Epinephrine (Adrenaline)
- Atc Codes:A01AD01#B02BC09#C01CA24#R01AA14#R03AA01#S01EA01
- CAS Codes:51-43-4#51-42-3
- PHARMGKB ID:51-43-4#51-42-3
Table of contents
- Brand Names
- Drug Combinations
- Chemistry
- Pharmacologic Category
- Mechanism of Action
- Therapeutic Use
- Unlabeled Use
- Pregnancy and Lactation Implications
- Contraindications
- Warnings and Precautions
- Adverse Reactions
- Toxicological Effects
- Genes that may be involved
- Substrate of
- Inhibits
- Drug Interactions
- Nutrition/Nutraceutical Interactions
- Dosage
- Pharmacokinetics and Pharmacodynamics
- Special Considerations
Brand Names
Europe
Austria: Anapen, EpiPen, L-Adrenalin, Suprarenin; Belgium: Adrenaline, EpiPen; Bulgaria: Adrenaline, Anapen; Cyprus: Adrenaline, Anapen; Czech Republic: Adrenaline, Anapen, EpiPen; Denmark: Adrenalin, EpiPen; Estonia: Adrenaline; Finland: Adrenalin; France: Adrenaline, Anapen; Germany: Adrenalin, Allergohal, Anapen, Epihal, Fastjekt, Infectokrupp, Suprarenin, Surgident Gingival Retraktionsfaden; Greece: Adrenaline, Anapen, EpiPen; Hungary: Anapen, EpiPen, Tonogen; Ireland: Adrenaline, Anapen; Italy: Adrenal, Fastjekt; Lithuania: Adrenalinum; Luxembourg: Adrenalin, Adrenaline, Epifrin, Fastjekt; Malta: Adrenaline, EpiPen; Netherlands: Adrenaline, Adrenalinum, Anapen, EpiPen; Poland: Adrenalina, Anapen, EpiPen, Fastjekt; Portugal: Adrenalina, Anapen, EpiPen; Romania: Adrenalina, Anapen; Slovakia: Adrenalin, EpiPen; Slovenia: Suprarenin; Spain: Adrenalina, Altellus; Sweden: Adrenalin, Anapen, EpiPen; UK: Adrenaline, Epinephrine, EpiPen.
North America
Canada: Adrenalin, Epifrin, Epinephrine, EpiPen, S2, Twinject; USA: Adrenalin, EpiPen, Twinject.
Latin America
Argentina: Adrenalina, EpiPen; Brazil: Drenalin; Mexico: Pinadrina.
Asia
Japan: Adrenaline, Bosmin, EpiPen.
Drug combinations
Epinephrine and Articaine
Epinephrine and Atropine
Epinephrine and Bupivacaine
Epinephrine and Chlorpheniramine
Epinephrine and Etidocaine
Epinephrine and Guanethidine
Epinephrine and Lidocaine
Epinephrine and Mepivacaine
Epinephrine and Prilocaine
Epinephrine and Procaine
Chemistry
Epinephrine: C~9~H~13~NO~3~. Mw: 183.20. (1) 1,2-Benzenediol, 4-[1-hydroxy-2-(methylamino)ethyl]-, (R)-; (2)(-)-3,4-Dihydroxy-α-[(methylamino)methyl]benzyl alcohol. CAS-51-43-4.
Epinephrine Bitartrate: C~9~H~13~NO~3~ C~4~H~6~O~6~. Mw: 333.29. 1,2-Benzenediol, 4-[1-hydroxy-2-(methylamino)ethyl]-, (R)-, [R-(R*,R*)]-2,3-dihydroxybutanedioate (1:1). CAS-51-42-3.
Pharmacologic Category
Sympathomimetic (Adrenergic) Agents; α- and β-Adrenergic Agonists. EENT Preparations; Vasoconstrictors. EENT Preparations; Mydriatics. Antidotes. (ATC-Code: A01AD01; B02BC09; C01CA24; R01AA14; R03AA01; S01EA01).
Mechanism of action
Epinephrine is an endogenous catecholamine which is the active principle of the adrenal medulla. It acts directly on both α- and β-adrenergic receptors, resulting in relaxation of the bronchial tree smooth muscle, cardiac stimulation, and dilation of skeletal muscle vasculature. Small doses can cause vasodilation via β~2~-vascular receptors. Large doses may produce constriction of skeletal and vascular smooth muscle.
Therapeutic use
Treatment of bronchospasms, bronchial asthma, nasal congestion, viral croup, anaphylactic reactions, cardiac arrest. Added to local anesthetics to decrease their systemic absorption and increase duration of action. Decreasing superficial hemorrhage.
Pregnancy and lactiation implications
If used during pregnancy, epinephrine may cause anoxia to the fetus. Should be administered cautiously by oral inhalation to pregnant patients. Should be used during pregnancy only if potential benefits justify possible risks to the fetus.
Unlabeled use
Ventricular fibrillation or pulseless ventricular tachycardia unresponsive to initial defibrillatory shocks. Pulseless electrical activity, asystole, hypotension unresponsive to volume resuscitation. Symptomatic bradycardia or hypotension unresponsive to atropine or pacing. Inotropic support.
Contraindications
Hypersensitivity to epinephrine or any component of the formulation. Contraindicated in shock (other than anaphylactic shock), organic heart disease, or cardiac dilatation, as well as most patients with arrhythmias, organic brain damage, or cerebral arteriosclerosis. Epinephrine injection contraindicated in angle-closure glaucoma.
Warnings and precautions
Epinephrine should be administered with caution in the following cases: to geriatric patients, diabetes mellitus, cardiovascular diseases (including angina pectoris, tachycardia, and MI), Parkinson’s disease, thyroid disease, history of sensitivity to sympathomimetic amines or in patients taking MAOIs. Coronary insufficiency usually considered to be a contraindication to parenteral use of the drug. To be used cautiously in patients with long-standing bronchial asthma and substantial emphysema who may also have degenerative heart disease. Epinephrine injection should be used with caution in psychoneurotic disorders. Rapid I.V. infusion may cause death from cerebrovascular hemorrhage or cardiac arrhythmias. Oral inhalation of epinephrine not the preferred route of administration. Some products contain sulfites as preservatives. Avoid topical application where reduced perfusion could lead to ischemic tissue damage (e.g. penis, ears, digits).