Epinephrine 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 1970
DEA Schedule
Not Controlled
Overview
What is this medicine?
Epinephrine is a powerful medicine used in emergencies to treat severe allergic reactions (anaphylaxis), severe asthma attacks, or to restart the heart during cardiac arrest. It works by opening up airways, tightening blood vessels to raise blood pressure, and speeding up the heart.
How to Use This Medicine
Taking Your Medication
To use this medication correctly, follow your doctor's instructions and read all the information provided. It's essential to follow the instructions carefully.
Administration:
For allergic reactions: This medication is administered via injection into a muscle or the fatty layer under the skin.
For other conditions: Your doctor will administer this medication.
Storage and Disposal
If you need to store this medication at home, consult with your doctor, nurse, or pharmacist for guidance on proper storage.
Missed Dose
If you miss a dose, seek medical attention immediately.
To use this medication correctly, follow your doctor's instructions and read all the information provided. It's essential to follow the instructions carefully.
Administration:
For allergic reactions: This medication is administered via injection into a muscle or the fatty layer under the skin.
For other conditions: Your doctor will administer this medication.
Storage and Disposal
If you need to store this medication at home, consult with your doctor, nurse, or pharmacist for guidance on proper storage.
Missed Dose
If you miss a dose, seek medical attention immediately.
Lifestyle & Tips
- Always carry prescribed epinephrine auto-injectors if you have severe allergies.
- Know how to properly use your auto-injector and teach family/friends.
- Avoid known allergens or triggers.
- Wear a medical alert bracelet/necklace if you have severe allergies.
Available Forms & Alternatives
Dosing & Administration
Adult Dosing
Standard Dose:
Varies significantly by indication. For anaphylaxis: 0.3-0.5 mg IM/SC; For cardiac arrest: 1 mg IV/IO every 3-5 minutes; For severe asthma: 0.3-0.5 mg SC every 20 minutes for 3 doses.
Dose Range:
0.3 - 1 mg
Condition-Specific Dosing:
anaphylaxis:
0.3-0.5 mg IM/SC, may repeat every 5-15 minutes as needed.
cardiac_arrest:
1 mg (10 mL of 0.1 mg/mL solution) IV/IO every 3-5 minutes during resuscitation.
bradycardia_hypotension_post_cardiac_arrest:
2-10 mcg/min IV infusion, titrated to effect.
severe_asthma:
0.3-0.5 mg SC every 20 minutes for 3 doses.
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: Not typically used in neonates, consult specialist.
Infant:
Anaphylaxis: 0.01 mg/kg (max 0.3 mg) IM/SC, may repeat every 5-15 minutes. Cardiac arrest: 0.01 mg/kg (0.1 mL/kg of 0.1 mg/mL solution) IV/IO every 3-5 minutes.
Child:
Anaphylaxis: 0.01 mg/kg (max 0.5 mg) IM/SC, may repeat every 5-15 minutes. Cardiac arrest: 0.01 mg/kg (0.1 mL/kg of 0.1 mg/mL solution) IV/IO every 3-5 minutes. Severe asthma: 0.01 mg/kg (max 0.3-0.5 mg) SC every 20 minutes for 3 doses.
Adolescent:
Anaphylaxis: 0.3-0.5 mg IM/SC, may repeat every 5-15 minutes. Cardiac arrest: 1 mg IV/IO every 3-5 minutes. Severe asthma: 0.3-0.5 mg SC every 20 minutes for 3 doses.
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment needed.
Moderate:
No specific adjustment needed.
Severe:
No specific adjustment needed.
Dialysis:
Not significantly dialyzable. No specific adjustment needed, but monitor closely for adverse effects.
Hepatic Impairment:
Mild:
No specific adjustment needed.
Moderate:
No specific adjustment needed.
Severe:
No specific adjustment needed.
Pharmacology
Mechanism of Action
Epinephrine is a naturally occurring catecholamine that acts on alpha-1, beta-1, and beta-2 adrenergic receptors. Its alpha-1 effects cause vasoconstriction, increasing peripheral vascular resistance and blood pressure. Beta-1 effects increase heart rate, myocardial contractility, and cardiac output. Beta-2 effects cause bronchodilation and mast cell stabilization, reducing mediator release. These combined actions make it effective in treating anaphylaxis, cardiac arrest, and severe asthma.
