Epinephrine 0.25mg/1ml

Epinephrine 0.25mg

Warnings

Contraindications

There are no contraindications for life-threatening situations

Nonanaphylactic shock

Narrow-angle glaucoma

Coadministration during genral anesthesia with halogenated hydrocarbons or cyclopropane

Labor

Situations where vasopressors may be contraindicated, including thyrotoxicosis, diabetes

Maternal blood pressure in excess of 130/80 mm Hg in hypertension and other cardiovascular disorders

Cautions

Use caution in patients with cardiac disease, angina (especially with history of CAD) or that are receiving drugs that sensitize the myocardium; treatment may induce cardiac arrhythmias

Pulmonary edema may occur as the result of cardiac stimulation and peripheral constriction

Decreased urine output may occur as the result of renal blood vessel constriction

Use caution in cerebrovascular insufficiency

Use with caution in patients with hypertension, diabetes mellitus, thyroid disease, prostatic hypertrophy, geriatric patients, pregnancy, and previous hospitalization for asthma

Rapid IV administration, although necessary in pulesless arrest, may cause death from cerebrovascular hemorrhage or cardiac arrhythmias

Patients that are sulfite-sensitive, should still be treated during a serious allergic reaction or other emergency even if products available contain sulfites

May cause worsening of symptoms in patients with Parkinson disease

Avoid extravasation; ensure proper needle or catheter placement prior to and during infusion

Correct blood volume depletion before administering any vasopressor

Rare cases of serious skin and soft tissue infections, including necrotizing fasciitis and myonecrosis caused by Clostridia (gas gangrene), reported at injection site following injection for anaphylaxis; to decrease risk, do not inject into buttock; advise patients to seek medical care if they develop signs or symptoms of infection, such as persistent redness, warmth, swelling, or tenderness, at epinephrine injection site; cleansing with alcohol does not kill bacterial spores, and therefore, does not lower risk of infection

Multiple-dose vial not for ophthalmic use; contains chlorobutanol which may be harmful to corneal endothelium

Solutions must be diluted prior to intraocular use; other epinephrine products containing sodium bisulfite have been associated with corneal endothelial damage when used in the eye at undiluted concentrations (1 mg/mL)

Autoinjector is to be used in conjunction with immediate medical or hospital care; more than two sequential doses of epinephrine should only be administered under direct medical supervision

Extravasation

  • Avoid extravasation; ensure proper needle or catheter placement prior to and during infusion
  • To prevent sloughing and necrosis in areas has extravasation, infiltrate the area with 10-15 mL of 0.9% NaCl solution containing phentolamine 5-10 mg
  • Use a syringe with a fine hypodermic needle, with solution being infiltrated liberally throughout the area, which has a cold, hard, and pallid appearance
  • Phentolamine may cause immediate and conspicuous local hyperemic changes if area is infiltrated within 12 hr

Injection related complications

  • Injection into buttock may not provide effective treatment of anaphylaxis
  • Accidental injection into hands, digits, or feet may result in local reactions including injection site coldness, pallor, and hypoesthesia or injury resulting in bruising, discoloration, erythema, bleeding, or skeletal injury
  • To minimize the risk of injection-related injury when administering autoinjector to children or infants, instruct caregivers to firmly hold child’s leg in place and limit movement prior to and during injection

Drug interactions overview

  • Coadministration with cardiac glycosides, diuretics, or anti-arrhythmics should be observed carefully for the development of cardiac arrhythmias
  • Effects of epinephrine may be potentiated by tricyclic antidepressants, monoamine oxidase inhibitors, levothyroxine sodium, and certain antihistamines, notably chlorpheniramine, tripelennamine, and diphenhydramine
  • Cardiostimulating and bronchodilating effects of epinephrine are antagonized by beta-adrenergic blocking drugs, such as propranolol
  • Vasoconstricting and hypertensive effects of epinephrine are antagonized by alpha-adrenergic blocking drugs, such as phentolamine
  • Ergot alkaloids may reverse the pressor effects of epinephrine

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.