Epinephrine 1mg/ml Inj, 30ml

Epinephrine is a direct-acting sympathomimetic agent that acts on both alpha- and beta-adrenergic receptors. Its alpha-adrenergic effects (vasoconstriction) are mediated by alpha-1 receptors, leading to increased peripheral vascular resistance, increased blood pressure, and decreased mucosal edema. Its beta-adrenergic effects (bronchodilation, positive inotropy and chronotropy) are mediated by beta-1 and beta-2 receptors. Beta-1 effects increase heart rate and myocardial contractility. Beta-2 effects cause bronchodilation and can decrease peripheral vascular resistance.

Serious Side Effects: Seek Medical Help Immediately

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 right away:

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
+ An irregular heartbeat
Signs of high blood pressure, such as:
+ Severe headache or dizziness
+ Passing out
+ Changes in eyesight
Chest pain or pressure
Rapid heartbeat
Shortness of breath
Difficulty urinating or changes in urine output
Burning, numbness, or tingling sensations that are not normal
Weakness on one side of the body, trouble speaking or thinking, changes in balance, drooping on one side of the face, or blurred vision
Abnormal heartbeat (which can be life-threatening, especially if you have pre-existing heart problems or take certain medications)

If you experience any allergic reactions, such as infections at the injection site, seek medical help immediately. Signs of infection may include:
Redness that does not go away
Warmth
Swelling
Tenderness

If you receive this medication through a vein, monitor the injection site for signs of tissue damage, such as:
Redness
Burning
Pain
Swelling
Blisters
Skin sores
Leaking of fluid
Inform your nurse immediately if you notice any of these symptoms.

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, some may be bothered by the following:
Feeling anxious, nervous, excitable, shaky, or restless
Upset stomach or vomiting
Excessive sweating
Pale skin
Headache
Dizziness, tiredness, or weakness
Goosebumps

If you experience any of these side effects or any other unusual symptoms, contact your doctor for advice. Not all possible side effects are listed here. If you have questions or concerns, discuss them with your doctor.

Reporting Side Effects

You can report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.

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 other medications. 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) medications, natural products, and vitamins. This is not an exhaustive list, and it is crucial to disclose all your medications and health issues to your doctor and pharmacist.
Any health problems you have, as they may interact with this medication. Your doctor and pharmacist need to be aware of your complete medical history to ensure safe treatment.
Do not initiate, discontinue, or modify the dosage of any medication without first consulting your doctor. It is vital to verify that it is safe to take this medication in conjunction with your other medications and health conditions.

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 taking 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 possible 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.

• Non-anaphylactic shock (unless diluted and titrated for specific indications)
• Local anesthesia of digits, toes, nose, ears, or penis (due to vasoconstriction leading to ischemia)
• Closed-angle glaucoma (relative contraindication)
• Organic brain damage
• Cerebral arteriosclerosis
• Cardiac dilation
• Coronary insufficiency
• Arrhythmias
• General anesthesia with halogenated hydrocarbons (e.g., halothane)

• Beta-blockers (non-selective) - can lead to unopposed alpha-adrenergic effects (severe hypertension, reflex bradycardia)
• Tricyclic antidepressants (TCAs) - potentiate pressor effects
• Monoamine oxidase inhibitors (MAOIs) - potentiate pressor effects
• Cocaine - potentiates pressor effects
• Digitalis glycosides - increased risk of arrhythmias
• Diuretics (loop/thiazide) - may reduce pressor response
• Alpha-adrenergic blockers - may antagonize pressor effects
• Ergot alkaloids - may cause severe hypertension and peripheral ischemia

• Antihistamines (e.g., diphenhydramine) - may potentiate effects
• Thyroid hormones - increased risk of arrhythmias/coronary insufficiency
• Phenothiazines - may reverse pressor effect
• Oxytocic drugs - may cause severe persistent hypertension

• Chest pain
• Palpitations
• Headache
• Anxiety
• Tremor
• Nausea/Vomiting
• Dizziness
• Dyspnea
• Skin pallor/cyanosis

Use in pregnancy only if the potential benefit justifies the potential risk to the fetus. Epinephrine can cause fetal anoxia due to uterine vasoconstriction and can inhibit uterine contractions. However, in life-threatening situations like anaphylaxis or cardiac arrest, the benefit to the mother outweighs the fetal risk.

Epinephrine is rapidly metabolized and has a very short half-life. It is unlikely to be excreted in breast milk in clinically significant amounts. Use is generally considered compatible with breastfeeding, especially in emergency situations.

Dosing is weight-based. Close monitoring is essential due to increased sensitivity and potential for adverse effects. Specific formulations (e.g., auto-injectors) are available for pediatric use.

Use with caution in elderly patients due to increased risk of adverse cardiovascular effects (e.g., arrhythmias, hypertension, myocardial ischemia). Start with lower doses and titrate carefully. Monitor closely for adverse reactions.

• Epinephrine is the first-line treatment for anaphylaxis and a critical drug in cardiac arrest.
• Always check concentration carefully; 1mg/ml is for IM/SC or IV dilution, not direct IV push in most cases (except cardiac arrest).
• Protect from light and freezing. Discard if discolored or contains precipitate.
• Patients with underlying cardiovascular disease are at higher risk for adverse effects.
• Educate patients (and caregivers) on proper use of auto-injectors if prescribed.

• Anaphylaxis: Antihistamines (e.g., diphenhydramine), Corticosteroids (e.g., methylprednisolone), H2 blockers (e.g., ranitidine/famotidine) - these are adjunctive, not alternatives to epinephrine for severe reactions.
• Cardiac Arrest: Vasopressin (historically used, now less common as first-line alternative to epi), Atropine (for bradycardia), Amiodarone (for arrhythmias).
• Asthma (severe): Albuterol (nebulized), Ipratropium, Systemic corticosteroids.
• Shock (vasopressor): Norepinephrine, Dopamine, Phenylephrine, Vasopressin.

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. Properly dispose of unused or expired medications by checking with your pharmacist for the recommended disposal method. Unless instructed to do so, avoid flushing medications down the toilet or pouring them down the drain, as this can harm the environment. Many communities offer drug take-back programs, which your pharmacist can help you locate. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about your medication, consult 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 emergency medical attention. Be prepared to provide information about the medication taken, the amount, and the time it was taken, as this will aid in providing appropriate care.