Adrenaline (epinephrine): An important drug in emergency resuscitation

Adrenaline (also known as epinephrine) is a drug widely used in resuscitation and emergency. So how is adrenaline used and what should be noted when using it? Let's learn the necessary information about drugs through the following SignsSymptomsList article.

Drugs containing similar ingredients: Adrenalin, Adretop,…

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• What is adrenaline (epinephrine)?
• What does adrenaline (epinephrine) do?
• Instructions for taking adrenaline (epinephrine)
• Contraindications Adrenaline (epinephrine)
• Precautions while using adrenaline
• How to manage Adrenaline (epinephrine) side effects
• Drug interactions when taking adrenaline
• Treatment of an overdose of adrenaline (epinephrine)
• For pregnant and lactating women
• How to store adrenaline?

What is adrenaline (epinephrine)?

Drug information Adrenaline (epinephrine)

Adrenaline (epinephrine) comes in the following forms:

• 0.1 mg/ml injection solution or 1 mg/ml adrenaline as the hydrochloride salt.
• 1% eye drops solution.
• 280 mcg adrenaline acid tartrate spray/spray..
• Aerosol solution: 0.22 mg/spray.
• Combination drugs with anti-asthma drugs
• Drugs in combination with other drugs.

How much does Adrealin cost?

• Packing: Box of 10 tubes x 1ml/mg.
• Dosage form: Solution for injection.
• Type of drug: Sold by prescription.
• Reference price: 4,000 VND/tube.

Learn about the drug Adrenaline (epinephrine)

What does adrenaline (epinephrine) do?

The appointment and use of adrenaline must be performed by experienced doctors and nurses. Accordingly, the effects of adrenaline are as follows:

• Cardiopulmonary resuscitation.
• Emergency treatment for anaphylactic and anaphylactoid shock (with systemic vasodilatation and low cardiac output), emergency cardiac arrest .
• Malignant asthma (in combination with other drugs such as glucocorticoids, salbutamol).
• Primary open-angle glaucoma.
• Used topically to prevent bleeding of the skin surface and mucous membranes of the eyes, nose, mouth, oropharynx during surgery.
• In combination with local anesthetics and spinal anesthesia to reduce systemic absorption and prolong the duration of action.

Adrenaline (epinephrine) is used as directed by your doctor

Instructions for taking adrenaline (epinephrine)

How to use

The appointment and use of adrenaline (epinephrine) must be performed by an experienced doctor and nurse.

• Adrenaline injection solution: Can be used intramuscularly, intravenously, intraocularly, subcutaneously or endotracheally. Subcutaneous injections are usually absorbed more slowly and are less effective. Intramuscular injection should be avoided in the buttock, and should be administered in the anterolateral area of ​​the thigh in case of anaphylaxis. Intravenous injection of undiluted adrenaline is strictly prohibited.
• Inhalation form: Solution to be diluted, inhaled for 15 minutes or more.
• Endotracheal: Mix the drug in distilled water. As the catheter passes through the tip of the tracheal tube, spray the drug rapidly into the trachea, immediately pump several times rapidly and continue chest compressions.

Adrenaline mixing and dosage must be calculated according to the severity and response of each patient.

Dosage

Here are some suggested doses of adrenaline (epinephrine). However, before using the drug, you need to listen to the treatment instructions of your doctor. Never self-medicate without medical advice.

Anaphylaxis

Adrenaline (epinephrine) is the drug of choice for the treatment of anaphylaxis with the following dosage:

• The recommended initial dose in adults is 0.3 to 0.5 ml of a solution of 1 mg/ml subcutaneously or intramuscularly, repeated every 20 or 30 minutes.
• If intramuscular or subcutaneous injection has no effect, intravenous administration must be given; intravenous dose is from 3 to 5 ml of 0.1 mg/ml solution; times are 5 to 10 minutes apart.
• If heart failure is severe, adrenaline must be injected directly into the heart.
• In the event of shock, severe dyspnea or when there is airway obstruction, intravenous administration is recommended.

Heart stop

Adrenaline is the drug of choice for the treatment of cardiac arrest at the following dosages:

• The commonly recommended dose is 0.5 to 1 mg intravenously, 3 to 5 minutes apart. In patients who have had cardiac arrest before admission, much higher doses (up to 5 mg intravenously) may be required.
• Continuous adrenaline infusion (0.2 to 0.6 mg/min) may be given, if necessary.
• It is also possible to inject 0.1 to 1.0 mg of adrenaline directly into the heart in a few ml of saline or isotonic glucose solution.
• Intravenous, tracheal, or cardiac administration of adrenaline is effective in the treatment of cardiac arrest due to ventricular fibrillation. Adrenalin is mainly used in cases where the treatment of ventricular fibrillation with electric shock has failed.
• The recommended dose in children is 7 to 27 micrograms/kg (mean 10 mcg/kg).

Learn Dosage and Administration of Adrenalin (epinephrine)

Contraindications Adrenaline (epinephrine)

Adrenaline (epinephrine) should not be used in the following cases:

• Anesthetized with cyclopropan, halothane or halothane-type anesthetics because it can cause ventricular fibrillation .
• Are taking an MAO inhibitor within 2 weeks.
• People with severe cardiovascular disease , people with dilated cardiomyopathy, coronary heart failure.
• Obstructive urinary retention.
• Narrow angle glaucoma, patients are at risk of closed angle glaucoma.
• Brain damage, shock not due to anaphylaxis: do not use injection form.
• General contraindications to vasopressors: Diabetes , patients with hyperthyroidism, high blood pressure, pregnant women with blood pressure above 130/80 (except in the case of combination with local anesthetics at local anesthetics). site to reduce absorption and prolong duration of action).
• Hypersensitivity to sympathomimetic amines.
• Concomitant use of local anesthetic injections in certain areas such as fingers, toes, and ears may increase the risk of vasoconstriction and scaling in those tissues.