Pharmacokinetics
Absorption:
Bioavailability:
Poor oral bioavailability; rapidly absorbed after IM/SC injection. IV administration provides 100% bioavailability.
Tmax:
IM: ~5-10 minutes; SC: ~10-20 minutes; IV: Immediate
FoodEffect:
Not applicable (parenteral administration)
Distribution:
Vd:
Not precisely quantified, but rapidly distributed to tissues.
ProteinBinding:
Not significantly protein-bound.
CnssPenetration:
Limited (does not readily cross the blood-brain barrier in significant amounts)
Elimination:
HalfLife:
Very short, approximately 1-2 minutes (IV); longer after IM/SC due to absorption phase.
Clearance:
Very rapid, primarily by enzymatic degradation.
ExcretionRoute:
Renal (as inactive metabolites)
Unchanged:
<1% (renal)
Pharmacodynamics
OnsetOfAction:
IV: Immediate; IM: 5-10 minutes; SC: 10-20 minutes
PeakEffect:
IV: 1-2 minutes; IM: 20 minutes; SC: 20 minutes
DurationOfAction:
IV: 5-10 minutes; IM/SC: 1-4 hours (due to sustained absorption)
Safety & Warnings
Side Effects
Urgent 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: 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, or swelling of the mouth, face, lips, tongue, or throat
Signs of low potassium levels: muscle pain or weakness, muscle cramps, or an abnormal heartbeat
Signs of high blood pressure: severe headache or dizziness, fainting, or changes in vision
Chest pain or pressure
Rapid heartbeat
Shortness of breath
Urination problems (inability to pass urine or changes in urine output)
Abnormal sensations: burning, numbness, or tingling
Weakness on one side of the body, trouble speaking or thinking, balance problems, drooping on one side of the face, or blurred vision
Severe abnormal heartbeat (which can be life-threatening, especially if you have pre-existing heart problems or take certain medications)
If you experience any of these symptoms, notify your doctor immediately.
Additional Important Safety Information
Rarely, infections can occur at the injection site. If you notice any signs of infection, such as persistent redness, warmth, swelling, or tenderness, contact your doctor right away.
Injection-Related Side Effects
If you receive this medication through a vein, it can cause tissue damage if the medication leaks. Inform your nurse immediately if you experience any redness, burning, pain, swelling, blisters, skin sores, or fluid leakage at the injection site.
Common Side Effects
Most people do not experience severe side effects, but some may occur. If you have any of the following side effects or any other concerns, contact your doctor:
Anxiety, nervousness, excitability, shakiness, or restlessness
Upset stomach or vomiting
Excessive sweating
Pale skin
Headache
Dizziness, tiredness, or weakness
* Goosebumps
This is not an exhaustive list of possible side effects. If you have questions or concerns, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or 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: 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, or swelling of the mouth, face, lips, tongue, or throat
Signs of low potassium levels: muscle pain or weakness, muscle cramps, or an abnormal heartbeat
Signs of high blood pressure: severe headache or dizziness, fainting, or changes in vision
Chest pain or pressure
Rapid heartbeat
Shortness of breath
Urination problems (inability to pass urine or changes in urine output)
Abnormal sensations: burning, numbness, or tingling
Weakness on one side of the body, trouble speaking or thinking, balance problems, drooping on one side of the face, or blurred vision
Severe abnormal heartbeat (which can be life-threatening, especially if you have pre-existing heart problems or take certain medications)
If you experience any of these symptoms, notify your doctor immediately.
Additional Important Safety Information
Rarely, infections can occur at the injection site. If you notice any signs of infection, such as persistent redness, warmth, swelling, or tenderness, contact your doctor right away.
Injection-Related Side Effects
If you receive this medication through a vein, it can cause tissue damage if the medication leaks. Inform your nurse immediately if you experience any redness, burning, pain, swelling, blisters, skin sores, or fluid leakage at the injection site.
