Epinephrine 0.25mg/1ml

Epinephrine 0.25mg

Dosing & Uses
Adult 

Dosage Forms & Strengths

SC/IM autoinjector (EpiPen, Adrenaclick, Auvi-Q, Symjepi)

  • 0.15mg/0.15mL
  • 0.3mg/0.3mg

injectable solution

  • 0.1mg/mL (1:10,000)
  • 1mg/mL (1:1000)

Cardiac Arrest

1 mg IV/IO q3-5min PRN; may administer up to 0.2 mg/kg if no response

Dose >1 mg not shown to improve survival or neurological outcomes as compared to standard dosing; not recommended

ET: 2-2.5 mg q3-5min until IV/IO access established or spontaneous circulation restored

Hypotension Associated with Septic Shock

Indicated to increase mean arterial blood pressure in adults with hypotension associated with septic shock

Recommended dose: 0.05-2 mcg/kg/,om; titrate to desired mean arterial pressure (MAP); may adjust dose q10-15 min by 0.05-0.2 mcg/kg/minute to achieve desired blood pressure goal

After hemodynamic stabilization, may wean incrementally q30min over 12-24 hr

See also Administration

Anaphylaxis

Indicated in emergency treatment of allergic reactions (Type I) including anaphylaxis

0.1 mg (1:10,000 solution; 0.1mg/mL) IV at rate of 1-4 mcg/min over 5 min to prevent the need to repeat injections frequently OR may initiate with infusion at 5-15 mcg/min (with crystalloid administration); IV administration should only be done in patients who are profoundly hypotensive or are in cardiopulmonary arrest refractory to volume resuscitation and several epinephrine injections

1:1000 solution

  • 0.3-0.5 mg/kg (0.3-0.5 mL) SC/IM, may not to exceed 0.5 mg (0.5 mL) per injection, repeated q5-10 min as necessary

Autoinjector

  • 0.3 mg (contents of 1 autoinjector) SC/IM once in anterolateral aspect of the thigh; may repeat dose after 5-15 minutes if symptoms persist

Symptomatic Bradycardia

Unresponsive to atropine or pacing: 2-10 mcg//min by IV infusion or 0.1-0.5 mcg/kg/min (7-35 mcg/min in 70 kg patient); titrate to patient response

Mydriasis

Induction and maintenance of mydriasis during intraocular surgery

After dilution in an ophthalmic irrigating fluid, inject intracamerally as a bolus dos of 0.1 mL at dilution of 1:100,000 to 1:400,000 (10-2.5 mcg/mL)

See also Administration

Dosing Considerations

Anaphylaxis

  • With severe persistent anaphylaxis, repeat injections with an additional autoinjector may be necessary
  • More than two sequential doses of epinephrine should only be administered under direct medical supervision

Pediatric

Dosage Forms & Strengths

autoinjector (EpiPen, Twinject, Adrenaclick, Auvi-Q)

  • 0.15mg
  • 0.3mg

injectable solution

  • 0.1mg/mL (1:10,000)
  • 1mg/mL (1:1000)

Asystole/Pulseless Arrest (Off-label)

1:10,000 solution: 0.01 mg/kg (0.1 mg/mL) IO/IV; not to exceed 1 mg; repeat q3-5min until return of spontaneous circulation

0.1 mg/kg (0.1 mL/kg of 1:1000 solution; 1 mg/mL) endotracheal; not to exceed 2.5 mg q3-5min until IO/IVP access established or spontaneous circulation achieved; flush with 5 mL of normal saline immediately after administration

Symptomatic Bradycardia (Off-label)

1:10,000 solution: 0.01 mg/kg IO/IV q3-5min; not to exceed 1 mg

1:1,000 solution: 0.1 mg/kg (0.1mL/kg) of endotracheal q3-5min if necessary; flush each dose with at least 5 mL isotonic sodium chloride injection

Neonates (<28 days old): 0.01-0.03 mg/kg IVP (1:10,000 solution) q3-5min; higher doses not recommended

Neonate IV access not available: 0.05-0.1 mg/kg endotracheal tube (1:10,000 soluiton); lower doses not effective; follow each dose with at least 5 mL isotonic sodium chloride injection

Anaphylaxis

Indicated in emergency treatment of allergic reactions (Type I) including anaphylaxis

1:1000 solution

  • <30 kg (66lbs): 0.01 mg/kg (0.01 mL/kg) SC/IM, may not to exceed 0.3 mg (0.3 mL) per injection, repeated q5-10 min as necessary
  • ≥30 kg (66lbs): 0.3-0.5 mg/kg (0.3-0.5 mL) SC/IM, may not to exceed 0.5 mg (0.5 mL) per injection, repeated q5-10 min as necessary

Autoinjector

  • May repeat dose after 5-15 minutes if symptoms persist
  • AUVI-Q only: 7.5-15 kg (16.5-33 lb): 0.1 mg SC/IM once
  • Weight <30 kg: 0.15 mg (contents of 1 autoinjector) SC/IM once; may repeat dose q5-15min
  • Weight ≥30 kg: 0.3 mg (contents of 1 autoinjector) SC/IM once; may repeat dose q5-15min

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Epinephrine 0.25mg/1ml only for the indication prescribed.