Presentation and Status in Health Basket
25 X 1mg/ml
Parenteral drug products should be inspected visually for particulate matter and
discoloration prior to administration, whenever solution and container permit.
The recommended dosage is 0.2-1 ml, administered intramuscularly or
subcutaneously. Treatment should be started with a small dose and increased if
Subcutaneous is the preferred route of administration. If given intramuscularly,
injection into the buttocks should be avoided.
For bronchial asthma and certain allergic situations such as angioedema, urticaria, serum sickness and anaphylactic shock, adrenaline should be administered subcutaneously.
Bronchial Asthma in Children: 0.01 mg/kg body weight or 0.3 mg/m2 body surface to a maximum of 0.5 mg administered subcutaneously and repeated every 4 hours if required.
Cardiac Resuscitation: 0.5 ml (0.5 mg) diluted to 10 ml with sodium chloride injection, may be administered intravenously or intracardially to restore myocardial contractility. When used intracardially, external cardiac massage should be applied to permit the drug to enter the coronary circulation. The drug should be used only if attempts with physical or electromechanical methods have been unsuccessful.
Relief of respiratory distress due to bronchospasm. Rapid relief of hypersensitivity reactions to drugs and other allergens. Prolongation of the action of infiltration anesthetics. May be of value in restoring cardiac rhythm in cardiac arrest, however it is not used in cardiac failure or in hemorrhagic, traumatic or cardiogenic shock. Treatment of mucosal congestion of hay fever, rhinitis and acute sinusitis. Relief of bronchial asthmatic paroxysms. Symptomatic relief of serum sickness, urticaria and angioneurotic edema. Open-angle glaucoma. Relaxation of uterine musculature and inhibition of uterine contractions. Hemostatic agent in syncope due to complete heart block or carotid sinus hypersensitivity and for resuscitation in cardiac arrest following anesthetic accidents.
Known hypersensitivity to adrenaline or to any other ingredient of the preparation, or known hypersensitivity to sympathetic amines. Narrow-angle glaucoma, shock. Should not be used in most patients with arrhythmias and cerebral arteriosclerosis, where vasopressor drugs may be contraindicated, e.g., in thyrotoxicosis, in obstetrics when maternal blood pressure is in excess of 130/80. During general anesthesia with halogenated hydrocarbons or cyclopropane. Individuals with organic brain damage. In labor, because it may delay the second stage. Cardiac dilatation. Coronary insufficiency. With local anesthesia of certain areas, e.g., fingers and toes, because of the danger of vasoconstriction producing sloughing of tissue. Hyperthyroidism, hypertension, ischemic heart disease, diabetes mellitus.
See prescribing information for full details.
Use with caution in patients with ventricular fibrillation, prefibrillatory rhythm,
tachycardia, myocardial infarction, phenothiazine induced circulatory collapse and prostatic hypertrophy.
Adrenaline is ordinarily administered with extreme caution to patients who have a heart disease. Use of adrenaline with drugs that may sensitise the heart to
arrhythmias, e.g., digitalis, mercurial diuretics, or quinidine, ordinarily is not
recommended. Anginal pain may be induced by adrenaline in patients with coronary insufficiency.
Administer slowly with caution to elderly patients and to patients with hypertension, diabetes mellitus, hyperthyroidism and psychoneurosis. Use with extreme caution in patients with long-standing bronchial asthma and emphysema who have developed degenerative heart disease. (see also Contraindications).
Adrenaline may delay the second stage of labour by inhibiting contractions of the uterus.
Syncope has occurred following administration to asthmatic children.
In patients with Parkinsonian syndrome the drug increases rigidity and tremor. Intraarterial administration should be avoided since marked vasoconstriction may result in gangrene.
Intramuscular injection into the buttocks should be avoided as gas gangrene is a
Accidental injection into the hands or feet may result in loss of blood flow to the
affected area and should be avoided. If there is an accidental injection into these areas, advise the patient to go immediately to the nearest emergency room or hospital casualty department for treatment.
Local ischaemic necrosis can occur from repeated injections in one site.
Adrenaline injection contains sodium metabisulfite as a preservative. As with other sulfites, sodium metabisulfite may cause allergic-type reactions in certain susceptible patients, including anaphylactic symptoms and life-threatening or less severe asthmatic episodes. The overall prevalence of sulfite sensitivity in the general population is unknown and probably low. Sulfite sensitivity is seen more frequently in asthmatic than in non-asthmatic patients.
Adrenaline should be administered with caution to elderly people, to those with
cardiovascular disease, hypotension, diabetes, hyperthyroidism and to
Patients with long-standing bronchial asthma and emphysema who have developed degenerative heart disease should be given the drug with extreme caution.
