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EPINEPHrine (Nasal)

Medically reviewed by Drugs.com. Last updated on Sep 26, 2020.

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)

Generic: 0.1% (10 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

Nasal congestion: Children ≥6 years and Adolescents: Intranasal: 1 mg/mL topical solution: Apply locally as drops or spray or with sterile swab; may also further dilute prior to application; consult product specific labeling

Administration

May be diluted with isotonic saline for a less concentrated solution.

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 (Beta1 Selective): May diminish the therapeutic effect of EPINEPHrine (Nasal). Monitor therapy

Beta-Blockers (Nonselective): May enhance the hypertensive effect of EPINEPHrine (Nasal). Exceptions: Arotinolol; Carvedilol; Labetalol. Monitor therapy

Beta-Blockers (with Alpha-Blocking Properties): May diminish the therapeutic effect of EPINEPHrine (Nasal). Monitor therapy

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

Chloroprocaine: May enhance the hypertensive effect of Alpha-/Beta-Agonists. Monitor therapy

Cocaine (Topical): 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 increase the serum concentration 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

Guanethidine: May enhance the arrhythmogenic effect of Sympathomimetics. Guanethidine may enhance the hypertensive effect of Sympathomimetics. Monitor therapy

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

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

Monoamine Oxidase Inhibitors: May enhance the hypertensive effect of EPINEPHrine (Nasal). Monitor therapy

Ozanimod: May enhance the hypertensive effect of Sympathomimetics. Management: Concomitant use of ozanimod with sympathomimetic agents is not recommended. If combined, monitor patients closely for the development of hypertension, including hypertensive crises. Consider therapy modification

Procarbazine: May enhance the adverse/toxic effect of Sympathomimetics. Management: Consider alternatives to this combination when possible. Procarbazine prescribing information states that this combination should be avoided. Consider therapy modification

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. Management: If possible, avoid coadministration of direct-acting alpha-/beta-agonists and serotonin/norepinephrine reuptake inhibitors. If coadministered, monitor for increased sympathomimetic effects (eg, increased blood pressure, chest pain, headache). Consider therapy modification

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

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. Management: Avoid, if possible, the use of 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.

Pregnancy Considerations

Refer to the EPINEPHrine (Systemic) monograph.

Patient Education

What is this drug used for?

• It is used to treat nose stuffiness.

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine's uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

Further information

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