Adrenaline, 0.1% 1 ml 5 pcs

How to take, the dosage

Subcutaneously, intramuscularly, intravenously drip.

Allergic reactions of immediate type (anaphylactic shock): intravenously slowly 0.1-0.25 mg diluted in 10 ml of 0.9% sodium chloride solution, if necessary continue intravenous drip infusion at a concentration of 1:10000. If there is no immediate threat to life, intramuscular or subcutaneous administration of 0.3-0.5 mg is preferable, if necessary, repeated administration after 10-20 minutes up to 3 times.

Bronchial asthma: subcutaneously 0.3-0.5 mg, if necessary repeated doses can be given every 20 minutes up to 3 times, or intravenously 0.1-0.25 mg with dilution at a concentration of 1:10000.

In asystole: intracardiac 0.5 mg (diluted with 10 ml of 0.9% sodium chloride solution or other solution); during resuscitation, 0.5-1 mg (diluted) intravenously every 3-5 minutes. If the patient is intubated, endotracheal instillation is possible – the doses should be 2-2.5 times the doses for intravenous administration.

Stopping bleeding: locally in the form of swabs moistened with the drug solution.

In case of arterial hypotension: intravenous drip 1 mcg/min, the rate of administration can be increased to 2-10 mcg/min.

To prolong the action of local anesthetics:at a concentration of 0.005 mg/ml (the dose depends on the type of anesthetic used), for spinal anesthesia 0.2-0.4 mg.

Morgany-Adams-Stokes syndrome (bradyarrhythmic form) at a dose of 1 mg in 250 mL of 5% glucose solution intravenously, gradually increasing the infusion rate until a minimum adequate heart rate is achieved.

As a vasoconstrictor: Intravenous drip 1 mcg/min, the infusion rate can be increased to 2-10 mcg/min.

Application in pediatric practice:

Infants (asystole): intravenously, 10-30 mcg/kg every 3-5 minutes, slowly.

Children over 1 month: intravenously, 10 mcg/kg (thereafter, 100 mcg/kg every 3-5 minutes if necessary (after at least 2 standard doses, higher doses of 200 mcg/kg can be used every 5 minutes). Endotracheal administration can be used.

Children in anaphylactic shock: subcutaneously or intramuscularly 0.01 mg/kg (up to 0.3 mg max), if necessary these doses are repeated every 15 minutes (up to 3 times).

Children with bronchospasm: subcutaneously 10 mcg/kg (up to a maximum of 0.3 mg), doses repeated every 15 minutes (up to 3-4 times) or every 4 hours if necessary.

Interaction

Epinephrine antagonists are α- and β-adrenoceptor blockers.

The effectiveness of epinephrine is reduced in patients with severe anaphylactic reactions taking β-adrenoblockers. In this case salbutamol is administered intravenously.

Combination with other adrenomimetics may increase the effect of epinephrine.

It reduces the effects of narcotic analgesics and hypnotics.

When used simultaneously with cardiac glycosides, quinidine, tricyclic antidepressants, dopamine, agents for inhalation anesthesia (enflurane, halothane, isoflurane, methoxyflurane), cocaine the risk of arrhythmias increases (use with extreme caution or not use at all); with other adrenomimetics – increased intensity of side effects of the cardiovascular system; with antihypertensive agents – decrease of their effectiveness.

With diuretics – possible increase of pressor effect of epinephrine.

Simultaneous use with drugs that inhibit monoamine oxidase (procarbazine, selegiline), as well as with furazolidone may cause a sudden and significant increase in blood pressure, hyperpyretic crisis, headache, arrhythmia, vomiting; with nitrates – weakening of their therapeutic effect; with phenoxybenzamine – increased antihypertensive effect and tachycardia; with phenytoin – sudden decrease in blood pressure and bradycardia (depending on the dose and speed of administration); with thyroid hormone drugs – mutual enhancement of action. With drugs that prolong the QT-interval (with antiarrhythmic drugs (such as lidocaine, amiodarone, sotalol, etc.), with antibiotics (such as erythromycin, levofloxacin, etc.), and with antihistamines.), with antihistamines (such as loratadine, dimedrol, etc.), with tricyclic and tetracyclic antidepressants (such as amitriptyline, imipramine, sertraline, chlorpromazine, etc.), with tetracyclic and tetracyclic antidepressants (such as amitriptyline, imipramine, sertraline, chlorpromazine, etc.).), with neuroleptics (such as haloperidol, risperidone, etc.), with dopamine receptor antagonists (such as domperidone, etc.), with antimalarials (such as chloroquine, mefloquine, etc.), with antifungals (such as ketoconazole, fluconazole, etc.), with antihypertensive drugs (such as indapamide, ephedrine, etc.) –

Concomitant use with diatriazote, iothalamic or yoxagolic acids – increased neurological effects, with ergot alkaloids – increased vasoconstrictor effect (up to severe ischemia and gangrene development).
Reduces the effect of insulin and other hypoglycemic drugs.

Special Instructions

The determination of serum potassium ion concentration (K⁺), measurement of blood pressure, diuresis, minute volume of circulation, electrocardiogram, central venous pressure, pulmonary artery pressure and pulmonary capillary wedging pressure are recommended during treatment.

The excessive doses of epinephrine in myocardial infarction may exacerbate ischemia by increasing myocardial oxygen demand.

Epinephrine increases plasma glucose levels, requiring higher doses of insulin and sulfonylurea derivatives in diabetics.

The use of epinephrine is inadvisable for the long term (narrowing of peripheral blood vessels, leading to possible development of necrosis or gangrene).

The use to correct reduced blood pressure during labor is not recommended because it may delay the second period of labor; if administered in high doses to weaken uterine contractions, it may cause prolonged uterine atony with bleeding.

