MASSACHUSETTS GENERAL HOSPITAL

Department of Pharmacy

Department of Nursing

Critical Care

Generic Name : Epinephrine

Trade Name : Adrenalin®

Action : Adrenergic agonist

Indications:

Ventricular fibrillation
Asystole
Bronchospasm/Upper airway edema
Anaphylaxis
Hypotension
Low cardiac output

Administration Guidelines:

Usual Dosage Range and Route:

Anaphylaxis: 0.5 - 1.0 mg SQ (1:1000 Ampule 1 ml)

Asystole, V-FIB: 0.5 - 1.0 mg IVP (1:10,000 Syringe 10 ml)

5 - 10 mg IVP FOR CARDIAC ARREST

Maintenance: 1 - 12 mcg / minute IV infusion as titrated to patient response

Bronchospasm: IV infusion 0 . 25-1 mcg/minute as titrated to patient response

Upper Airway Edema : Nebulized (inhalation) epinephrine 1:1000 (l-isomer) is 2 . 5-5 mls, then diluted for nebulization (inhalation). Reduce for patients with cardiac disease (e.g., AF)

Invasive blood pressure monitoring (e.g. a-line) should be considered when centrally administered vasoactive agents are used or when frequent changes in infusion rate are required.

Standard Concentrations:

Central maximum : 8 mg / 250 ml

Syringe based, variable flow, continuous microinfusuon pump : 1 mg / 50 ml, 50mg/50ml

Peripheral: *Central line required for administration ; Only in cases of emergency or extenuating circumstances; epinephrine may be given peripherally using the 2 mg / 250 ml concentration while preparation for central line is underway.

EW Standard: 8 mg / 250 mL Central maximum

Peripheral: *Central line required for administration ; Only in cases of emergency or extenuating circumstances; epinephrine may be given peripherally using the 2 mg / 250 ml concentration while preparation for central line is underway.

Special Considerations:

- Should be used with extreme caution in patients with ischemic heart disease

- PA line monitoring of cardiac output, and filling pressures is encouraged during maintenance infusions.

-Do not use in patients with droperidol induced hypotension: may result in a paradoxical lowering of BP

Precautions and Side Effects:

- Hypertension

- Tachycardia, Palpitations, Arrhythmias

- Angina

- Agitation, Restlessness, Headache

- Cerebral Hemorrhage

rev: 04/08