Epinephrine hydrochloride

Section 1.1

Midwives may independently prescribe, order and administer this drug.

Stimulates adrenergic receptors resulting in relaxation of smooth muscle, cardiac stimulation (increasing myocardial oxygen consumption), and dilation of skeletal muscle vasculature.

Indications and Clinical Use:

For the treatment of anaphylactic shock as a result of an allergic reaction following administration of a drug, vaccine or serum. Also used for neonatal resuscitation. If epinephrine is required it may be administered intravenously by umbilical vein catheter or via endotracheal tube according to NRP guidelines. This drug is for emergency purposes, and its use should be immediately followed by a physician consultation and if out-of-hospital, emergency transport to hospital.

Contraindications:

No contraindications to the use of injectable in a life-threatening situation.

Warnings and Precautions:

Use in pregnancy if the benefits outweigh the potential risk to the fetus. Use with caution in patients with cardiovascular diseases, diabetes mellitus and in patients with thyroid disease.

Pregnancy:

Human Data Suggest Risk

Lactation:

Category L2 – Limited Data – Probably Compatible

Adverse Reactions:

Angina, cardiac arrhythmia, chest pain, flushing, hypertension, pallor, palpitation, sudden death, tachycardia (parenteral), vasoconstriction, transient anxiety, apprehensiveness, cerebral hemorrhage, dizziness, headache, restlessness, dry throat, nausea and vomiting.

Dosage and Administration:

Adult: 0.3 mg (0.3 mL) IM of 1:1000 concentration.
Midwives may choose to use an auto-injector (EpiPen®) for ease of administration. Each auto-injector contains: 2 mL epinephrine injection 1:1000 and is designed to deliver a single dose of epinephrine 0.3 mg. EpiPen® contains 2 mL but delivers a single dose of 0.3 mL only, with 1.7 mL remaining in the unit after use.

Dosage and Administration:

Neonatal: ETT route – 1 mL/kg to a maximum of 3 mL of 1:10,000 concentration (do NOT chase or dilute with saline) or
IV push: 0.1 mL/kg of 1:10,000 concentration (do NOT dilute in saline) followed by 2 mL of normal saline.

Epinephrine should be administered during neonatal resuscitation when the neonate’s heart rate remains less than 60 beats per minute after 30 seconds of effective IPPV with room air, followed by 30 seconds of chest compressions with IPPV+100% oxygen. The preferred route is IV, however, an initial dose of epinephrine can be delivered by ETT while IV access is being obtained. May be repeated every 3-5 minutes as needed.

Onset of Action:

Rapid

Half-life:

2 minutes

Elimination:

Urine (as inactive metabolites)