storage and Disposal
If you need to store this medication at home, consult with your doctor, nurse, or pharmacist to determine the proper storage procedure.
Missed Dose
If you miss a dose, seek medical attention immediately.
Lifestyle & Tips
- This medication is for emergency use only and is administered by healthcare professionals.
- Patients with known severe allergies should carry an epinephrine auto-injector (e.g., EpiPen) for self-administration, which is a different concentration and route of administration (IM).
Available Forms & Alternatives
Dosing & Administration
Adult Dosing
Standard Dose:
Cardiac Arrest: 1 mg (10 mL of 0.1 mg/mL solution) IV/IO every 3-5 minutes. Anaphylaxis (severe, refractory to IM): 0.1-0.5 mg (1-5 mL of 0.1 mg/mL solution) IV slowly over 5-10 minutes, or continuous infusion 1-10 mcg/min.
Dose Range:
0.1 - 1 mg
Condition-Specific Dosing:
cardiacArrest:
1 mg IV/IO every 3-5 minutes
anaphylaxisRefractory:
0.1-0.5 mg IV slowly, or 1-10 mcg/min continuous infusion
bradycardiaHypotension:
2-10 mcg/min continuous IV infusion, titrated to effect
Pediatric Dosing
Neonatal:
Cardiac Arrest: 0.01-0.03 mg/kg (0.1-0.3 mL/kg of 0.1 mg/mL solution) IV/IO every 3-5 minutes. Anaphylaxis (severe, refractory to IM): 0.01 mg/kg (0.1 mL/kg of 0.1 mg/mL solution) IV slowly over 5-10 minutes, max 0.5 mg/dose.
Infant:
Cardiac Arrest: 0.01-0.03 mg/kg (0.1-0.3 mL/kg of 0.1 mg/mL solution) IV/IO every 3-5 minutes. Anaphylaxis (severe, refractory to IM): 0.01 mg/kg (0.1 mL/kg of 0.1 mg/mL solution) IV slowly over 5-10 minutes, max 0.5 mg/dose.
Child:
Cardiac Arrest: 0.01-0.03 mg/kg (0.1-0.3 mL/kg of 0.1 mg/mL solution) IV/IO every 3-5 minutes. Anaphylaxis (severe, refractory to IM): 0.01 mg/kg (0.1 mL/kg of 0.1 mg/mL solution) IV slowly over 5-10 minutes, max 0.5 mg/dose.
Adolescent:
Cardiac Arrest: 0.01-0.03 mg/kg (0.1-0.3 mL/kg of 0.1 mg/mL solution) IV/IO every 3-5 minutes. Anaphylaxis (severe, refractory to IM): 0.01 mg/kg (0.1 mL/kg of 0.1 mg/mL solution) IV slowly over 5-10 minutes, max 0.5 mg/dose.
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment required, use with caution.
Moderate:
No specific adjustment required, use with caution.
Severe:
No specific adjustment required, use with caution.
Dialysis:
Not significantly removed by dialysis. No specific adjustment required, use with caution.
Hepatic Impairment:
Mild:
No specific adjustment required, use with caution.
Moderate:
No specific adjustment required, use with caution.
Severe:
No specific adjustment required, use with caution.
Pharmacology
Mechanism of Action
Epinephrine is a direct-acting sympathomimetic amine. It acts on both alpha- and beta-adrenergic receptors. Its alpha-adrenergic effects (vasoconstriction) increase systemic vascular resistance and arterial blood pressure, improving coronary and cerebral perfusion pressure during CPR. Its beta-adrenergic effects (bronchodilation, positive inotropy and chronotropy) increase heart rate, myocardial contractility, and relax bronchial smooth muscle.
Pharmacokinetics
Absorption:
Bioavailability:
Rapid and complete after IV/IO administration.
Tmax:
Rapid, within minutes after IV/IO administration.
FoodEffect:
Not applicable for injectable formulation.
Distribution:
Vd:
Not precisely quantified, rapidly distributed to tissues.
ProteinBinding:
Approximately 50% (to albumin and other plasma proteins).
CnssPenetration:
Limited (does not readily cross the blood-brain barrier).
Elimination:
HalfLife:
Very short, approximately 1-2 minutes (plasma half-life).
Clearance:
Rapid.
ExcretionRoute:
Metabolites excreted primarily in urine.
Unchanged:
<1% (excreted unchanged in urine).
Pharmacodynamics
OnsetOfAction:
Immediate (seconds) after IV/IO administration.
PeakEffect:
Within 1-2 minutes.
DurationOfAction:
Short, approximately 5-10 minutes.