Common Side Effects
Most people do not experience severe side effects, but some may occur. If you have any of the following side effects or any other concerns, contact your doctor:
Anxiety, nervousness, excitability, shakiness, or restlessness
Upset stomach or vomiting
Excessive sweating
Pale skin
Headache
Dizziness, tiredness, or weakness
* Goosebumps
This is not an exhaustive list of possible side effects. If you have questions or concerns, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe headache
- Pounding heart or palpitations
- Chest pain
- Dizziness or lightheadedness
- Nervousness or anxiety
- Tremor
- Difficulty breathing (worsening)
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 symptoms you experienced as a result of the allergy.
All medications you are currently taking, including prescription and over-the-counter (OTC) drugs, natural products, and vitamins.
* Any health problems you have, as they may interact with this medication.
This medication can interact with other drugs and health conditions, so it is crucial to discuss your individual situation with your doctor. Do not start, stop, or change the dose of any medication without first consulting your doctor to ensure your safety. Your doctor and pharmacist need to know about all your medications and health problems to determine if it is safe for you to take this medication.
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 symptoms you experienced as a result of the allergy.
All medications you are currently taking, including prescription and over-the-counter (OTC) drugs, natural products, and vitamins.
* Any health problems you have, as they may interact with this medication.
This medication can interact with other drugs and health conditions, so it is crucial to discuss your individual situation with your doctor. Do not start, stop, or change the dose of any medication without first consulting your doctor to ensure your safety. Your doctor and pharmacist need to know about all your medications and health problems to determine if it is safe for you to take this medication.
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.
Age-Related Precautions
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.
Age-Related Precautions
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, including ventricular fibrillation)
- Cerebral hemorrhage (bleeding in the brain)
- Pulmonary edema (fluid in the lungs)
- Myocardial infarction (heart attack)
- Renal failure
What to Do:
Seek immediate medical attention. Treatment is supportive and symptomatic, including alpha-blockers (e.g., phentolamine) for severe hypertension, beta-blockers for arrhythmias, and other supportive measures. Call 911 or Poison Control at 1-800-222-1222.
Drug Interactions
Major Interactions
- Non-selective beta-blockers (e.g., propranolol, nadolol): May cause severe hypertension and reflex bradycardia due to unopposed alpha-adrenergic effects.
- Alpha-adrenergic blockers (e.g., phentolamine): May antagonize the pressor effects of epinephrine.
- Cocaine: Potentiates cardiac effects, increasing risk of arrhythmias and hypertension.
- General anesthetics (e.g., halothane, cyclopropane): May sensitize the myocardium to epinephrine, increasing risk of ventricular arrhythmias.
Moderate Interactions
- Tricyclic antidepressants (TCAs) and MAO inhibitors (MAOIs): May potentiate the pressor effects of epinephrine, leading to hypertensive crisis.
- Antihistamines (e.g., diphenhydramine): May potentiate the effects of epinephrine.
- Cardiac glycosides (e.g., digoxin): Increased risk of arrhythmias.
- Diuretics (e.g., furosemide, hydrochlorothiazide): May reduce the pressor response to epinephrine.
Minor Interactions
- Thyroid hormones: May increase sensitivity to catecholamines.
Monitoring
Baseline Monitoring
Blood Pressure (BP)
Rationale: To establish baseline and monitor for hypertensive crisis or inadequate response.
Timing: Prior to administration
Heart Rate (HR) and ECG
Rationale: To establish baseline and monitor for tachycardia, arrhythmias, or myocardial ischemia.
Timing: Prior to administration
Respiratory Rate (RR) and Oxygen Saturation (SpO2)
Rationale: To assess respiratory status, especially in anaphylaxis or asthma.
Timing: Prior to administration
Routine Monitoring
Blood Pressure (BP)
Frequency: Continuously (IV infusion) or every 5-15 minutes (IM/SC)
Target: Individualized based on clinical need (e.g., MAP >65 mmHg for shock, normotensive for anaphylaxis)
Action Threshold: Significant hypertension (>180/110 mmHg) or hypotension (MAP <60 mmHg); adjust dose or intervene.
Heart Rate (HR) and ECG
Frequency: Continuously (IV infusion) or every 5-15 minutes (IM/SC)
Target: Individualized, generally avoid severe tachycardia (>120-140 bpm) or arrhythmias.
Action Threshold: New onset arrhythmias, severe tachycardia, or signs of myocardial ischemia; adjust dose or intervene.
