EPINEPHRINE
(Adrenalin)Standard Prescription
epinephrine __mg IM x 1 dose; may repeat q__min prn (anaphylaxis)
epinephrine 1 mg/ml solution __mg (__mg/kg) ETT x 1 dose;
repeat Q3 to 5 min prn (resuscitation)
low dose push epinephrine 0.01 mg/mL __mg (__mg/kg) IV/IO repeated per MD direction (pre-emptive/severe hypotension)
Dosages
Asystolic or Pulseless Arrest:
Initial and subsequent doses:
IV/IO:
10 mcg/kg (0.01mg/kg) (0.1 mL/kg of 0.1 mg/mL solution) Q 3-5 min. Maximum dose 1 mg
**note dosage/strength for each indication/ route of administration**
Pre-emptive to avoid hypotension or Severe Hypotension during a procedure (Spritzer epinephrine or low dose push epinephrine)
1 mcg/kg (0.001 mg/kg) (0.1 mL/kg of 0.01 mg/mL solution) IV/IO repeated per MD direction
Anaphylaxis:
10 mcg/kg (0.01 mg/kg) (0.01 mL/kg of 1 mg/mL solution) IM up to a maximum of 0.5 mg (0.5 mL) and repeat Q 5-15 min. for 3-4 doses.
If inadequate response after 4 doses,
1 mcg/kg (0.001 mg/kg) IV every 30s to 10 minutes or to 1 mg total dose and start a continuous infusion
Circulatory Support after initial resuscitation:
0.01- 1 mcg/kg/min. by continuous IV infusion titrate dosage to desired effect
QT Stress Test:
0.05 mcg/kg/min. by continuous IV infusion. Titrate Q 5 minutes up to maximum of 0.2 mcg/kg/min (refer to Medical Day Unit [MDU] protocol)
Initial and subsequent doses:
IV/IO:
10 mcg/kg (0.01mg/kg) (0.1 mL/kg of 0.1 mg/mL solution) Q 3-5 min. Maximum dose 1 mg
**note dosage/strength for each indication/ route of administration**
Pre-emptive to avoid hypotension or Severe Hypotension during a procedure (Spritzer epinephrine or low dose push epinephrine)
1 mcg/kg (0.001 mg/kg) (0.1 mL/kg of 0.01 mg/mL solution) IV/IO repeated per MD direction
Anaphylaxis:
10 mcg/kg (0.01 mg/kg) (0.01 mL/kg of 1 mg/mL solution) IM up to a maximum of 0.5 mg (0.5 mL) and repeat Q 5-15 min. for 3-4 doses.
If inadequate response after 4 doses,
1 mcg/kg (0.001 mg/kg) IV every 30s to 10 minutes or to 1 mg total dose and start a continuous infusion
Circulatory Support after initial resuscitation:
0.01- 1 mcg/kg/min. by continuous IV infusion titrate dosage to desired effect
QT Stress Test:
0.05 mcg/kg/min. by continuous IV infusion. Titrate Q 5 minutes up to maximum of 0.2 mcg/kg/min (refer to Medical Day Unit [MDU] protocol)
Mechanism of Action
Low dose epinephrine (0.3 mcg/kg/min) provides primarily beta effect.
High
dose epinephrine (>0.3 mcg/kg/min) provides a mixture of beta and alpha
effects.
Forms Supplied
injection: 1 mg/mL, 0.1 mg/mL PFS ; also available with intracardiac needle.
1 mg/mL multidose vial, 30 mL
Standard Concentrations for Critical Care:
25, 50 and 100 mcg/mL in D5W in PFS
10 mcg/mL in NS in PFS
1:1000 = 1 mg/mL
1:10,000 = 0.1 mg/mL
1 mcg = 0,001 mg
10 mcg = 0.01 mg
1 mg/mL multidose vial, 30 mL
Standard Concentrations for Critical Care:
25, 50 and 100 mcg/mL in D5W in PFS
10 mcg/mL in NS in PFS
1:1000 = 1 mg/mL
1:10,000 = 0.1 mg/mL
1 mcg = 0,001 mg
10 mcg = 0.01 mg
Comments
Note: Careful attention to appropriate concentration selection and dosage calculation is important as potential of making a 10-100X error is high.
Expression of epinephrine strength as ratios is no longer supported by ISMP (Institute for Safe Medication Practice)
May cause tachycardia, dysrhythmias, hypertension, headaches, ventricular fibrillation.
Low dose epinephrine (0.3 mcg/kg/min) is primarily beta effect. High dose epinephrine (>0.3 mcg/kg/min) is a mixture of beta and alpha effects.
Incompatible with alkaline solutions (eg bicarbonate)
Continuous IV infusion in critical care areas only
Can be administered via peripheral line if no central line available.
Protect from light
Refer to Prevention and Management of Infiltration and Extravasation - Guidelines for Antidote Administration on PHSA SHOP
May be given SC for anaphylaxis but IM is the preferred route.
For spritzer/low dose push epinephrine 0.01 mg/mL: Dilute 0.1 mg/mL product to 0.01 mg/mL by adding 1 mL of 0.1 mg/mL epinephrine to 9 mL of NS
Expression of epinephrine strength as ratios is no longer supported by ISMP (Institute for Safe Medication Practice)
May cause tachycardia, dysrhythmias, hypertension, headaches, ventricular fibrillation.
Low dose epinephrine (0.3 mcg/kg/min) is primarily beta effect. High dose epinephrine (>0.3 mcg/kg/min) is a mixture of beta and alpha effects.
Incompatible with alkaline solutions (eg bicarbonate)
Continuous IV infusion in critical care areas only
Can be administered via peripheral line if no central line available.
Protect from light
Refer to Prevention and Management of Infiltration and Extravasation - Guidelines for Antidote Administration on PHSA SHOP
May be given SC for anaphylaxis but IM is the preferred route.
For spritzer/low dose push epinephrine 0.01 mg/mL: Dilute 0.1 mg/mL product to 0.01 mg/mL by adding 1 mL of 0.1 mg/mL epinephrine to 9 mL of NS
References
1, 37, 44, 695
Last Edited
2023-12-28 22:11:52