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EPINEPHrine (Nasal)

Pronunciation

Pronunciation

(ep i NEF rin)

Index Terms

  • Adrenaline
  • Epinephrine Hydrochloride

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Nasal, as hydrochloride:

Adrenalin: 0.1% (30 mL)

Brand Names: U.S.

  • Adrenalin

Pharmacologic Category

  • Alpha/Beta Agonist

Pharmacology

Stimulates alpha-, beta1-, and beta2-adrenergic receptors resulting in local vasoconstriction and relief of nasal congestion

Metabolism

Taken up into the adrenergic neuron and metabolized by monoamine oxidase and catechol-o-methyltransferase; circulating drug hepatically metabolized

Excretion

Urine (as inactive metabolites, metanephrine, and sulfate and hydroxy derivatives of mandelic acid; small amounts as unchanged drug)

Onset of Action

Local vasoconstriction (topical): 5 minutes

Duration of Action

Local vasoconstriction (topical): <1 hour

Use: Labeled Indications

Treatment of nasal congestion

Dosing: Adult

Decongestant: Intranasal: Apply 1 mg/mL solution locally as drops or spray or with sterile swab

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Decongestant: Children ≥6 years: Refer to adult dosing

Storage

Epinephrine is sensitive to light and air. Protection from light is recommended. Oxidation turns drug pink, then a brown color. Solutions should not be used if they are discolored or contain a precipitate.

Drug Interactions

Alpha1-Blockers: May diminish the vasoconstricting effect of Alpha-/Beta-Agonists. Similarly, Alpha-/Beta-Agonists may antagonize Alpha1-Blocker vasodilation. Monitor therapy

AtoMOXetine: May enhance the hypertensive effect of Sympathomimetics. AtoMOXetine may enhance the tachycardic effect of Sympathomimetics. Monitor therapy

Beta-Blockers: May enhance the vasopressor effect of Alpha-/Beta-Agonists (Direct-Acting). Epinephrine used as a local anesthetic for dental procedures will not likely cause clinically relevant problems. Some beta-adrenoceptor mediated effects of Alpha-/Beta-Agonists (Direct-Acting), including anti-anaphylactic effects of epinephrine, may be diminished by Beta-Blockers. Management: Cardioselective beta-blockers and lower doses of epinephrine may confer a more limited risk. Patients who may require acute subcutaneous epinephrine (e.g., bee sting kits) should probably avoid beta blockers. Consider therapy modification

Cannabinoid-Containing Products: May enhance the tachycardic effect of Sympathomimetics. Exceptions: Cannabidiol. Monitor therapy

Cocaine: May enhance the hypertensive effect of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. Consider therapy modification

COMT Inhibitors: May decrease the metabolism of COMT Substrates. Monitor therapy

Doxofylline: Sympathomimetics may enhance the adverse/toxic effect of Doxofylline. Monitor therapy

Ergot Derivatives: May enhance the hypertensive effect of Alpha-/Beta-Agonists. Ergot Derivatives may enhance the vasoconstricting effect of Alpha-/Beta-Agonists. Exceptions: Ergoloid Mesylates; Nicergoline. Avoid combination

Inhalational Anesthetics: May enhance the arrhythmogenic effect of EPINEPHrine (Nasal). Monitor therapy

Iobenguane I 123: Sympathomimetics may diminish the therapeutic effect of Iobenguane I 123. Avoid combination

Linezolid: May enhance the hypertensive effect of Sympathomimetics. Management: Reduce initial doses of sympathomimetic agents, and closely monitor for enhanced pressor response, in patients receiving linezolid. Specific dose adjustment recommendations are not presently available. Consider therapy modification

MAO Inhibitors: May enhance the hypertensive effect of EPINEPHrine (Nasal). Exceptions: Tedizolid. Monitor therapy

Promethazine: May diminish the vasoconstricting effect of EPINEPHrine (Nasal). Monitor therapy

Serotonin/Norepinephrine Reuptake Inhibitors: May enhance the tachycardic effect of Alpha-/Beta-Agonists. Serotonin/Norepinephrine Reuptake Inhibitors may enhance the vasopressor effect of Alpha-/Beta-Agonists. Consider therapy modification

Spironolactone: May diminish the vasoconstricting effect of Alpha-/Beta-Agonists. Monitor therapy

Sympathomimetics: May enhance the adverse/toxic effect of other Sympathomimetics. Monitor therapy

Tedizolid: May enhance the hypertensive effect of Sympathomimetics. Tedizolid may enhance the tachycardic effect of Sympathomimetics. Monitor therapy

Tricyclic Antidepressants: May enhance the vasopressor effect of Alpha-/Beta-Agonists (Direct-Acting). Management: Avoid, if possible, the use of direct-acting alpha-/beta-agonists in patients receiving tricyclic antidepressants. If combined, monitor for evidence of increased pressor effects and consider reductions in initial dosages of the alpha-/beta-agonist. Consider therapy modification

Adverse Reactions

Frequency not defined.

Cardiovascular: Angina pectoris, cardiac arrhythmia, chest pain, flushing, hypertension, palpitations, tachycardia (parenteral administration), vasoconstriction, ventricular ectopy

Central nervous system: Anxiety (transient), apprehension, cerebral hemorrhage, dizziness, headache, insomnia, nervousness, restlessness

Dermatologic: Diaphoresis, pallor

Gastrointestinal: Anorexia, nausea, vomiting, xerostomia

Genitourinary: Acute urinary retention (patients with bladder outflow obstruction)

Hypersensitivity: Hypersensitivity reaction (eyelid)

Neuromuscular & skeletal: Tremor, weakness

Ophthalmic: Angle-closure glaucoma (precipitation or exacerbation), burning sensation of eyes, eye irritation, eye pain, stinging of eyes (transient)

Respiratory: Dry throat, dyspnea, pulmonary edema

Warnings/Precautions

Disease-related concerns:

• Cardiovascular disease: Use with caution in patients with cardiovascular diseases (eg, coronary artery disease, hypertension).

• Cerebrovascular disease: Use with caution in patients with cerebrovascular disease.

• Diabetes: Use with caution in patients with diabetes mellitus; may transiently increase blood glucose levels.

• Parkinson's disease: Use with caution in patients with Parkinson's disease; may cause temporary worsening of symptoms.

• Thyroid disease: Use with caution in patients with thyroid disease.

Concurrent drug therapy issues:

• Tricyclic antidepressants: Use with caution in patients taking tricyclic antidepressants; effects of epinephrine may be potentiated.

Special populations:

• Elderly: Use with caution in the elderly.

Monitoring Parameters

Heart rate, blood pressure

Pregnancy Considerations

Refer to the EPINEPHrine (Systemic) monograph.

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

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