Formulary
Adrenaline Epinephrine: Indications, Dosing, Side Effects and Interactions
For adrenaline/epinephrine Acts on both alpha and beta receptors and increases both heart rate and contractility (beta 1 effects); it can cause peripheral...
MedNext Academy | 4 min read
Adrenaline Epinephrine: Indications, Dosing, Side Effects and Interactions
For adrenaline/epinephrine Acts on both alpha and beta receptors and increases both heart rate and contractility (beta 1 effects); it can cause peripheral...
Drug action
For adrenaline/epinephrine Acts on both alpha and beta receptors and increases both heart rate and contractility (beta 1 effects); it can cause peripheral vasodilation (a beta 2 effect) or vasoconstriction (an alpha effect).
Indications and dose
**Cardiopulmonary resuscitation (specialist use only) for adrenaline/epinephrine**
- **Neonate up to 1 days** (By slow intravenous injection): Consult Resuscitation Council (UK) guidance on newborn resuscitation or local protocols.
- **Neonate 1 days to 28 days** (By slow intravenous injection): 10 micrograms/kg every 3-5 minutes as required, a 1 in 10 000 (100 micrograms/mL) solution is recommended, suitable syringe to be used for measuring small volume.
- **Child** (By slow intravenous injection): 10 micrograms/kg every 3-5 minutes (max. per dose 1 mg) as required, a 1 in 10 000 (100 micrograms/mL) solution is recommended, suitable syringe to be used for measuring small volume.
**Acute hypotension for adrenaline/epinephrine**
- **Neonate** (By continuous intravenous infusion): Initially 100 nanograms/kg/minute, to be adjusted according to response, higher doses up to 1.5 micrograms/kg/minute have been used in acute hypotension.
- **Child** (By continuous intravenous infusion): Initially 100 nanograms/kg/minute, to be adjusted according to response, higher doses up to 1.5 micrograms/kg/minute have been used in acute hypotension.
**Croup (when not effectively controlled with corticosteroid treatment) for adrenaline/epinephrine**
- **Child 1 month-11 years** (By inhalation of nebulised solution): 400 micrograms/kg for 1 dose (max. per dose 5 mg), dose to be repeated after 30 minutes if necessary.
**Emergency treatment of acute anaphylaxis (under expert supervision) for adrenaline/epinephrine**
- **Child up to 6 months** (By intramuscular injection): 100-150 micrograms, using adrenaline 1 in 1000 (1 mg/mL) injection, repeat dose after 5 minutes if no response; if life-threatening features persist, further doses can be given every 5 minutes until specialist critical care available, suitable syringe to be used for measuring small volume; injected preferably into the anterolateral aspect of the middle third of the thigh.
- **Child 6 months-5 years** (By intramuscular injection): 150 micrograms, using adrenaline 1 in 1000 (1 mg/mL) injection, repeat dose after 5 minutes if no response; if life-threatening features persist, further doses can be given every 5 minutes until specialist critical care available, suitable syringe to be used for measuring small volume; injected preferably into the anterolateral aspect of the middle third of the thigh.
- **Child 6-11 years** (By intramuscular injection): 300 micrograms, using adrenaline 1 in 1000 (1 mg/mL) injection, repeat dose after 5 minutes if no response; if life-threatening features persist, further doses can be given every 5 minutes until specialist critical care available, to be injected preferably into the anterolateral aspect of the middle third of the thigh.
- **Child 12-17 years** (By intramuscular injection): 500 micrograms, using adrenaline 1 in 1000 (1 mg/mL) injection, repeat dose after 5 minutes if no response; if life-threatening features persist, further doses can be given every 5 minutes until specialist critical care available, to be injected preferably into the anterolateral aspect of the middle third of the thigh, 300 micrograms to be administered if child is small or prepubertal.
**Refractory anaphylaxis [persistent symptoms despite at least 2 appropriate doses of intramuscular adrenaline/epinephrine] (specialist use only) for adrenaline/epinephrine**
- **Child** (By intravenous infusion): Consult Resuscitation Council (UK) emergency treatment of anaphylaxis guideline or local protocols.
**Acute anaphylaxis (for self-administration at the first signs of anaphylaxis) for EpiPen Auto-injector 0.3mg**
- **Child (body-weight 25 kg and above)** (By intramuscular injection): 300 micrograms, then 300 micrograms after 5 minutes as required.
**Acute anaphylaxis (for self-administration at the first signs of anaphylaxis) for EpiPen Jr Auto-injector 0.15mg**
- **Child (body-weight up to 15 kg)** (By intramuscular injection): 150 micrograms, then 150 micrograms after 5 minutes as required.
- **Child (body-weight 15-24 kg)** (By intramuscular injection): 150 micrograms, then 150 micrograms after 5 minutes as required, on the basis of a dose of 10 micrograms/kg, 300 micrograms may be more appropriate for some children.
**Acute anaphylaxis (for self-administration at the first signs of anaphylaxis) for Jext 150 micrograms**
- **Child (body-weight up to 15 kg)** (By intramuscular injection): 150 micrograms, then 150 micrograms after 5 minutes as required.
- **Child (body-weight 15-24 kg)** (By intramuscular injection): 150 micrograms, then 150 micrograms after 5 minutes as required, on the basis of a dose of 10 micrograms/kg, 300 micrograms may be more appropriate for some children.
**Acute anaphylaxis (for self-administration at the first signs of anaphylaxis) for Jext 300 micrograms**
- **Child (body-weight 25 kg and above)** (By intramuscular injection): 300 micrograms, then 300 micrograms after 5 minutes as required.
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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