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Adrenalin (epinephrine in sodium chloride)

EPINEPHRINE IN SODIUM CHLORIDE

Manufacturer: Endo USA, Inc.

Score: 141.0

Quick Summary

Adrenalin (epinephrine in sodium chloride) is a sympathomimetic catecholamine used to increase mean arterial blood pressure in adult patients with hypotension associated with septic shock. It acts on both alpha and beta-adrenergic receptors, causing a 3-fold mechanism of action: direct myocardial stimulation, increased heart rate, and peripheral vasoconstriction. The drug is administered by intravenous infusion, with a suggested dosing rate of 0.05 mcg/kg/min to 2 mcg/kg/min, titrated to achieve a desired mean arterial pressure. Important safety information includes the risk of hypertension, pulmonary edema, cardiac arrhythmias, and extravasation and tissue necrosis. Special population considerations include use during pregnancy, pediatric use, and geriatric use.

Key Clinical Findings and Indications

  • Increase mean arterial blood pressure in adult patients with hypotension associated with septic shock
  • Acts on both alpha and beta-adrenergic receptors
  • Causes a 3-fold mechanism of action: direct myocardial stimulation, increased heart rate, and peripheral vasoconstriction

Important Safety Information

Warning

Risk of hypertension, pulmonary edema, cardiac arrhythmias, and extravasation and tissue necrosis

Contraindications

Adverse Reactions

  • Hypertension
  • Pulmonary edema
  • Cardiac arrhythmias and ischemia
  • Extravasation and tissue necrosis
  • Renal impairment
  • Tachycardia
  • Supraventricular tachycardia
  • Ventricular arrhythmias
  • Myocardial ischemia
  • Myocardial infarction
  • Limb ischemia

Dosing Recommendations

General Guidance

Titrate dose every 10 to 15 minutes in increments of 0.05 mcg/kg/min to 0.2 mcg/kg/min to achieve desired blood pressure goal

Hypotension associated with septic shock

Adult Dose

0.05 mcg/kg/min to 2 mcg/kg/min, titrated to achieve a desired mean arterial pressure

Pediatric Dose

Not established

Special Population Considerations

Pregnancy

  • Limited published data on epinephrine use in pregnant women
  • Risk of teratogenic effects, embryonic lethality, and delayed skeletal ossification

Nursing Mothers

Pediatric Use

  • Safety and effectiveness not established

Geriatric Use

  • Dose selection should be cautious, usually starting at the low end of the dosing range
  • Greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy

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