For people in need of emergency treatment for anaphylaxis, there is no absolute contraindication to the use of adrenaline.

Precautions while using adrenaline

Intravenous injection of undiluted adrenaline (epinephrine) is strictly prohibited .

Use with caution in humans:

• Hypersensitive to adrenaline, especially people with hyperthyroidism.
• Cardiovascular disease (myocardial ischemia, arrhythmia or tachycardia), obstructive vascular disease (atherosclerosis, hypertension, aneurysm). Chest pain in a patient who has had angina.
• Have diabetes or narrow angle glaucoma.
• Are taking cardiac glycosides, quinidine, tricyclic antidepressants.

Rapid intravenous injection may result in death due to cerebral hemorrhage or cardiac arrhythmia. However, in the event of cardiac arrest with loss of pulse, rapid intravenous administration is required.

Do not instill adrenaline solution into the eyes of patients with narrow-angle glaucoma or patients at risk of developing angle-closure glaucoma. Instilling too much adrenaline can cause a rebound congestion and increased rhinorrhea.

Avoid using topically in the extremities, ears, penis... because reduced perfusion of these areas can cause damage to congestive tissue. Accidental injection into toes, fingers, hands, feet can cause local reactions such as cyanosis, cold, loss of sensation, bruising, bleeding, erythema, bone damage. If the above symptoms occur, seek medical attention immediately.

What should be noted when using adrenaline (epinephrine) in treatment?

How to manage Adrenaline (epinephrine) side effects

Adrenaline side effects

Frequent:

• Body as a whole: Headache, fatigue, sweating.
• Cardiovascular: Tachycardia, increased blood pressure, palpitations, palpitations.
• Nervous: Tremor, anxiety, dizziness, headache, paresthesia.
• Digestion: Profuse salivation.
• Skin: pale, sweating.

Less common:

• Cardiovascular: Ventricular arrhythmia.
• Gastrointestinal: Anorexia, nausea, vomiting.
• Nervous: Fear, restlessness, insomnia, excitability.
• Urogenital - Genitourinary: Difficulty urinating, urinary retention.
• Respiratory: Shortness of breath, pulmonary edema.

Rarely:

• Cardiovascular: Cerebral hemorrhage, pulmonary edema (due to hypertension), gangrene (due to vasoconstriction), arrhythmia, angina pectoris, hypotension, dizziness, fainting, cardiac arrest, tissue necrosis (caused by adrenaline escaping into blood vessels when injected).
• Neurological: Confusion, psychosis, cerebral hemorrhage.
• Metabolic disorders: especially glucose metabolism.

How to deal with Adrenalin side effects?

• Accidental injection into toes, fingers, hands, feet can cause local reactions such as cyanosis, cold, loss of sensation, bruising, bleeding, erythema, bone damage. If the above symptoms occur, seek medical attention immediately.
• It is necessary to stop the drug and consult a doctor when signs such as increased sensitivity or discomfort appear and increase during the use of the drug during surgery.
• Treatment when drugs leak into the blood vessels: use phentolamine as an antidote, and do it by a doctor. After the injection, the pale spot will disappear. Monitor that area, if recurrence can be injected more phentolamine.
• During administration (and continuous infusion), pulmonary function, cardiac function, blood pressure, degree of pallor at the infusion site, extravasation should be monitored.
• If used to treat hypotension, the intravascular volume should be assessed.

Drug interactions when taking adrenaline

• Non-selective beta-blockers such as propranolol; MAO inhibitors; Rauwolfia alkaloids: altering the hypertensive effect of adrenaline. A significant, life-threatening hypertensive reaction and/or bradycardia may occur.
• Volatile anesthetics (cyclopropan, enfluran, halothan, isoflurane, fluroxen, methoxyflurane, diethyl ether): risk of cardiac arrhythmias if adrenaline is co-administered, unless in very small doses. Children suffer less.
• Tricyclic antidepressants: make patients respond very strongly to adrenaline (increased blood pressure, arrhythmia...).
• Ephedra, yohimbin: Avoid concomitant use because it can cause central nervous system stimulation.

Treatment of an overdose of adrenaline (epinephrine)

Because adrenaline is deactivated very quickly in the body, the harmful effects of adrenaline are short-lived. The treatment of toxic reactions in patients who are sensitive to the drug or due to overdose is mainly supportive. Immediately go to the nearest medical facility for timely treatment.

For pregnant and lactating women

Pregnant women

Adrenalin crosses the placenta and enters the fetal blood in very small amounts, which may not cause malformations in the fetus. Taking adrenaline during the last months of pregnancy or during delivery can cause hypoxia to the fetus. Adrenaline should be used during pregnancy only when the potential benefits outweigh the possible risks to the fetus.

Breastfeeding Women

It is not known whether the drug passes into breast milk or not, so it should be used with caution.

How to store adrenaline?

• Adrenaline is sensitive to light and air. Store the medicine in the refrigerator (2 – 8 °C), not in a hot place and protected from light.
• It must be discarded if the medicine turns brown-pink or has residue.

Adrenalin (epinephrine) is a drug widely used in cardiopulmonary resuscitation, anaphylaxis emergency... Above are the reference information from SignsSymptomsList about Adrenalin. If you have any problems, contact your dermatologist or pharmacist for specific advice.