Oxygen Saturation (SpO2)
Frequency: Continuously (IV infusion) or every 5-15 minutes (IM/SC)
Target: >92-94%
Action Threshold: <90%; administer supplemental oxygen, assess airway/breathing.
Blood Glucose
Frequency: Periodically, especially with prolonged infusions or in diabetic patients
Target: 70-180 mg/dL
Action Threshold: Hypoglycemia (<70 mg/dL) or significant hyperglycemia (>200 mg/dL); manage as appropriate.
Symptom Monitoring
- Chest pain or discomfort
- Palpitations
- Headache
- Anxiety or nervousness
- Tremor
- Dizziness
- Nausea/vomiting
- Skin pallor or flushing
- Difficulty breathing or wheezing (improvement or worsening)
- Signs of extravasation (for IV administration: pain, swelling, pallor at injection site)
Special Patient Groups
Pregnancy
Category C. Epinephrine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. In life-threatening situations (e.g., anaphylaxis, cardiac arrest), the benefits of maternal treatment generally outweigh the risks. May cause uterine vasoconstriction and reduced placental blood flow, especially with high doses.
Trimester-Specific Risks:
First Trimester:
Limited data, but generally avoided unless life-saving.
Second Trimester:
Use with caution, monitor fetal heart rate.
Third Trimester:
May inhibit uterine contractions and delay labor. Monitor fetal heart rate and uterine activity.
Lactation
L3 (Moderately Safe). Epinephrine is naturally occurring and rapidly metabolized. It is unlikely to cause adverse effects in a breastfed infant due to its short half-life and poor oral bioavailability. Caution is advised, but generally considered compatible with breastfeeding in emergency situations.
Infant Risk:
Low risk of adverse effects due to rapid maternal metabolism and poor oral absorption by infant.
Pediatric Use
Dosing is weight-based. Careful calculation and administration are crucial to avoid overdose. Use appropriate concentrations (e.g., 0.1 mg/mL for IV/IO, 1 mg/mL for IM/SC in anaphylaxis).
Geriatric Use
Use with caution due to increased risk of adverse cardiovascular effects (e.g., hypertension, arrhythmias, myocardial ischemia) in elderly patients, especially those with pre-existing cardiovascular disease. Start with lower doses and titrate slowly. Monitor closely.
Clinical Information
Clinical Pearls
- Epinephrine is a life-saving medication; prompt administration is critical in anaphylaxis and cardiac arrest.
- Always verify the concentration before administration: 1 mg/mL (1:1000) for IM/SC, and 0.1 mg/mL (1:10,000) for IV/IO in cardiac arrest.
- For anaphylaxis, the IM route in the anterolateral thigh is preferred over SC due to faster and more reliable absorption.
- Protect from light and store at room temperature. Discard if discolored or contains precipitate.
- Extravasation of IV epinephrine can cause severe tissue necrosis; treat with phentolamine if it occurs.
Alternative Therapies
- For anaphylaxis: H1/H2 blockers (e.g., diphenhydramine, ranitidine), corticosteroids (e.g., methylprednisolone), bronchodilators (e.g., albuterol) - these are adjunctive, not replacements for epinephrine.
- For cardiac arrest: Vasopressin (alternative to epinephrine in some protocols), atropine (for bradycardia).
- For severe asthma: Albuterol, ipratropium, corticosteroids, magnesium sulfate.
Cost & Coverage
Average Cost:
Varies widely, typically $10-$50 per 1mg/ml, 10ml vial
Generic Available:
Yes
Insurance Coverage:
Tier 1 or 2 (generic), Tier 3 or 4 (brand auto-injectors)
General Drug Facts
If your symptoms or health problems persist or worsen, 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 for 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 to do so by a healthcare professional, avoid flushing medications down the toilet or pouring them down the drain. If you are unsure about the correct disposal method, consult your pharmacist for guidance. Additionally, you may want to inquire about potential drug take-back programs in your area. Some medications may come with a separate patient information leaflet, so be sure to check with your pharmacist. If you have any questions or concerns about your medication, do not hesitate 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 medical attention. Be prepared to provide information about the medication taken, the amount, and the time it was taken to ensure prompt and effective treatment.