Generic Name Epinephrine
A sterile solution intended for subcutaneous or intramuscular injection. When diluted, it may also be administered intracardially or intravenously. It may also be administered intraspinally by adding to anesthetic spinal fluid mixture. Each milliliter contains 1 mg Adrenalin (epinephrine) as the hydrochloride dissolved in Water for Injection, USP, with sodium chloride added for isotonicity.
1 mL Vial
Contains not more than 0.1% sodium bisulfite as an antioxidant, and the air in the vial has been displaced by nitrogen.
30 mL Vial
Contains 0.5%Chlorobutanol (chloroform derivative) as a preservative and not more than 0.15% sodium bisulfite as an antioxidant.
Indications and Usage
In general, the most common uses of epinephrine are to relieve respiratory distress due to bronchospasm, to provide rapid relief of hypersensitivity reactions to drugs and other allergens, and to prolong the action of infiltration anesthetics.
Its cardiac effects may be of use in restoring cardiac rhythm in cardiac arrest due to various causes, but it is not used in cardiac failure or in hemorrhagic, traumatic, or cardiogenic shock.
Epinephrine is used as a hemostatic agent. It is also used in treating mucosal congestion of hay fever, rhinitis, and acute sinusitis to relieve bronchial asthmatic paroxysms in syncope due to complete heart block or carotid sinus hypersensitivity for symptomatic relief of serum sickness, urticaria, angioneurotic edema for resuscitation in cardiac arrest following anesthetic accidents in simple (open angle) glaucoma for relaxation of uterine musculature and to inhibit uterine contractions. Epinephrine injection can be utilized to prolong the action of intraspinal and local anesthetics (see CONTRAINDICATIONS section).
Epinephrine is contraindicated in narrow angle (congestive) glaucoma, shock, during general anesthesia with halogenated hydrocarbons or cyclopropane and in individuals with organic brain damage. Epinephrine is also contraindicated with local anesthesia of certain areas, e.g., fingers, toes, because of the danger of vasoconstriction producing sloughing of tissue in labor because it may delay the second stage in cardiac dilatation and coronary insufficiency.
Administer with caution to elderly people to those with cardiovascular disease, hypertension, diabetes, or hyperthyroidism in psychoneurotic individuals and in pregnancy.
Patients with long-standing bronchial asthma and emphysema who have developed degenerative heart disease should be administered the drug with extreme caution.
Overdosage or inadvertent intravenous injection of epinephrine may cause cerebrovascular hemorrhage resulting from the sharp rise in blood pressure.
Fatalities may also result from pulmonary edema because of the peripheral constriction and cardiac stimulation produced. Rapidly acting vasodilators, such as nitrites, or alpha blocking agents may counteract the marked pressor effects of epinephrine.
Epinephrine is the preferred treatment for serious allergic or other emergency situations even though this product contains sodium bisulfite, a sulfite that may in other products cause allergic-type reactions including anaphylactic symptoms or life-threatening or less severe asthmatic episodes in certain susceptible persons. The alternatives to using epinephrine in a life-threatening situation may not be satisfactory. The presence of a sulfite in this product should not deter administration of the drug for treatment of serious allergic or other emergency situations.
Transient and minor side effects of anxiety, headache, fear, and palpitations often occur with therapeutic doses, especially in hyperthyroid individuals. Repeated local injections can result in necrosis at sites of injection from vascular constriction. “Epinephrine-fastness” can occur with prolonged use.