Doses should be reduced gradually when discontinuing treatment, since abrupt withdrawal of therapy can lead to severe arterial hypotension.

It is easily broken down by alkalis and oxidizing agents. Sodium metabisulfite, a component of the drug, may cause an allergic reaction, including symptoms of anaphylaxis and bronchospasm, especially in patients with a history of asthma or allergies. Epinephrine should be used with caution in patients with tetraplegia because of the increased sensitivity of such individuals to epinephrine.

The rapid increase in blood pressure when using epinephrine can lead to hemorrhage, especially in elderly patients with cardiovascular disease.

Patients with Parkinson’s disease may have psychomotor agitation or temporary worsening of symptoms when using adrenaline, and therefore caution should be exercised when using adrenaline in this population.

Do not inject repeatedly into the same areas to avoid development of tissue necrosis. Injection into the gluteal muscles is not recommended.

Epinephrine should be used with caution in elderly patients, patients with coronary heart disease, arterial hypertension, diabetes mellitus, hyperthyroidism, prostatic hyperplasia and urinary disorders.

Particular caution should be exercised when using epinephrine in patients with long-standing bronchial asthma, pulmonary emphysema, and organic heart disease (pulmonary heart disease).

Epinephrine may cause cardiac rhythm disturbances and myocardial ischemia, especially in patients with coronary heart disease or cardiomyopathy.

Epinephrine increases cardiac output and causes peripheral vasoconstriction, which may lead to pulmonary edema.

Epinephrine causes narrowing of the renal arterioles, which can lead to oliguria and renal failure.

Intramuscular injection of epinephrine should be given into the anterolateral surface of the thigh (in the lateral broad muscle of the thigh). Injection into smaller muscles (e.g. deltoid) is not recommended.

Rare cases of severe skin and soft tissue infections, including Clostridia necrotizing fasciitis and muscle necrosis (gas gangrene), at the site of epinephrine administration for anaphylaxis have been described. Patients should be warned to seek medical attention immediately if symptoms of infection, such as persistent redness, increased skin temperature, swelling, or soreness at the site of epinephrine injection occur.

The drug should not be injected into the vessels of the fingers, hands and feet because epinephrine is a powerful vasoconstrictor and can lead to poor blood supply and tissue necrosis (gangrene).

Do not use the drug if there is a discoloration or residue in the solution. The unused portion of the solution should be disposed of.

Influence on the ability to drive vehicles, mechanisms

After using the drug the doctor shall decide on a case-by-case basis whether the patient is allowed to drive vehicles or engage in other potentially dangerous activities requiring increased concentration and quick psychomotor reactions.

Synopsis

A clear colorless or yellowish liquid with a characteristic odor.

Contraindications

• hypersensitivity to any of the ingredients of the drug;
• hypertrophic obstructive cardiomyopathy, tachyarrhythmia, ventricular fibrillation, chronic heart failure stages II B – III;
• pheochromocytoma;
• acute and chronic arterial insufficiency;
• hyperkalemia;
• shock of non-allergic genesis (including cardiogenic, traumatic, hemorrhagic);
• cold trauma;
• organic brain damage;
• closed angle glaucoma;
• children under 18 years of age (except for conditions immediately life-threatening);
• pregnancy, breastfeeding period;
• current use of inhaled general anaesthetic agents (halothane).

The use of epinephrine in combination with local anesthetics is not recommended for local anesthesia in fingers and toes because of the risk of ischemic tissue damage.

In emergency conditions, all contraindications are relative.

With caution

• metabolic acidosis;
• coronary heart disease;
• arterial hypertension;
• hypercapnia, hypoxia;
• atrial fibrillation;
• ventricular arrhythmia;
• pulmonary hypertension;
• hypovolemia;
• myocardial infarction;
• vascular occlusive disease (including.ч. history of arterial embolism, atherosclerosis, Buerger’s disease, diabetic endarteritis, Raynaud’s disease);
• diabetes mellitus;
• hyperthyroidism;
• old bronchial asthma and emphysema;
• cerebral atherosclerosis;
• Parkinson’s disease;
• tetraplegia;
• convulsive syndrome;
• prostate hyperplasia and/or difficulty urinating;
• older age;
• paresis and paralysis;
• increased tendon reflexes in spinal cord injury.

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Side effects

The incidence of side effects was determined according to the World Health Organization classification: very common (≥ 1/10), common (≥ 1/100, < 1/10), infrequent (≥ 1/1000, < 1/100), rare (≥ 1/10000, < 1/1000), very rare (< 1/10000), including individual reports.

Immune system disorders: infrequent– angioedema, bronchospasm, skin rash, erythema multiforme.

Nervous system disorders: often – headache, anxiety, tremor, tics;not infrequently – dizziness, nervousness, fatigue, nausea, vomiting, personality disorders (psychomotor agitation, disorientation, memory disturbance, psychotic disorders: aggressive or panic behavior, schizophrenic-like disorders, paranoia), sleep disturbance, muscle twitching.

Cardiac disorders: infrequent– angina pectoris, bradycardia or tachycardia, palpitations, increased or decreased blood pressure, at high doses – ventricular arrhythmias (including ventricular fibrillation); frequently– arrhythmias, chest pain, pulmonary edema.

vascular disorders: infrequent increase or decrease in blood pressure; rare – pulmonary edema.

Gastrointestinal tract disorders: frequently – nausea, vomiting.

Skin and subcutaneous tissue disorders: infrequent – increased sweating.

Recreational and urinary tract disorders: rarely – difficulty and painful urination (with prostatic hyperplasia).

General disorders and disorders at the site of injection: infrequent – pain or burning at the site of intramuscular injection.

Laboratory and instrumental findings: rarely – hypokalemia.

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