DRUG SUPPLIED DOSE COMMENTS
EPINEPHRINE (Paeds)
(Adrenalin)

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.



Ref: 1, 37, 44, 694, 695


Last update: 2025-10-05		 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
 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 1 mg/dose

**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 and repeat Q 5-15 min. PRN for up to 3-4 doses.
Maximum: 0.5 mg/dose.

If inadequate response after 4 doses or unconscious/requiring assisted ventilation: 
1 mcg/kg (0.001 mg/kg) IV every 2-3 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.

 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



Standard Prescription:

epinephrine __mg IM x 1 dose; may repeat q__min prn (anaphylaxis)

epinephrine 0.1 mg/ml solution __mg (__mg/kg) IV/IO x 1 dose; repeat Q3 to 5 min prn (resuscitation)

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)

epinephrine __mcg/kg/min continuous IV infusion