Epinephrine Dosage

The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for Shock

IV: 2 to 10 mcg/min (1 mg in 250 mL of D5W or 4 mcg/mL). May increase as necessary to establish an adequate heart rate and blood pressure. Rarely doses as high as 20 mcg/min are required.

Endotracheal: 1 mg (10 mL of 1:10,000) once, followed by 5 quick insufflations.

Intracardiac: 0.3 to 0.5 mg (3 to 5 mL of 1:10,000) by direct injection into the left ventricular chamber once.

Usual Adult Dose for Asystole

IV: 0.5 to 1 mg (5 to 10 mL of 1:10,000) once.
May be repeated every 3 to 5 minutes as necessary.
If there is inadequate response to 1 mg, then high dose therapy (2 to 5 mg) every 3 to 5 minutes, escalating 1, 3, then 5 mg every 3 minutes, or 0.1 mg/kg every 3 to 5 minutes, has been used.

Endotracheal: 1 mg (10 mL of 1:10,000) once, followed by 5 quick insufflations.

Intracardiac: 0.3 to 0.5 mg (3 to 5 mL of 1:10,000) by direct injection into the left ventricular chamber once.

Usual Adult Dose for Electromechanical Dissociation

IV: 0.5 to 1 mg (5 to 10 mL of 1:10,000) once.
May be repeated every 3 to 5 minutes as necessary.
If there is inadequate response to 1 mg, then high dose therapy (2 to 5 mg) every 3 to 5 minutes, escalating 1, 3, then 5 mg every 3 minutes, or 0.1 mg/kg every 3 to 5 minutes, has been used.

Endotracheal: 1 mg (10 mL of 1:10,000) once, followed by 5 quick insufflations.

Intracardiac: 0.3 to 0.5 mg (3 to 5 mL of 1:10,000) by direct injection into the left ventricular chamber once.

Usual Adult Dose for AV Heart Block

IV: 0.5 to 1 mg (5 to 10 mL of 1:10,000) once.
May be repeated every 3 to 5 minutes as necessary.
If there is inadequate response to 1 mg, then high dose therapy (2 to 5 mg) every 3 to 5 minutes, escalating 1, 3, then 5 mg every 3 minutes, or 0.1 mg/kg every 3 to 5 minutes, has been used.

Usual Adult Dose for Asthma - Acute

Subcutaneous: 0.1 to 0.5 mg (0.1 to 0.5 mL of 1:1000 solution). May be repeated every 20 minutes to once every 4 hours as needed.

Subcutaneous suspension: 0.5 mg (0.1 mL of 1:200 suspension) once. An additional dose of 0.5 to 1 mg may be given as needed but not more frequently than every 6 hours.

IM: 0.1 to 0.5 mg (0.1 to 0.5 mL of 1:1000 solution). May be repeated every 20 minutes to once every 4 hours as needed.

Inhalation aerosol: 160 to 220 mcg (1 inhalation) once. An additional inhalation may be used after at least one minute. It is recommended that subsequent doses not be administered for at least three hours.

Nebulized: 1 to 3 inhalations (8 to 10 drops of a 1% 1:100 solution) once. If relief does not occur within 5 minutes, the dose may be repeated once. It is recommended that subsequent doses not be repeated more often than every 3 hours.

Intermittent positive pressure breathing: 0.3 mg (0.03 mL of a 1:100 solution) once. The least amount of tolerated inhalations required to provide relief is the recommended dose. Most patients respond within 15 minutes. This dose may be repeated once every 3 to 4 hours as needed.

Usual Adult Dose for Chronic Obstructive Pulmonary Disease - Acute

Subcutaneous: 0.3 mg (0.3 mL of 1:1000) every 20 minutes for up to 3 doses. May be repeated once every 2 hours as needed.

IM: 0.1 to 0.5 mg (0.1 to 0.5 mL of 1:1000) once. May be repeated every 20 minutes to 4 hours as needed.

Inhalation aerosol: 160 to 220 mcg (1 inhalation) once. An additional inhalation may be used after at least one minute. It is recommended that subsequent doses not be administered for at least three hours.

Nebulized: 1 to 3 inhalations (8 to 15 drops of a 1% 1:100 solution or 2.25% racepinephrine solution) once. If relief does not occur within 5 minutes, the dose may be repeated once. It is recommended that subsequent doses not be repeated more often than every 3 hours.

Intermittent positive pressure breathing: 0.3 mg (0.03 mL of a 1:100 solution) once. The least amount of tolerated inhalations required to provide relief is the recommended dose. Most patients respond within 15 minutes. This dose may be repeated once every 3 to 4 hours as needed.

Usual Adult Dose for Allergic Reaction

Subcutaneous: 0.1 to 0.5 mg (0.1 to 0.5 mL of 1:1000 solution). May be repeated every 20 minutes to once every 4 hours as needed.

Subcutaneous suspension: 0.5 mg (0.1 mL of 1:200 suspension) once. An additional dose of 0.5 to 1 mg may be given as needed but not more frequently than every 6 hours.

IM: 0.1 to 0.5 mg (0.1 to 0.5 mL of 1:1000 solution). May be repeated every 10 to 15 minutes.

IV: 0.1 to 0.25 mg (1 to 2.5 mL of a 1:10,000 solution) once slowly and cautiously over 5 to 10 minutes. The dose may be repeated every 5 to 15 minutes as needed and tolerated. In some cases of severe anaphylaxis, an intravenous infusion of epinephrine (1 mg in 250 mL of D5W, or 4 mcg/mL) can be started to run at 1 to 4 mcg/min (15 to 60 mL/hour).

