Epinephrine hydrochloride

Revised June 11, 2018

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. For use during neonatal resuscitation according to Neonatal Resuscitation Program (NRP) guidelines, by umbilical vein catheter (UVC), intraosseous (IO) needle or endotracheal tube (ET). 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.

Adult Dosage and Administration:

Adult:         IM= 0.3 mg (0.3 mL) 1mg/mL of (formerly 1:1000 concentration) every 5 to 15 minutes in the absence of clinical improvement.

Midwives may choose to use an auto-injector (EpiPen®) for ease of administration. Each auto-injector contains 2 mL of 1mg/mL epinephrine and is designed to deliver a single 0.3 mg dose of epinephrine; 1.7 mL remains in the unit after use.

Neonatal Dosage and Administration:

Neonatal: UVC/IO: 0.1 mL/kg of 0.1 mg/mL (formerly 1:10,000 concentration) (do NOT flush or dilute in saline) followed by 0.1- 1 mL 0.9% saline flush.

ET = 1 mL/kg of 0.1 mg/mL (formerly 1:10,000 concentration) (do NOT flush or dilute with saline), to a maximum dose of 3mL per dose.

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 positive pressure ventilation (PPV), followed by 60 seconds of chest compressions with PPV using 100% oxygen. UVC continues to be the preferred route for emergency vascular access, but IO access can be used as an alternative if UVC access is not possible and the midwife has the required training and equipment. Additionally, an initial dose of epinephrine can be delivered by ETT while UVC/IO 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)