Uses

Indicated for emergency treatment of severe allergic reactions (anaphylaxis) including those caused by insect stings, foods, or drugs. Also used in cardiac arrest for resuscitation, and as a vasoconstrictor adjunct to local anesthetics. Used in severe asthma and croup unresponsive to other therapies.

Do not use if

No absolute contraindications in life-threatening anaphylaxis or cardiac arrest. Relative contraindications include narrow-angle glaucoma, organic heart disease, hypertension, hyperthyroidism, and concurrent non-selective beta-blocker use which may cause paradoxical hypertension.

Side effects

Palpitations, tachycardia, anxiety, tremor, headache, and pallor are common. Hypertensive crisis, arrhythmias including ventricular fibrillation, pulmonary edema, and cerebral hemorrhage may occur with excessive doses. Tissue necrosis may result from local vasoconstriction with extravasation.

Warnings

Store in a cool, dark place; solution darkens on oxidation indicating degradation. Use with caution in patients with hypertension, heart disease, or hyperthyroidism. When used with non-selective beta-blockers, alpha-mediated hypertension may be unmasked. Avoid intra-arterial injection.

How it works

Adrenaline (epinephrine) is an endogenous catecholamine that acts on alpha-1, alpha-2, beta-1, and beta-2 adrenergic receptors. In anaphylaxis, alpha-1 effects cause vasoconstriction reversing hypotension and reducing mucosal edema; beta-2 effects produce bronchodilation; beta-1 effects increase heart rate and contractility. Onset is rapid with IM injection.

Storage

Store at room temperature, 15–25°C. Protect from light and freezing. Do not use if solution is discolored or contains particles. Keep out of reach of children.