Adrenalin Chloride

Name: Adrenalin Chloride

Descriptions

Epinephrine injection is used for emergency treatment of severe allergic reactions (including anaphylaxis) to insect bites or stings, medicines, foods, or other substances. It is also used to treat anaphylaxis caused by unknown substances or triggered by exercise.

This medicine is available only with your doctor's prescription.

This product is available in the following dosage forms:

  • Injectable
  • Solution

Commonly used brand name(s)

In the U.S.

  • Adrenaclick
  • Adrenalin
  • Adrenalin Chloride
  • Auvi-Q
  • Epipen
  • Epipen Jr
  • Symjepi
  • Twinject

Available Dosage Forms:

  • Injectable
  • Solution

Therapeutic Class: Anaphylaxis Agent

Pharmacologic Class: Adrenergic

Chemical Class: Alkylarylamine

Uses For Adrenalin Chloride

Epinephrine injection is used for emergency treatment of severe allergic reactions (including anaphylaxis) to insect bites or stings, medicines, foods, or other substances. It is also used to treat anaphylaxis caused by unknown substances or triggered by exercise.

This medicine is available only with your doctor's prescription.

Before Using Adrenalin Chloride

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of epinephrine injection in children.

Geriatric

No information is available on the relationship of age to the effects of epinephrine injection in geriatric patients. However, elderly patients are more likely to have age-related heart disease which may require caution in patients receiving epinephrine injection.

Pregnancy

Pregnancy Category Explanation
All Trimesters C Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Dihydroergotamine
  • Isocarboxazid
  • Linezolid
  • Phenelzine
  • Tranylcypromine

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Amitriptyline
  • Amoxapine
  • Bucindolol
  • Carteolol
  • Carvedilol
  • Clomipramine
  • Desipramine
  • Digoxin
  • Dilevalol
  • Dothiepin
  • Doxepin
  • Entacapone
  • Halothane
  • Imipramine
  • Iobenguane I 123
  • Levalbuterol
  • Levobunolol
  • Lofepramine
  • Metipranolol
  • Nadolol
  • Nortriptyline
  • Opipramol
  • Oxprenolol
  • Penbutolol
  • Pindolol
  • Propranolol
  • Protriptyline
  • Rasagiline
  • Sotalol
  • Tertatolol
  • Timolol
  • Trimipramine

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Labetalol

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Angina pectoris (severe chest pain) or
  • Asthma or
  • Blood vessel problems or
  • Depression, history of or
  • Diabetes or
  • Heart attack or
  • Heart disease (eg, coronary artery disease, organic heart disease) or
  • Heart rhythm problems (eg, arrhythmia) or
  • Hypertension (high blood pressure) or
  • Hyperthyroidism (overactive thyroid) or
  • Parkinson's disease—Use with caution. May make these conditions worse.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Angina pectoris (severe chest pain) or
  • Asthma or
  • Blood vessel problems or
  • Depression, history of or
  • Diabetes or
  • Heart attack or
  • Heart disease (eg, coronary artery disease, organic heart disease) or
  • Heart rhythm problems (eg, arrhythmia) or
  • Hypertension (high blood pressure) or
  • Hyperthyroidism (overactive thyroid) or
  • Parkinson's disease—Use with caution. May make these conditions worse.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For injection dosage form:
    • For allergic reactions:
      • Adults and children weighing more than 30 kilograms (kg)—0.3 milligram (mg) injected under the skin or into the muscle of your thigh.
      • Children weighing 15 to 30 kg—0.15 mg injected under the skin or into the muscle of your thigh.
      • Children weighing less than 15 kg—Use and dose must be determined by your doctor.

Usual Adult Dose for Anaphylaxis

Auto-Injector:
30 kg or greater: 0.3 mg IM or subcutaneously into anterolateral aspect of thigh; repeat as needed

Comments:
-The manufacturer product information for the specific auto-injector being used should be consulted for administration instructions.
-More than 2 sequential doses should only be administered under direct medical supervision.
-The auto-injectors are intended for immediate administration as emergency supportive therapy only and not as a replacement or substitute for immediate medical care.

