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Twinject Auto-Injector Side Effects

Generic Name: epinephrine

Note: This page contains side effects data for the generic drug epinephrine. It is possible that some of the dosage forms included below may not apply to the brand name Twinject Auto-Injector.

For the Consumer

Applies to epinephrine: injection injectable, injection solution

As well as its needed effects, epinephrine (the active ingredient contained in Twinject Auto-Injector) may cause unwanted side effects that require medical attention.

Severity: Major

If any of the following side effects occur while taking epinephrine, check with your doctor immediately:

Incidence not known:
  • Abnormal or decreased touch sensation
  • arm, back, or jaw pain
  • bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site
  • blurred vision
  • chest pain or discomfort
  • chest tightness or heaviness
  • dizziness
  • fainting
  • fast, irregular, pounding, or racing heartbeat or pulse
  • fear or nervousness
  • headache
  • nausea or vomiting
  • paleness of the skin
  • pounding in the ears
  • restlessness
  • shakiness in the legs, arms, hands, or feet
  • slow or fast heartbeat
  • stroke
  • sweating
  • trembling or shaking of the hands or feet
  • troubled breathing
  • unusual tiredness or weakness

If any of the following symptoms of overdose occur while taking epinephrine, get emergency help immediately:

Symptoms of overdose:
  • Agitation
  • coldness of the skin
  • coma
  • confusion
  • decreased urine output
  • depression
  • drowsiness
  • hostility
  • irritability
  • lethargy
  • lightheadedness, dizziness, or fainting
  • muscle twitching
  • pounding, slow heartbeat
  • rapid weight gain
  • rapid, deep breathing
  • seizures
  • stomach cramps
  • stupor
  • swelling of the face, ankles, or hands

For Healthcare Professionals

Applies to epinephrine: compounding powder, inhalation aerosol, inhalation solution, injectable kit, injectable solution, intravenous solution, subcutaneous suspension

Nervous system

Nervous system side effects have included fear, agitation, anxiety, tenseness, restlessness, headache, tremor, dizziness, lightheadedness, nervousness, sleeplessness, excitability, weakness, and increased parkinsonian tremors. Complications associated with epidural anesthesia with epinephrine (the active ingredient contained in Twinject Auto-Injector) have included nerve root ischemia and clinical paralysis/plegia.[Ref]


Epinephrine can induce hypokalemia with resultant T wave changes on the electrocardiogram.

Rare cases of myocardial infarction have been associated with relatively small doses of epinephrine (the active ingredient contained in Twinject Auto-Injector) in patients at risk for coronary artery disease.

Rare cases of cardiomyopathy have been associated with brief and chronic exposure to epinephrine (including inhaled epinephrine). Animal studies have shown that catecholamines can cause an influx of calcium into myocardial cells, which may cause myocardial injury, particularly during periods of epinephrine-induced coronary vasoconstriction. Limited animal data suggest that calcium antagonists may protect against the cardiotoxic effects of catecholamines by preventing the generation of plasma borne cytotoxic compounds, which are probably free radicals.

Epinephrine may be more arrhythmogenic in some patients, such as patients with congenital long QT syndrome.[Ref]

Cardiovascular side effects have included elevations in heart rate or blood pressure in up to 55% and arrhythmias in 3% to 17% (including fatal ventricular arrhythmias) when used to treat cardiac arrest. In smaller doses, epinephrine has caused peripheral coronary arterial vasodilation, but in larger doses, epinephrine has caused diffuse vasoconstriction. This has caused increased peripheral vascular resistance, which was important in patients with coronary artery disease (worsened myocardial ischemia/angina) or hypertension (risk of emergent hypertension/stroke). Dilated cardiomyopathy and acute left ventricular dysfunction have been associated with the use of epinephrine.

Arrhythmias, including fatal ventricular fibrillation, have been reported in patients with underlying cardiac disease. Rapid rises in blood pressure have produced cerebral hemorrhage, particularly in elderly patients with cardiovascular disease. Angina may occur in patients with coronary artery disease.[Ref]


Local side effects have included local tissue ischemia after repeated injections. Chronic IM epinephrine (the active ingredient contained in Twinject Auto-Injector) injections have induced local vasoconstriction, predisposing patients to Clostridial infections. Other local reactions have included injection site pallor, coldness and hypoesthesia or injury at the injection site resulting in bruising, bleeding, discoloration, erythema or skeletal injury.[Ref]


Psychiatric side effects have included agitation, disorientation, impaired memory, aggressive or assaultive behavior, hallucinations, and psychosis.[Ref]


Respiratory side effects have rarely included pulmonary edema. In some cases, acute left ventricular dysfunction has been documented in the presence of epinephrine-induced pulmonary edema. In some patients, epinephrine (the active ingredient contained in Twinject Auto-Injector) has precipitated severe, prolonged asthmatic attacks.[Ref]


Metabolic side effects have included severe metabolic acidosis because of elevated blood concentrations of lactic acid after prolonged use of intravenous epinephrine (the active ingredient contained in Twinject Auto-Injector) Catecholamines have induced glycogenolysis, elevated blood glucose and insulin concentrations, and hypokalemia. Rare cases of hyperglycemia and acidosis have been associated with high catecholamine states, such as anaphylaxis.[Ref]


Mattana and Singhal reviewed 420 consecutive cases of cardiac arrest and found a 28.6% incidence of acute renal failure (ARF) among patients who survived for at least 24 hours after cardiac arrest. Patients in whom ARF developed received markedly higher doses of epinephrine (the active ingredient contained in Twinject Auto-Injector) during resuscitative efforts than patients without ARF. High doses of epinephrine were associated with a longer duration of cardiopulmonary resuscitation. The patients with ARF had a significantly decreased survival rate. It is possible that patients with severe cardiac disease were less resuscitatable, required more epinephrine, and were prone to develop ARF anyway. Other data have failed to associated ARF with the use of high dose epinephrine.[Ref]

Renal side effects have included new or worsened renal insufficiency in adult survivors of cardiac arrest, adults who underwent epinephrine-assisted venography, and in rare pediatric cases.[Ref]


Hypersensitivity side effects have been extremely unusual. Contact dermatitis has been associated with ocularly applied epinephrine (the active ingredient contained in Twinject Auto-Injector) These reactions have typically presented with lid edema and a thick yellow discharge.[Ref]


Gastrointestinal side effects have included nausea and vomiting.[Ref]


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It is possible that some side effects of Twinject Auto-Injector may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. 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 substances you are taking, check with your doctor, nurse, or pharmacist.