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Ephedrine

Pronunciation

Pronunciation: eh-FED-rin
Class: Vasopressor used in shock

Trade Names

Ephedrine Sulfate
- Solution 0.25% ephedrine sulfate

Pharmacology

Stimulates both alpha-and beta-receptors, causing increased heart rate, unchanged or augmented stroke volume, enhanced cardiac output, and increased BP. Causes relaxation of smooth muscle of bronchi and GI tract, stimulation of cerebral cortex, and pupil dilation.

Slideshow: Flashback: FDA Drug Approvals 2013

Pharmacokinetics

Distribution

Excreted in breast milk.

Metabolism

Small amounts are slowly metabolized in the liver.

Elimination

Renally eliminated and mostly as unchanged drug. The t ½ is approximately 3 to 6 h (dependent on urinary pH).

Onset

Immediate (IV). More than 20 min (subcutaneous). 10 to 20 min (IM). 15 to 60 min (oral).

Duration

1 h (parenteral). 3 to 5 h (oral).

Indications and Usage

IM/IV/subcutaneous

Treatment of acute hypotensive states; treatment of Adams-Stokes syndrome with complete heart block; stimulation of CNS to combat narcolepsy and depressive states; treatment of acute bronchospasm; treatment of enuresis; treatment of myasthenia gravis; allergic disorders, such as bronchial asthma.

Nasal

Treatment of nasal congestion; promotion of nasal or sinus drainage; relief of eustachian tube congestion.

PO

Temporary relief of shortness of breath, tightness of chest, and wheezing caused by bronchial asthma. Eases breathing for asthma patients by reducing spasms of bronchial muscles.

Contraindications

Angle-closure glaucoma; patients anesthetized with cyclopropane or halothane; cases in which vasopressor drugs are contraindicated (eg, thyrotoxicosis, diabetes mellitus, hypertension of pregnancy); MAOI therapy; narrow-angle glaucoma; nonanaphylactic shock during general anesthesia with halogenated hydrocarbons or cyclopropane.

Dosage and Administration

Asthma
Adults and children 12 yr and older

PO 12.5 to 25 mg every 4 h, not to exceed 150 mg in 24 h.

Adults

subcutaneous/IM/IV 25 to 50 mg subcutaneous or IM, or 5 to 25 mg administered by slow IV, repeated every 5 to 10 min, if necessary.

Children

subcutaneous/IM 0.5 to 0.75 mg/kg or 16.7 to 25 mg/m 2 every 4 to 6 h.

Hypotension
Adults

subcutaneous 25 to 50 mg.

(IM/IV if rapid effect is needed) 10 to 25 mg may be given by IV push; may give additional doses at 5 to 10 min intervals (max, 150 mg/24 h).

Children

IV/subcutaneous 3 mg/kg/day or 25 to 100 mg/m 2 /day in 4 to 6 divided doses.

Labor
Adults

subcutaneous/IV/IM prn to maintain BP 130/80 mm Hg or less.

Nasal Congestion
Adults

Nasal Dose is product specific. See labeling.

Storage/Stability

Protect from light. Do not give unless solution is clear. Discard any unused medication.

Drug Interactions

Alpha-adrenergic blockers (eg, phentolamine)

Vasoconstricting and hypertensive effects are antagonized.

Diuretics

Vascular response may be decreased.

General anesthetics (eg, halothane, cyclopropane), cardiac glycosides

The potential for the myocardium to be sensitized to the effects of sympathomimetic amines is increased. Arrhythmias may result with coadministration and may respond to beta blockers.

Guanethidine

May negate antihypertensive effects.

MAOIs

Increases pressor response from vasopressors significantly; hypertensive crisis and intracranial hemorrhage are possible.

Rauwolfia alkaloids, methyldopa, furazolidone

May result in hypertension.

Tricyclic antidepressants

May potentiate pressor response.

Urinary acidifiers

May increase elimination of ephedrine.

Urinary alkalinizers

May decrease elimination of ephedrine.

Incompatibility

Ephedrine is chemically incompatible with sodium bicarbonate; avoid admixture.

Laboratory Test Interactions

Amphetamine enzyme-multiplied immunoassay test (EMIT) assay

False-positive results may occur.

Adverse Reactions

Cardiovascular

Palpitation; tachycardia; precordial pain; cardiac arrhythmias; hypertension.

CNS

Headache; insomnia; sweating; nervousness; vertigo; confusion; delirium; restlessness; anxiety; tension; tremor; weakness; dizziness; hallucinations.

EENT

Local irritation, sneezing, rebound congestion (nasal use).

GI

Nausea; vomiting; anorexia; dry mouth.

Genitourinary

Difficult and painful urination; urinary retention in men with prostatism; decreased urine formation (initial parenteral use).

Respiratory

Shortness of breath.

Miscellaneous

Pallor.

Precautions

Pregnancy

Category C . Parenteral administration of ephedrine to maintain BP during low or other spinal anesthesia for delivery can cause acceleration of fetal heart rate; do not use in obstetrics when maternal BP exceeds 130/80.

Lactation

Undetermined.

Sulfite Sensitivity

Use nasal decongestant form of drug with caution.

Asthma

Use drug with caution.

Hypertension

Drug may cause severe hypertension, resulting in intracranial hemorrhage, angina, or potentially fatal arrhythmias, especially in patients with organic heart disease or those receiving drugs that sensitize myocardium.

Labor

Do not use when maternal BP exceeds 130/80 mmHg; use during delivery may cause acceleration of fetal heart rate.

Overdosage

Symptoms

Convulsions, nausea, vomiting, chills, cyanosis, irritability, nervousness, fever, suicidal behavior, tachycardia, dilated pupils, blurred vision, opisthotonos, spasms, pulmonary edema, gasping respirations, coma, respiratory failure, personality changes, hypertension with anuria.

Patient Information

  • Caution patient to use topical decongestants only in acute states and not to use for more than 3 to 5 days.
  • Inform patient that nasal burning or stinging may occur with nasal drops or spray.
  • Caution patient not to share nasal spray container with others.
  • Advise patient to notify health care provider if symptoms do not improve after 7 days.
  • With topical decongestant form of drug, instruct patient to report the following symptoms to health care provider: headache, palpitations, tremors, sweating, faintness, insomnia, weakness.
  • With subcutaneous form of drug, advise patient to notify health care provider of syncope, palpitations, weakness, agitation, dizziness, or chest pain.
  • Instruct patient to take sips of water frequently, suck on ice chips or sugarless hard candy, or chew gum if dry mouth occurs.

Copyright © 2009 Wolters Kluwer Health.

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