Usual Adult Dose for Pupillary Dilation

Induction and Maintenance of Mydriasis during Intraocular Surgery:
-Use the irrigating solution as needed for the surgical procedure
Comment:
-Dilute 1 mL of epinephrine 1 mg/mL (1:1000) in 100 mL to 1000 mL of an ophthalmic irrigation fluid to a concentration of 1:100,000 to 1:1,000,000 (10 mcg/mL to 1 mcg/mL)
-Do not use if solution is colored, cloudy or contains particulate matter.

-Inject intracamerally a 0.1 mL bolus dose diluted to a concentration of 1:100,000 to 1:400,000 (10 mcg/mL to 2.5 mcg/mL)
Comment:
-Dilute epinephrine 1 mg/mL (1:1000) with an ophthalmic irrigating fluid
-Do not use if solution is colored, cloudy or contains particulate matter.

Usual Pediatric Dose for Asystole

Neonates:
IV or Intratracheal: 0.01 to 0.03 mg/kg (0.1 to 0.3 mL/kg of 1:10,000) every 3 to 5 minutes as needed. Dilute intratracheal dose in 1 to 2 mL of normal saline.

Infants and children:
IV: Initial dose: 0.01 mg/kg (0.1 mL/kg of 1:10,000). May be repeated every 3 to 5 minutes. Maximum dose: 1 mg or 10 mL.

Intratracheal: 0.1 mg/kg (0.1 mL of 1:1,000 solution). Doses as high as 0.2 mg/kg may be effective. May be repeated every 3 to 5 minutes.

Usual Pediatric Dose for Shock

Neonates:
IV or Intratracheal: 0.01 to 0.03 mg/kg (0.1 to 0.3 mL/kg of 1:10,000) every 3 to 5 minutes as needed. Dilute intratracheal dose in 1 to 2 mL of normal saline.

Infants and children:
IV: Initial dose: 0.01 mg/kg (0.1 mL/kg of 1:10,000). May be repeated every 3 to 5 minutes. Maximum dose: 1 mg or 10 mL.

Intratracheal: 0.1 mg/kg (0.1 mL of 1:1,000 solution). Doses as high as 0.2 mg/kg may be effective. May be repeated every 3 to 5 minutes.

Usual Pediatric Dose for Allergic Reaction

Infants to 2 years: 0.05 to 0.1 mL IM or subcutaneously of 1:1000 solution. If after 10 minutes from the first injection symptoms are not noticeably improved, administer a second dose.

Children:
2 to 5 years: 0.15 mL IM or subcutaneously
6 to 11 years: 0.2 mL IM or subcutaneously
12 years older: 0.3 mL IM or subcutaneously
If after 10 minutes from the first injection symptoms are not noticeably improved, administer a second dose.

Alternative subcutaneous dosing: 0.01 mg/kg (0.01 mL/kg/dose of 1:1000 solution) not to exceed 0.5 mg.

Subcutaneous suspension: 0.025 mg/kg (0.005 mL/kg of 1:200) once. Not to exceed 0.15 mL every 8 to 12 hours.

Usual Pediatric Dose for Asthma - Acute

Infants to 2 years: 0.05 to 0.1 mL IM or subcutaneously of 1:1000 solution. If after 10 minutes from the first injection symptoms are not noticeably improved, administer a second dose.

Children:
2 to 5 years: 0.15 mL IM or subcutaneously
6 to 11 years: 0.2 mL IM or subcutaneously
12 years or older: 0.3 mL IM or subcutaneously
If after 10 minutes from the first injection symptoms are not noticeably improved, administer a second dose.

Alternative subcutaneous dosing: 0.01 mg/kg (0.01 mL/kg/dose of 1:1000 solution) not to exceed 0.5 mg.

Subcutaneous suspension: 0.025 mg/kg (0.005 mL/kg of 1:200 suspension) not to exceed 0.15 mL every 8 to 12 hours.

4 years or older:
Inhalation aerosol: 220 mcg (1 inhalation) once. An additional inhalation may be used after at least one minute. It is recommended that subsequent doses not be administered for at least three hours.

Usual Pediatric Dose for Pupillary Dilation

Induction and Maintenance of Mydriasis during Intraocular Surgery:
-Use the irrigating solution as needed for the surgical procedure
Comment:
-Dilute 1 mL of epinephrine 1 mg/mL (1:1000) in 100 mL to 1000 mL of an ophthalmic irrigation fluid to a concentration of 1:100,000 to 1:1,000,000 (10 mcg/mL to 1 mcg/mL)
-Do not use if solution is colored, cloudy or contains particulate matter.

-Inject intracamerally a 0.1 mL bolus dose diluted to a concentration of 1:100,000 to 1:400,000 (10 mcg/mL to 2.5 mcg/mL)
Comment:
-Dilute epinephrine 1 mg/mL (1:1000) with an ophthalmic irrigating fluid
-Do not use if solution is colored, cloudy or contains particulate matter.

Renal Dose Adjustments

Because epinephrine is primarily metabolized by the liver, no dosage adjustments are recommended for patients with renal dysfunction.

Liver Dose Adjustments

Because epinephrine is primarily metabolized by the liver, it is recommended that multiple doses or dose increments be given cautiously to patients with liver dysfunction.

Precautions

The suspension is for subcutaneous administration only. Rotate injection sites to avoid tissue necrosis from vascular constriction.

Dialysis

Data not available

Other Comments

Patient advice: Auvi-Q, an epinephrine auto-injector for anaphylaxis, provides audio instructions (activated by removing the outer case) and a 5-second countdown during the injection.

Hide
(web3)