Safety & Warnings
Side Effects
Serious Side Effects: Seek Medical Help Right Away
Although rare, this medication can cause severe and potentially life-threatening side effects. If you experience any of the following symptoms, contact your doctor or seek medical attention immediately:
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 low potassium levels, including:
+ Muscle pain or weakness
+ Muscle cramps
+ Abnormal heartbeat
Signs of high blood pressure, such as:
+ Severe headache
+ Dizziness
+ Passing out
+ Changes in eyesight
Chest pain or pressure
Rapid heartbeat
Shortness of breath
Urination problems, such as:
+ Inability to pass urine
+ Changes in urine output
Abnormal sensations, such as:
+ Burning
+ Numbness
+ Tingling
Weakness on one side of the body
Trouble speaking or thinking
Changes in balance
Drooping on one side of the face
Blurred eyesight
This medication can also cause severe abnormal heartbeats, which may be life-threatening, especially if you have pre-existing heart problems or take certain medications. If you experience an abnormal heartbeat, contact your doctor immediately.
Additional Warnings for Allergic Reactions
In rare cases, infections can occur at the injection site. If you experience any signs of infection, such as redness, warmth, swelling, or tenderness that doesn't go away, contact your doctor right away.
Injection-Related Warnings
If this medication is administered intravenously, it can cause tissue damage if it leaks from the vein. Inform your nurse immediately if you experience any of the following symptoms at the injection site:
Redness
Burning
Pain
Swelling
Blisters
Skin sores
Fluid leakage
Other Possible Side Effects
Most people taking this medication do not experience serious side effects, but some may occur. If you experience any of the following side effects, contact your doctor if they bother you or do not go away:
Anxiety
Nervousness
Restlessness
Shaking
Upset stomach
Vomiting
Excessive sweating
Pale skin
Headache
Dizziness
Fatigue
Weakness
* Goosebumps
This is not an exhaustive list of possible 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, this medication can cause severe and potentially life-threatening side effects. If you experience any of the following symptoms, contact your doctor or seek medical attention immediately:
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 low potassium levels, including:
+ Muscle pain or weakness
+ Muscle cramps
+ Abnormal heartbeat
Signs of high blood pressure, such as:
+ Severe headache
+ Dizziness
+ Passing out
+ Changes in eyesight
Chest pain or pressure
Rapid heartbeat
Shortness of breath
Urination problems, such as:
+ Inability to pass urine
+ Changes in urine output
Abnormal sensations, such as:
+ Burning
+ Numbness
+ Tingling
Weakness on one side of the body
Trouble speaking or thinking
Changes in balance
Drooping on one side of the face
Blurred eyesight
This medication can also cause severe abnormal heartbeats, which may be life-threatening, especially if you have pre-existing heart problems or take certain medications. If you experience an abnormal heartbeat, contact your doctor immediately.
Additional Warnings for Allergic Reactions
In rare cases, infections can occur at the injection site. If you experience any signs of infection, such as redness, warmth, swelling, or tenderness that doesn't go away, contact your doctor right away.
Injection-Related Warnings
If this medication is administered intravenously, it can cause tissue damage if it leaks from the vein. Inform your nurse immediately if you experience any of the following symptoms at the injection site:
Redness
Burning
Pain
Swelling
Blisters
Skin sores
Fluid leakage
Other Possible Side Effects
Most people taking this medication do not experience serious side effects, but some may occur. If you experience any of the following side effects, contact your doctor if they bother you or do not go away:
Anxiety
Nervousness
Restlessness
Shaking
Upset stomach
Vomiting
Excessive sweating
Pale skin
Headache
Dizziness
Fatigue
Weakness
* Goosebumps
This is not an exhaustive list of possible 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 chest pain
- Irregular heartbeat (palpitations)
- Severe headache
- Sudden weakness or numbness
- Difficulty breathing
- Confusion
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, any of its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
All medications you are currently taking, including prescription and over-the-counter (OTC) drugs, natural products, and vitamins. This is not an exhaustive list, and it is crucial to disclose all your medications to avoid potential interactions.
* Any health problems you have, as they may affect the safety of taking this medication.
To ensure your safety, do not start, stop, or change the dosage of any medication without first consulting your doctor. It is your responsibility to verify that it is safe to take this medication with all your other medications and health conditions. Your doctor and pharmacist will work together to help you make informed decisions about your treatment.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, any of its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
All medications you are currently taking, including prescription and over-the-counter (OTC) drugs, natural products, and vitamins. This is not an exhaustive list, and it is crucial to disclose all your medications to avoid potential interactions.
* Any health problems you have, as they may affect the safety of taking this medication.
