Learn how to prepare for Severe Allergy Attacks.

epinephrine injection

Pronunciation

Generic Name: epinephrine injection (EP i NEF rin)
Brand Name: Adrenaclick Two-Pack, Adrenalin, Auvi-Q, EpiPen 2-Pak, EpiPen JR 2-Pak, ...show all 25 brand names

What is epinephrine injection?

Epinephrine is a chemical that narrows blood vessels and opens airways in the lungs. These effects can reverse severe low blood pressure, wheezing, severe skin itching, hives, and other symptoms of an allergic reaction.

Epinephrine injection is used to treat severe allergic reactions (anaphylaxis) to insect stings or bites, foods, drugs, and other allergens. Epinephrine is also used to treat exercise-induced anaphylaxis.

Epinephrine auto-injectors may be kept on hand for self-injection by a person with a history of an severe allergic reaction.

Epinephrine injection may also be used for purposes not listed in this medication guide.

What is the most important information I should know about epinephrine injection?

Seek emergency medical attention after any use of epinephrine to treat a severe allergic reaction. After the injection you will need to receive further treatment and observation.

Slideshow: Flashback: FDA Drug Approvals 2013

What should I discuss with my healthcare provider before using epinephrine injection?

Before using epinephrine, tell your doctor if any past use of this medicine caused an allergic reaction to get worse.

To make sure epinephrine injection is safe for you, tell your doctor if you have:

  • heart disease or high blood pressure;

  • asthma;

  • Parkinson's disease;

  • depression or mental illness;

  • a thyroid disorder; or

  • diabetes (you may need to adjust your dose of insulin or other diabetes medication after using epinephrine injection).

FDA pregnancy category C. It is not known whether epinephrine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

It is not known whether epinephrine passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

In an emergency situation it may not be possible to tell your caregivers if you are pregnant or breast feeding. Make sure any doctor caring for your pregnancy or your baby knows you have received this medication.

How should I use epinephrine injection?

Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Epinephrine is injected into the muscle of your outer thigh. In an emergency, this injection can be given through your clothing.

Your medicine may also come with a "trainer pen." The trainer pen contains no medicine and no needle. It is only for non-emergency use to practice giving yourself an epinephrine injection. Do not use a trainer pen to treat an allergic reaction.

The auto-injector device is a disposable single-use system that comes with patient instructions for safe and effective use. Do not inject this medicine if you do not understand these instructions.

Do not remove the safety cap until you are ready to use the auto-injector. Never put your fingers over the injector tip when removing the safety cap or after the safety cap has been removed.

To use an epinephrine auto-injector:

  • Form a fist around the auto-injector with the tip pointing down. Pull off the safety cap.

  • Place the tip against the fleshy portion of your outer thigh. You may give the injection directly through your clothing.

  • Push the auto-injector firmly against your thigh to release the needle that injects the dose of epinephrine. Hold the auto-injector in place for 10 seconds after activation.

  • Remove the auto-injector from your thigh and massage the area gently. Carefully re-insert the used device needle-first into the carrying tube. Re-cap the tube and take it with you to the emergency room so that anyone who treats you will know how much epinephrine you have received.

  • Use an auto-injector only one time. Do not try to reinsert an auto-injector a second time if the needle has come out of your skin before the full 10 seconds. If the needle is bent from the first use, it may cause serious injury to your skin.

Seek emergency medical attention after any use of epinephrine to treat a severe allergic reaction. The effects of epinephrine may wear off after 10 or 20 minutes. You will need to receive further treatment and observation.

Do not use epinephrine injection if it has changed colors or has particles in it, or if the expiration date on the label has passed. Call your pharmacist for a new prescription.

Store at room temperature away from moisture, heat, and light. Do not refrigerate or freeze this medication, and do not store it in a car.

What happens if I miss a dose?

Since epinephrine is normally used only as needed in an emergency, you are not likely to be on a dosing schedule. Do not use repeat doses of epinephrine without a doctor's advice.

What happens if I overdose?

Seek emergency medical attention right away after any use of epinephrine injection.

Symptoms of an epinephrine overdose may include worsened breathing trouble, sudden numbness or weakness on one side of the body, slurred speech, problems with vision or balance, or dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).

What should I avoid while using epinephrine injection?

Do not inject epinephrine into a vein or into the muscles of your buttocks, or it may not work as well. Inject it only into the fleshy outer portion of the thigh.

Accidentally injecting epinephrine into your hands or feet may result in a loss of blood flow to those areas, and resulting numbness.

Epinephrine injection side effects

Before using epinephrine, tell your doctor if any past use of this medicine caused an allergic reaction to get worse.

Common side effects may include:

  • fast or pounding heartbeats;

  • pale skin, sweating;

  • nausea and vomiting;

  • dizziness;

  • weakness or tremors;

  • throbbing headache; or

  • feeling nervous, anxious, or fearful.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Epinephrine injection dosing information

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.

What other drugs will affect epinephrine injection?

Other drugs may interact with epinephrine injection, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

  • Your doctor or pharmacist can provide more information about epinephrine injection.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 8.03. Revision Date: 2014-09-11, 3:16:02 PM.

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