Epinephrine
Epinephrine (adrenaline)
EpiPen, EpiPen Jr, Auvi-Q, Adrenaclick, Symjepi; many generic
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Summary
Classes
Common uses
Anaphylaxis (first-line; IM auto-injector for outpatient use)0, Cardiac arrest (ACLS)0, Severe bronchospasm0, Severe croup (racemic nebulized)0, Local hemostasis (vasoconstriction with local anesthetics)0, Anesthesia prolongation in regional/local blocks0
Pharmacy
Starting dose
Anaphylaxis IM 0.3-0.5 mg (adult) into lateral thigh, repeat q5-15 minutes prn; pediatric 0.01 mg/kg IM (max 0.3 mg, max 0.5 mg in adolescents); cardiac arrest 1 mg IV/IO q3-5 minutes; severe asthma neb 0.1 mg/kg up to 5 mg; never IV bolus for anaphylaxis outside critical care
Preparations
Auto-injectors 0.15 mg (Jr/pediatric), 0.3 mg (adult); 1 mg/mL (1:1,000) ampules for IM/SC use; 0.1 mg/mL (1:10,000) for IV use; 2.25% racemic nebulizer
US FDA Max
Indication-specific; ACLS no fixed cumulative ceiling
Pharmacology
Routes
IM, IV, SC (less common), nebulized, intracardiac (historical only), endotracheal (legacy ACLS, not preferred)
Onset
IM: 5-10 minutes; IV: seconds; nebulized: 5-10 minutes
Duration
5-15 minutes
Half-life
~2 minutes[1]
Bioavailability
IM/SC ~100%; oral negligible (extensive first-pass and gut metabolism — hence the no-oral route)[1]
Pregnancy
Used in life-threatening obstetric anaphylaxis without hesitation; benefits clearly outweigh.[citation needed]
Legal status
Rx-only in US
Purported mechanism
Epinephrine is a non-selective α1, α2, β1, β2 adrenergic agonist; in anaphylaxis the integrated effects — α1-mediated vasoconstriction (raising BP, reducing mucosal edema), β1-mediated cardiac stimulation, β2-mediated bronchodilation, and inhibition of mast cell and basophil mediator release — make it the only first-line therapy that simultaneously addresses every system involved.0 The narrow safe-bolus window for IV use (sharp risk of arrhythmia, hypertensive emergency, intracerebral hemorrhage) is why anaphylaxis dosing is IM, not IV, outside critical care[1].
References
- ↑ 1.0 1.1 1.2 FDA Prescribing Information, EpiPen (epinephrine), Mylan/Viatris, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/019430s062lbl.pdf