To ensure your safety, do not start, stop, or change the dosage of any medication without first consulting your doctor. It is your responsibility to verify that it is safe to take this medication with all your other medications and health conditions. Your doctor and pharmacist will work together to help you make informed decisions about your treatment.
Precautions & Cautions
Important Warnings and Cautions
When taking this medication, it is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are using this drug.
Administration Precautions
Do not administer this medication into the fingers, hands, or feet, as this may cause reduced blood flow to these areas. If accidental administration occurs, seek immediate medical attention.
Allergy Considerations
If you have a sulfite allergy, consult your doctor before using this medication, as some products may contain sulfites.
Diabetes Management
If you have high blood sugar (diabetes), closely monitor your blood sugar levels while taking this medication.
Special Considerations for Older Adults
If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects.
Pregnancy and Breastfeeding
If you are pregnant, plan to become pregnant, or are breastfeeding, discuss the benefits and risks of this medication with your doctor to ensure the best outcome for you and your baby.
Ophthalmic Use
When using this medication in the eye, you may experience sensitivity to bright lights. To minimize discomfort, wear sunglasses to protect your eyes.
When taking this medication, it is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are using this drug.
Administration Precautions
Do not administer this medication into the fingers, hands, or feet, as this may cause reduced blood flow to these areas. If accidental administration occurs, seek immediate medical attention.
Allergy Considerations
If you have a sulfite allergy, consult your doctor before using this medication, as some products may contain sulfites.
Diabetes Management
If you have high blood sugar (diabetes), closely monitor your blood sugar levels while taking this medication.
Special Considerations for Older Adults
If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects.
Pregnancy and Breastfeeding
If you are pregnant, plan to become pregnant, or are breastfeeding, discuss the benefits and risks of this medication with your doctor to ensure the best outcome for you and your baby.
Ophthalmic Use
When using this medication in the eye, you may experience sensitivity to bright lights. To minimize discomfort, wear sunglasses to protect your eyes.
Overdose Information
Overdose Symptoms:
- Extreme hypertension (very high blood pressure)
- Tachycardia (very fast heart rate)
- Arrhythmias (irregular heartbeats)
- Cerebral hemorrhage (bleeding in the brain)
- Pulmonary edema (fluid in the lungs)
- Angina (chest pain)
- Myocardial infarction (heart attack)
What to Do:
Overdose requires immediate medical attention. Treatment is symptomatic and supportive, including rapid-acting vasodilators (e.g., nitrates, alpha-blockers) for severe hypertension and beta-blockers for arrhythmias. Call 1-800-222-1222 (Poison Control).
Drug Interactions
Major Interactions
- Non-selective beta-blockers (e.g., propranolol, nadolol): May result in severe hypertension and reflex bradycardia due to unopposed alpha-adrenergic effects.
- Alpha-blockers (e.g., phentolamine): May antagonize the pressor effects of epinephrine.
- Cocaine, tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs): Potentiate the effects of epinephrine, leading to severe hypertension and arrhythmias.
- Inhalation anesthetics (e.g., halothane, isoflurane): May sensitize the myocardium to the effects of epinephrine, increasing risk of arrhythmias.
Moderate Interactions
- Cardiac glycosides (e.g., digoxin): Increased risk of arrhythmias.
- Diuretics (e.g., furosemide, hydrochlorothiazide): May reduce the pressor response to epinephrine.
- Antihistamines (e.g., diphenhydramine): May potentiate the effects of epinephrine.
- Ergot alkaloids (e.g., ergotamine): May cause peripheral vasoconstriction and ischemia.
Monitoring
Baseline Monitoring
Cardiac rhythm (ECG)
Rationale: To assess for arrhythmias and guide resuscitation efforts.
Timing: Continuously during administration and resuscitation.
Blood pressure
Rationale: To assess hemodynamic response and prevent excessive hypertension.
Timing: Continuously or frequently during administration.
Heart rate
Rationale: To assess chronotropic response.
Timing: Continuously.
Oxygen saturation
Rationale: To assess respiratory status and oxygenation.
Timing: Continuously.
Routine Monitoring
Cardiac rhythm (ECG)
Frequency: Continuous
Target: Return of spontaneous circulation (ROSC) or stable rhythm
Action Threshold: Development of new arrhythmias, worsening bradycardia/tachycardia
Blood pressure
Frequency: Continuous (arterial line preferred) or every 1-2 minutes
Target: Systolic BP >90 mmHg (post-ROSC), MAP >65 mmHg
Action Threshold: Hypotension, severe hypertension
Heart rate
Frequency: Continuous
Target: Appropriate for clinical situation
Action Threshold: Tachycardia, bradycardia
Peripheral perfusion
Frequency: Clinical assessment every 5-15 minutes
Target: Warm extremities, capillary refill <2 seconds
Action Threshold: Mottling, cool extremities, prolonged capillary refill
Symptom Monitoring
- Chest pain (angina)
- Palpitations
- Headache
- Anxiety
- Tremor
- Nausea/vomiting
- Dyspnea
Special Patient Groups
Pregnancy
Category C. Use in pregnancy is generally reserved for life-threatening emergencies where the potential benefit outweighs the potential risk to the fetus. Epinephrine can cause uterine vasoconstriction and reduced placental blood flow.