Overdosage or inadvertent I.V. injection may cause cerebrovascular hemorrhage, due to a sharp rise in blood pressure.
Fatalities may also result from pulmonary edema, because of the peripheral
constriction and cardiac stimulation produced.
The potentially severe adverse reactions of adrenaline arise from its effect upon blood pressure and cardiac rhythm. Ventricular fibrillation may occur and severe hypertension may lead to cerebral hemorrhage and pulmonary edema. Symptomatic adverse reactions are anxiety, dyspnea, restlessness, palpitations, tachycardia, sweating, nausea and vomiting, respiratory difficulty, pallor, apprehension, nervousness, anxiety,sleeplessness, hallucinations, flushing or redness of face and skin, tremor, weakness,dizziness, headache and cold extremities, especially in hyperthyroid individuals. Biochemical effects include inhibition of insulin secretion, stimulation of growth hormone secretion, hyperglycemia (even with low doses), gluconeogenesis, glycolysis, lipolysis and ketogenesis, Psychomotor agitation, disorientation, impaired memory and psychosis may occur. Cardiac arrhythmias may follow administration of adrenaline. Accidental injection into hands or fingers resulting in peripheral ischemia has been reported. Patients may need treatment following accidental injection (see also precautions).
Adrenaline should not be administered with other sympathomimetic agents because of the danger of additive effects and increased toxicity. The effects of adrenaline may be potentiated by tricyclic antidepressants, certain antihistamines (e.g. diphenhydramine, tripelennamine and d-chlorpheniramine) and sodium L-thyroxine. Volatile liquid anesthetics such as halothane increase the risk of adrenaline-induced ventricular arrhythmias and acute pulmonary edema if hypoxia is present. Rapidly-acting vasodilators such as nitrites or alpha-blocking agents, or alpha-adrenergic blocking drugs may counteract the pressor effects of adrenaline. The vasoconstrictor and pressor effects of adrenaline, mediated by its alpha-adrenergic action, may be enhanced by concomitant administration of drugs with similar effects, such as ergot alkaloids or oxytocin. Adrenaline specifically reverses the antihypertensive effects of adrenergic neurone blockers such as guanethidine with the risk of severe hypertension. Severe hypertension and bradycardia may occur with non-selective beta-blocking drugs, such as propranolol. Propranolol also inhibits the bronchodilator effect of adrenaline. Patients on monoamine oxidase inhibitors should not receive sympathomimetic treatment. The risk of cardiac arrhythmias is higher when adrenaline is given to patients receiving digoxin or quinidine. Use of adrenaline with excessive dosage of digitalis, mercurial diuretics and other drugs that sensitize the heart to arrhythmias is not recommended. Adrenalin inhibits the secretion of insulin, thus increasing the blood glucose level. It may be necessary for diabetic patients receiving adrenaline to increase their dosage of insulin or oral hypoglycemic drugs. The patient’s ability to drive and use machines may be affected by the anaphylactic reaction as well as by possible adverse reactions to adrenaline.
Pregnancy and Lactation
Pregnancy: Adrenaline crosses the placenta. There is some evidence of a slightly increased incidence of congenital abnormalities. Injection of adrenaline may cause fetal tachycardia, cardiac irregularities, extrasystoles and louder heart sounds. In labor, adrenaline may delay the second stage. Adrenaline should only be used in pregnancy if the potential benefits to the mother outweigh the risks to the fetus.
Lactation: Adrenaline is secreted in breast milk but, as pharmacologically active plasma concentrations are not achieved by the oral route, the use of adrenaline in breastfeeding mothers is presumed to be safe.
Overdose or inadvertent intravascular injection of adrenaline may cause cerebral haemorrhage resulting from a sharp rise in blood pressure. Fatalities may also result from pulmonary oedema because of peripheral vascular constriction together with cardiac stimulation.
Manifestations: Manifestations include: cardiac arrhythmias leading to ventricular fibrillation and death, severe hypertension leading to pulmonary edema and cerebral hemorrhage.
Treatment: Combined α and β-adrenergic blocking agents (such as labetalol) may counteract the effects of adrenaline, or a Β-blocking agent may be used to treat any supraventricular arrhythmias, and phentolamine to control the α-mediated effects on the peripheral circulation. Rapidly acting vasodilators such as nitrates and sodium nitroprusside may also be helpful. If prolonged hypotension follows such measures, it may be necessary to administer another pressor drug, such as levarterenol.
Adrenaline overdose can also cause transient bradycardia followed by tachycardia, and these may be accompanied by potentially fatal cardiac arrhythmias. Treatment of arrhythmias may consist of administration of beta-adrenergic blocking drugs.
Immediate resuscitation support must be available.