Details About Overdose or Poisoning Generic Salt ::  Epinephrine

Epinephrine

    

Drug Pharmacology ::

I. Pharmacology. Epinephrineis an endogenous catecholamine with alpha- and beta-adrenergic agonistproperties that is used primarily in emergency situations to treatanaphylaxis or cardiac arrest. Beneficial effects include inhibition ofhistamine release from mast cells and basophils, bronchodilation,positive inotropic effects, and peripheral vasoconstriction.Epinephrine is not active after oral administration. Subcutaneousinjection produces effects within 5–10 minutes, with peak effects at 20minutes. Intravenous or inhalational administration produces much morerapid onset. Epinephrine is inactivated rapidly in the body, with anelimination half-life of 2 minutes.

Drug Indications ::

Indications

   

Anaphylaxis and anaphylactoid reactions.

Epinephrineoccasionally is used for hypotension resulting from overdose by betablockers, calcium antagonists, and other cardiac-depressant drugs.

Drug Contra-Indications ::

III. Contraindications./b>

   

Tachyarrhythmias or ventricular fibrillation and uncorrected hypovolemia.

Epinephrineis relatively contraindicated in patients with organic heart disease,peripheral arterial occlusive vascular disease with thrombosis, orergot poisoning (see Ergot Derivatives).

Narrow-angle glaucoma.

Drug Adverse Effects ::

IV. Adverse effects

   

Anxiety, restlessness, tremor, and headache.

Severe hypertension, which may result in intracranial hemorrhage, pulmonary edema, or myocardial necrosis or infarction.

Usewith caution in patients intoxicated by halogenated or aromatichydrocarbon solvents and anesthetics, because these agents maysensitize the myocardium to the arrhythmogenic effects of epinephrine.

Tissue necrosis after extravasation or intra-arterial injection.

E. Aggravation of tissue ischemia, resulting in gangrene.

F. Anaphylactoid reaction, which may occur owing to the bisulfite preservative in patients with sulfite hypersensitivity.

G. Hypokalemia, hypophosphatemia, hyperglycemia, and leukocytosis may occur owing to the beta-adrenergic effects of epinephrine.

H. Use in pregnancy. FDAcategory C (indeterminate). Epinephrine is teratogenic in animals,crosses the placenta, can cause placental ischemia, and may suppressuterine contractions, but these effects do not preclude its acute,short-term use for a seriously symptomatic patient (see Table III–1).

Drug Lab Interactions ::

Drug or laboratory interactions

   

Anenhanced arrhythmogenic effect may occur when epinephrine is given topatients with chloral hydrate overdose or anesthetized withcyclopropane or halogenated general anesthetics.

Usein patients taking propranolol and other nonselective beta blockers mayproduce severe hypertension owing to blockade of beta-2–mediatedvasodilation, resulting in unopposed alpha-mediated vasoconstriction.

Cocaine and cyclic antidepressants may enhance stimulant effects owing to inhibition of neuronal epinephrine reuptake.

Monoamine oxidase inhibitors may enhance pressor effects because of decreased neuronal epinephrine metabolism.

E. Digitalis intoxication may enhance the arrhythmogenicity of epinephrine.

Drug Dose Management ::

Dosage and method of administration

   

Caution: Avoid extravasation. Theintravenous infusion must be free flowing, and the infused vein shouldbe observed frequently for signs of subcutaneous infiltration (pallor,coldness, or induration).

   

1. Ifextravasation occurs, immediately infiltrate the affected area withphentolamine (see Phentolamine), 5–10 mg in 10–15 mL of normal saline(children, 0.1–0.2 mg/kg; maximum 10 mg total) via a fine (25- to27-gauge) hypodermic needle; improvement is evidenced by hyperemia andreturn to normal temperature.

2. Alternatively, topical application of nitroglycerin paste and infiltration of terbutaline have been reported to be successful.

Mild to moderate allergic reaction. Give0.3–0.5 mg SC or IM (children, 0.01 mg/kg of 1:1000 solution or 1:200suspension; maximum 0.5 mg). May be repeated after 10–15 minutes ifneeded.

Severe anaphylaxis. Give0.05–0.1 mg IV (0.5–1 mL of a 1:10,000 solution) every 5–10 minutes(children, 0.01 mg/kg; maximum 0.1 mg) or an IV infusion at 1–4mcg/min. If intravenous access is not available, the endotracheal routemay be used; give 0.5 mg (5 mL of a 1:10,000 solution) down theendotracheal tube.

Hypotension. Infuseat 1 mcg/min; titrate upward every 5 minutes as necessary. If thepatient has refractory hypotension and is on a beta-adrenergic blockingdrug, consider glucagon (see Glucagon).

Drug Chemical Formulations ::

Formulations

   

Parenteral. Epinephrinehydrochloride (Adrenalin, EpiPen, others), 0.01 mg/mL (1:100,000), 0.1mg/mL (1:10,000), in 10-mL prefilled syringes and vials; 0.5 mg/mL(1:2000) in 0.3-mL single-dose autoinjectors, and 1 mg/mL (1:1000) in1-mL ampules, 30-mL vials, and 0.3-mL single-dose autoinjectors. Mostpreparations contain sodium bisulfite or sodium metabisulfite as apreservative.

The suggested minimum stocking level to treat a 70-kg adult for the first 24 hours is 10 mg (10 ampules, 1:1000, 1 mL, or equivalent).

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