Epinephrine

EPIPEN

Open Epinephrine in the interactive console ↗

Pronunciation: ep-i-NEF-rin

Epinephrine ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Epinephrine ballicule

What it isEndogenous catecholamine with alpha and beta agonism; anaphylaxis, cardiac arrest and severe asthma.

Why this oneIt is the only drug that treats every element of anaphylaxis at once.

What limits itIn anaphylaxis it is intramuscular into the thigh, and delay is the main cause of death — there is no reason to wait.

Epinephrine molecular structure (skeletal formula) — Molecular structure: Epinephrine

FDA-approved for

anaphylaxis (~1939)

FDA label

Read the full label on DailyMed ↗

FDA dosing	Population	Start	Target	Max
Hypotension associated with septic shock	adult	IV infusion 0.05 mcg/kg/min	0.05–2 mcg/kg/min, titrated to target MAP	2 mcg/kg/min

Titration May adjust every 10–15 min in increments of 0.05–0.2 mcg/kg/min to reach target MAP.

Renal Undefined

Hepatic Undefined

Instructions

Continuous IV infusion into a large vein; ready-to-use, no further dilution
Avoid catheter tie-in technique and leg veins in elderly/occlusive vascular disease
Check infusion site frequently; avoid extravasation (tissue necrosis)
Wean gradually

Available strengths

auto-injector 0.15, 0.3 mg

Cautions

Acute severe hypertension
Pulmonary edema (may be fatal)
Cardiac arrhythmias and myocardial ischemia (esp. with heart disease)
Extravasation → local tissue necrosis
Oliguria / renal impairment
Sulfite allergy
MAOIs due to risk of hypertension

Adverse reactions

Tachycardia / arrhythmias (incl. ventricular fibrillation)
Stress cardiomyopathy, myocardial ischemia/infarction
Limb ischemia
Pulmonary edema, hypertension
Headache, tremor, anxiety
Hypokalemia, lactic acidosis
Diaphoresis, skin necrosis with extravasation

Pregnancy Decades of use identify no drug-associated risk of major birth defects/miscarriage; do not delay treatment for shock.

Lactation Low milk transfer expected (poor oral bioavailability, short half-life); do not delay treatment.

Cost

Epinephrine (EPIPEN)

Strength		#/mo	generic $/unit	CostPlus
0.15 mg	auto-injector	per unit		not offered
0.3 mg	auto-injector	per unit		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Epinephrine is dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

Available combined with: Articaine (SEPTOCAINE)

Generic entry1984

NO BOXED WARNINGS

Principal riskDelay is the main cause of death in anaphylaxis

Classes and tags

Clinical profile

Therapeutic safety burden1 / 4

Overdose danger2 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk1 / 4

Legacy pregnancy categoryC

Defining liabilityTremor, tachycardia or anticholinergic effects; excessive beta-agonist exposure can cause hypokalemia and arrhythmia.

Open Epinephrine in the interactive console ↗