Injectable Solution of 1 mg/mL (1:1000):
30 kg or greater: 0.3 to 0.5 mg (0.3 to 0.5 mL) of undiluted drug IM or subcutaneously into anterolateral aspect of the thigh; repeat every 5 to 10 minutes as needed
-Maximum dose per injection: 0.5 mg (0.5 mL)

Comments:
-For IM administration, use a long enough needle (at least 1/2 inch to 5/8 inch) to ensure injection into the muscle.
-Repeated injections should not be administered at the same site as resulting vasoconstriction may cause tissue necrosis.
-The patient should be monitored clinically for reaction severity and cardiac effects with repeat doses titrated to effect.

Injectable Solution of 0.1 mg/mL (1:10,000):
0.1 to 0.25 mg (1 to 2.5 mL) IV slowly once

Convenience Kit 1 mg/mL (1:1000):
0.2 to 1 mg IM or subcutaneous

Uses: For the emergency treatment of allergic reactions (Type I) including anaphylaxis to stinging or biting insects, allergen immunotherapy, foods, drugs, diagnostic testing substances, and other allergens, as well as idiopathic anaphylaxis or exercise-induced anaphylaxis; and for immediate administration in patients who are determined to be at increased risk for anaphylaxis, including those with a history of anaphylactic reactions

Usual Adult Dose for Shock

Injectable Solution of 1 mg/mL (1:1000): 0.05 to 2 mcg/kg/min IV and titrate to achieve desired mean arterial pressure (MAP)
-Dosage may be adjusted periodically, such as every 10 to 15 minutes in increments of 0.05 to 0.2 mcg/kg/min to achieve desired blood pressure goal

Comments:
-Must be diluted prior to use; consult manufacturer product information for appropriate dilution instructions.
-Correct blood volume depletion as fully as possible prior to administration; may be administered before and concurrently with blood volume replacement as an emergency measure.
-Continuous infusion is generally required over several hours or days until patient's hemodynamic status improves; the duration of perfusion or total cumulative dose cannot be known.
-Following hemodynamic stabilization, may wean incrementally over time, such as decreasing doses every 30 minutes over a 12 to 24 hour period.

Use: To increase mean arterial blood pressure in patients with hypotension associated with septic shock

Usual Adult Dose for Bradyarrhythmia

The manufacturer gives no specific dosing instructions.

The AHA recommends:
2 to 10 mcg/min IV and titrate to patient response
-Alternate dose: 0.1 to 0.5 mcg/kg/min (in a 70 kg patient, 7 to 35 mcg/min) IV; titrate to effect

Use: For patients with symptomatic bradycardia, particularly if associated with hypotension, for whom atropine may be inappropriate or after atropine fails

Usual Pediatric Dose for Cardiac Arrest

The manufacturer gives no specific dosing instructions.

The AHA recommends:
Neonates:
-IV: 0.01 to 0.03 mg/kg (1:10,000 injectable solution) IV once
-Endotracheal: 0.05 to 0.1 mg/kg (1:10,000 injectable solution) via endotracheal route once may be reasonable while attempting to gain IV access

Comments:
-Due to lack of data to support endotracheal use, it is reasonable to provide medications via IV route as soon as venous access is established.

Infants and Children:
-IV or intraosseous: 0.01 mg/kg (0.1 mL/kg of 1:10,000 injectable solution) IV or intraosseous once; may repeat every 3 to 5 minutes
-Maximum dose: 1 mg

Endotracheal: 0.1 mg/kg (0.1 mL/kg of 1:1000 injectable solution) via endotracheal tube once, flush with 5 mL normal saline and follow with 5 ventilations; may repeat every 3 to 5 minutes
-Maximum dose: 2.5 mg

Use: For resuscitation in the pediatric patient

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