Formulary
Ephedrine hydrochloride: Indications, Dosing, Side Effects and Interactions
Ephedrine hydrochloride clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Ephedrine hydrochloride: Indications, Dosing, Side Effects and Interactions
Ephedrine hydrochloride clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Reversal of hypotension from spinal or epidural anaesthesia**
- **Adult** (By Slow Intravenous Injection): 3-7.5 mg every 3-4 minutes (max. per dose 9 mg), adjusted according to response; maximum 30 mg per course.
**Reversible airways obstruction**
- **Adult** (By Mouth): 15-60 mg 3 times a day.
**Neuropathic oedema**
- **Adult** (By Mouth): 30-60 mg 3 times a day.
**Reversal of hypotension from spinal or epidural anaesthesia for ephedrine hydrochloride**
- **Child 1 month-11 years** (By slow intravenous injection): 500-750 micrograms/kg every 3-4 minutes (max. per dose 9 mg), adjusted according to response, injection solution to contain ephedrine hydrochloride 30 mg/mL, alternatively 17-25 mg/m2 every 3-4 minutes (max. per dose 9 mg), adjusted according to response, injection solution to contain ephedrine hydrochloride 30 mg/mL; maximum 30 mg per course.
- **Child 12-17 years** (By slow intravenous injection): 3-7.5 mg every 3-4 minutes (max. per dose 9 mg), adjusted according to response; maximum 30 mg per course.
**Nasal congestion, Sinusitis affecting the maxillary antrum for ephedrine hydrochloride**
- **Child 12-17 years** (By intranasal administration): Apply 1-2 drops up to 4 times a day as required for a maximum of 7 days, to be instilled into each nostril, administer ephedrine 0.5% nasal drops.
Cautions
General cautions: Diabetes mellitus; elderly (in adults); hypertension; hyperthyroidism; ischaemic heart disease (in adults); prostatic hypertrophy (risk of acute urinary retention) (in adults) Specific cautions: With intranasal use Avoid excessive or prolonged use; cardiovascular disease (in children) With intravenous use Susceptibility to angle-closure glaucoma
Side effects
General side-effects: Common or very common Anxiety; headache; insomnia; nausea Frequency not known Tremor Specific side-effects: Common or very common With intravenous use Arrhythmias; asthenia; confusion; depression; dyspnoea; hyperhidrosis; irritability; palpitations; vomiting Rare or very rare With intravenous use Acute urinary retention With oral use Myocardial infarction Frequency not known With intranasal use Appetite decreased; arrhythmia; circulation impaired; dermatitis; dizziness; drug dependence; dry mouth; dyspnoea; hallucination; hyperglycaemia; hyperhidrosis; hypersalivation; hypertension; hypokalaemia; hypotension; irritability; muscle weakness; mydriasis; pain; palpitations; paranoia; piloerection; rebound congestion; syncope; thirst; urinary disorders; vasoconstriction; vasodilation; vomiting With intravenous use Acute angle closure glaucoma; angina pectoris; appetite decreased; cardiac arrest; dizziness; hypokalaemia; intracranial haemorrhage; psychotic disorder; pulmonary oedema With oral use Arrhythmias; circulation impaired; dry mouth; enuresis; hypertension; sedation
Interactions
**Severe interactions:**
- Antidepressants: Ephedrine should not be given to patients who are being treated with monoamine oxidase inhibitors as they may cause hypertensive crisis with marked headache, severe hypertension and...
**Other interactions (7):**
- Other adrenoceptor stimulants: Concurrent use of ephedrine with theophylline may result in increased nausea, nervousness, and insomnia.
- Noradrenaline is displaced by ephedrine with the release of large amounts of catecholamine.
- There may be an increased risk of arrhythmias when ephedrine is used with tricyclic antidepressants.
- Antihypertensives: Loss of blood pressure control has been detected in hypertensive patients undergoing concurrent therapy with ephedrine and adrenergic neurone blocking drugs and may also occur...
- Antimigraine drugs: Enhanced vasoconstriction and pressor effects with ergotamine or methysergide; concurrent use of ergotamine not recommended (risk of gangrene).
- Corticosteroids: Ephedrine has been shown to increase the clearance and prolong the half-life of dexamethasone in asthmatic patients.
Pregnancy
With intranasal use or oral use: Manufacturer advises avoid. With intravenous use: Increased fetal heart rate reported with parenteral ephedrine.
Breast feeding
Present in milk; manufacturer advises avoid-irritability and disturbed sleep reported.
Renal impairment
With oral use: Use with caution. M
Medicinal forms
Solution,Tablet,Solution
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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