Composition
Inj Per ml: Adrenaline (as HCI) 0.1 mg (1:10000). Inj: Per ml: Adrenaline (as HCI) 1 mg.
Indications & Dosage
Asystole/pulseless arrest, pulseless ventricular tachycardia/ventricular fibrillation, Cardiopulmonary resuscitation: BY IV INJ: Adult: 1 mg every 3-5 minutes, a 1 in 10000 (100 mcg/ml) solution is recommended, until spontaneous circulation established, higher doses of epinephrine (up to 0.2 mg/kg) have been used for treatment of specific problems BY IV INJ: Infant & Children: 0.01 mg/kg (0.1 ml/kg of 1:10,000 [0.1 mg/ml] solution) (max 1 mg/dose) every 3-5 minutes until spontaneous circulation established. Endotracheal: BY IV INJ: Adult: 2-2.5 mg every 3-5 minutes until spontaneous circulation established, dilute in 5-10 ml NS or sterile water. BY IV INJ: Infant & Children: 0.1 mg/kg (0.1 ml/kg of 1:1000 [1 mg/ml] solution) (max 2.5 mg/dose) every 3-5 minutes until spontaneous circulation established, dilute in 5-10 ml NS or sterile water. Control of bradycardia in patients with arrhythmias after myocardial infarction, if there is a risk of asystole, or if the patient is unstable and has failed to respond to atropine: BY IV INF: Adult: 2-10 mcg/minute or 0.1-0.5 mcg/kg/ minute (7-35 mcg/minute in a 70 kg patient); adjust according to response BY IV INF: Infant& Children: 0.01 mg/kg (0.1 ml/kg of 1:10,000 [0.1 mg/ml] solution) (max 1 mg/dose) every 3-5 minutes as needed. Bronchodilator: BY SC INJ: Adult: 0.3-0.5 mg (1:1000 [1 mg/ml] solution) every 20 minutes for 3 doses. BY SC INJ: Infant & Children: 0.01 mg/kg (0.01 ml/kg of 1:1000 [1 mg/ml] solution); max 0.5 mg/dose) every 20 minutes for 3 doses. Acute anaphylaxis when there is doubt as to the adequacy of the circulation, Angioedema (if laryngeal oedema is present): BY SLOW IV INJ: Adult: 50 mcg, using 0.5ml of the dilute 1 in 10 000 adrenaline injection, dose to be repeated according to response, if multiple doses required, adrenaline should be given as a slow IV INF stopping when a response has been obtained. Hypotension/shock, severe and fluid resistant: BY CONT. IV INF: Adult: Initially 0.1-0.5 mcg/kg/minute (7-35 mcg/minute in a 70 kg patient) adjust according to desired response. Children & Neonate: Initially 100 nanograms/kg/minute, adjusted according to response, higher doses up to 1.5 mcg/kg/minute have been used in acute hypotension. Post-resuscitation INF to maintain cardiac output or stabilize: BY IV INF: Infant & Children: 0.1-1 mcg/kg/minute; doses less than 0.3 mcg/kg/minute generally produce beta-adrenergic effects and higher doses (more than 0.3mcg/kg/minute) generally produce alpha-adrenergic vasoconstriction, increase dose to desired effect. Emergency treatment of acute anaphylaxis, Angioedema (if laryngeal oedema is present): BY IM INJ: Adult: 500 mcg, to be injected preferably into the anterolateral aspect of the middle third of the thigh, doses may be repeated several times if necessary at 5 minute intervals according to blood pressure, pulse, and respiratory function. Children 1 month-5 yrs: 150 mcg, Children 6-11 yrs: 300 mcg, Children above 12 yrs: Same as adult.
Administration
Central administration only; IV infusions require an infusion pump. Endotracheal: Doses (2-2.5 times the IV dose) should be diluted to 10 ml with NS or distilled - water.IM: Intramuscularly into anterolateral aspect of thigh. SC: Use only 1:1000 solution. Continuous IV Infusion: Rate of infusion (ml/hr) = dose (mcg/kg/min) x weight (kg) x 60 min/hr divided by the concentration (mcg/min). Max concentration: 64 mcg/ min. Direct IV or Intraosseous: Dilute to a max Concentration of 100 mcg/ ml (if using 1:10000 concentrations, no dilution is necessary). The World Health Organization recommends the availability of one dose for every 10-20 minutes of travel time to a medical emergency facility for self-administration. More than 2 doses should only be administered under direct medical supervision.
Compatibility
Stable in dextran 6% in dextrose, dextran 6% in NS, D5LR, D5 1/4NS, D5 1/2NS, D5 NS, D5W, D1OW, D10 NS, LR, NS. Incompatible with sodium bicarbonate 5%, alkalies or oxidizing agents including bromine, chlorine, chromates, iodine, metal salts (as from iron), nitrites, oxygen and permanganates. .
Contraindications
Cardiac arrhythmias, angle-closure glaucoma.
Precautions
Diabetes mellitus, cardiovascular disease (angina, tachycardia, MI), thyroid disease, or cerebral arterio-sclerosis.
Interactions
Halogenated inhalational, anaesthetics; alpha and beta-blocking agents, phenothiazines, tricyclic antidepressants.
Pregnancy
Caution advised
Lactation
Caution advised
Side Effects
Anxiety, tremor, tachycardia, headache, cold extremities, arrhythmias, cerebral haemorrhage, pulmonary oedema, nausea, vomiting, sweating, weakness, dizziness and hyperglycaemia.