Trimester-Specific Risks:
First Trimester:
Potential for teratogenicity not well-established in humans, but animal studies show some risk. Use only if clearly needed.
Second Trimester:
Risk of uterine vasoconstriction and fetal hypoxia. Use only if clearly needed.
Third Trimester:
Risk of uterine vasoconstriction, fetal hypoxia, and inhibition of labor. Use only if clearly needed.
Lactation
L3 (Moderately Safe). Epinephrine is rapidly metabolized and has a very short half-life, making significant transfer into breast milk unlikely. Infant exposure is expected to be minimal. Caution is advised, but generally considered compatible with breastfeeding in emergency situations.
Infant Risk:
Low risk of adverse effects in breastfed infants due to rapid maternal metabolism and low oral bioavailability.
Pediatric Use
Dosing is weight-based. Extreme caution is needed to avoid medication errors, especially with concentration. Pediatric patients may be more sensitive to the effects of epinephrine. Close monitoring of vital signs and cardiac rhythm is essential.
Geriatric Use
Geriatric patients may be more susceptible to the adverse effects of epinephrine, particularly cardiovascular effects (e.g., hypertension, arrhythmias, myocardial ischemia). Use with caution and monitor closely, especially in those with pre-existing cardiovascular disease.
Clinical Information
Clinical Pearls
- Always verify the concentration of epinephrine before administration to avoid fatal medication errors (e.g., 1:10,000 vs 1:1,000).
- The 0.1 mg/mL (1:10,000) concentration is primarily for IV/IO use in cardiac arrest or severe, refractory anaphylaxis/shock.
- Rapid IV push of epinephrine can cause severe hypertension, arrhythmias, and myocardial ischemia. Administer slowly when not in cardiac arrest.
- Epinephrine is light-sensitive; store in original packaging and protect from light.
- Discard if discolored or contains precipitate.
- Consider alternative vasopressors (e.g., norepinephrine, dopamine) for prolonged shock states not responding to epinephrine, to minimize adverse effects.
Alternative Therapies
- Norepinephrine (for vasopressor support)
- Dopamine (for vasopressor support)
- Phenylephrine (pure alpha-agonist for vasoconstriction)
- Vasopressin (for cardiac arrest, vasodilatory shock)
- Isoproterenol (pure beta-agonist, rarely used)
- Albuterol (for bronchodilation, less systemic effects)
Cost & Coverage
Average Cost:
Highly variable, typically low per 10 mL vial
Generic Available:
Yes
Insurance Coverage:
Tier 1 (Generic)
General Drug Facts
If your symptoms or health problems persist or worsen, it is essential to contact your doctor for further evaluation and guidance. To ensure safe and effective treatment, 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. Dispose of unused or expired medications properly. Unless instructed otherwise, do not flush medications down the toilet or pour them down the drain. If you are unsure about the correct disposal method, consult your pharmacist for guidance. Many communities have drug take-back programs, which your pharmacist can help you locate.
Some medications may come with an additional patient information leaflet. Your pharmacist can provide this information if available. If you have any questions or concerns about your medication, it is crucial to discuss them with your doctor, nurse, pharmacist, or other healthcare provider.
In the event of a suspected overdose, immediately contact your local poison control center or seek emergency medical attention. Be prepared to provide detailed information about the medication, including the amount taken and the time of ingestion, to ensure prompt and effective treatment.
Store all medications in a secure location, out of reach of children and pets, to prevent accidental ingestion. Dispose of unused or expired medications properly. Unless instructed otherwise, do not flush medications down the toilet or pour them down the drain. If you are unsure about the correct disposal method, consult your pharmacist for guidance. Many communities have drug take-back programs, which your pharmacist can help you locate.
Some medications may come with an additional patient information leaflet. Your pharmacist can provide this information if available. If you have any questions or concerns about your medication, it is crucial to discuss them with your doctor, nurse, pharmacist, or other healthcare provider.
In the event of a suspected overdose, immediately contact your local poison control center or seek emergency medical attention. Be prepared to provide detailed information about the medication, including the amount taken and the time of ingestion, to ensure prompt and effective treatment.