Adrenaline - Instructions For Use, Indications, Doses, Analogues

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Adrenalin

Instructions for use:

1. Release form and composition
2. Indications for use
3. Contraindications
4. Method of application and dosage
5. Side effects
6. Special instructions
7. Drug interactions
8. Analogs
9. Terms and conditions of storage
10. Terms of dispensing from pharmacies

Prices in online pharmacies:

from 63 rub.

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Adrenaline is an alpha and beta adrenergic agonist with hypertensive, bronchodilator, antiallergic action.

Release form and composition

Dosage forms:

Solution for injection: slightly colored or colorless transparent liquid with a specific odor (1 ml in ampoules, in a blister strip of 5 ampoules, in a cardboard box 1 or 2 packs complete with a scarifier or ampoule knife (or without them); for a hospital - 20, 50 or 100 packs in cardboard boxes);
Solution for topical application 0.1%: a transparent colorless or slightly colored liquid with a specific odor (30 ml each in dark glass vials, 1 vial in a cardboard box).

1 ml of solution for injection contains:

Active ingredient: epinephrine - 1 mg;
Auxiliary components: sodium disulfite (sodium metabisulfite), hydrochloric acid, sodium chloride, chlorobutanol hemihydrate (chlorobutanol hydrate), glycerol (glycerin), disodium edetate (disodium salt of ethylenediaminetetraacetic acid), water for injection.

1 ml of solution for topical application contains:

Active ingredient: epinephrine - 1 mg;
Auxiliary components: sodium metabisulfite, sodium chloride, chlorobutanol hydrate, glycerin (glycerol), disodium salt of ethylenediaminetetraacetic acid (disodium edetate), hydrochloric acid solution 0.01 M.

Indications for use

Injection

Angioedema, urticaria, anaphylactic shock and other immediate-type allergic reactions that develop against the background of blood transfusion, the use of drugs and serums, the use of food, insect bites or the introduction of other allergens;
Exercise asthma;
Asystole (including with acutely developed atrioventricular block of the III degree);
Relief of asthmatic status of bronchial asthma, emergency care for bronchospasm during anesthesia;
Morgagni-Adams-Stokes syndrome, complete atrioventricular block;
Bleeding from the superficial vessels of the mucous membranes (including the gums) and skin;
Arterial hypotension, in the absence of a therapeutic effect from the use of adequate volumes of replacement fluids (including shock, open heart surgery, bacteremia, renal failure).

In addition, the use of the drug is shown as a vasoconstrictor for stopping bleeding and lengthening the period of action of local anesthetics.

Solution for topical application 0.1%

The solution is used to stop bleeding from the superficial vessels of the mucous membranes (including the gums) and skin.

Contraindications

Ischemic heart disease, tachyarrhythmia;
Arterial hypertension;
Ventricular fibrillation;
Hypertrophic obstructive cardiomyopathy;
Pheochromocytoma;
The period of pregnancy and breastfeeding;
Individual intolerance to the components of the drug.

Additionally, contraindications to the use of solution for injection:

Ventricular arrhythmias;
Atrial fibrillation;
Chronic heart failure III-IV degree;
Myocardial infarction;
Chronic and acute form of arterial insufficiency (including history - atherosclerosis, arterial embolism, Buerger's disease, Raynaud's disease, diabetic endarteritis);
Severe atherosclerosis, including cerebral atherosclerosis;
Organic brain damage;
Parkinson's disease;
Hypovolemia;
Thyrotoxicosis;
Diabetes;
Metabolic acidosis;
Hypoxia;
Hypercapnia;
Pulmonary hypertension;
Cardiogenic, hemorrhagic, traumatic and other types of shock of non-allergic genesis;
Cold injury;
Convulsive syndrome;
Closed-angle glaucoma;
Hyperplasia of the prostate;
Simultaneous use with inhalation agents for general anesthesia (halothane), with local anesthetics for anesthesia of fingers and toes (risk of ischemic tissue damage);
Age under 18.

All of the above contraindications are relative in conditions that threaten the patient's life.

Care should be taken to prescribe injection for hyperthyroidism and patients in old age.

For the prevention of arrhythmias, the drug is recommended to be used in combination with beta-blockers.

Adrenaline is prescribed with caution in the form of a solution for topical use in patients with metabolic acidosis, hypoxia, hypercapnia, atrial fibrillation, pulmonary hypertension, ventricular arrhythmia, hypovolemia, myocardial infarction, shock of non-allergic genesis (including cardiogenic, hemorrhagic vascular, traumatic diseases) atherosclerosis, arterial embolism, Buerger's disease, diabetic endarteritis, cold injuries, a history of Raynaud's disease), thyrotoxicosis, prostatic hypertrophy, angle-closure glaucoma, diabetes mellitus, cerebral atherosclerosis, convulsive syndrome, Parkinson's disease; with the simultaneous use of inhalation drugs for general anesthesia (fluorothane, chloroform, cyclopropane), in old or childhood.

Method of administration and dosage

Topical solution The

solution is applied topically.

When bleeding stops, it is necessary to apply a swab moistened with a solution to the wound.

Solution for injection

The solution is intended for intramuscular (i / m), subcutaneous (s / c), intravenous (i / v) drip or jet injection.

Recommended dosing regimen for adults:

Anaphylactic shock and other immediate reactions of allergic genesis: IV slowly - 0.1-0.25 mg should be diluted in 10 ml of 0.9% sodium chloride solution. To achieve a clinical effect, therapy is continued by intravenous drip, in a ratio of 1: 10000. In the absence of a real threat to the patient's life, the drug is recommended to be administered intramuscularly or subcutaneously at a dose of 0.3-0.5 mg, if necessary, the injection can be repeated with an interval of 10-20 minutes up to 3 times;
Bronchial asthma: s / c - 0.3-0.5 mg, to achieve the desired effect, repeated administration of the same dose every 20 minutes up to 3 times, or i / v - 0.1-0.25 mg, diluted with 0.9% sodium chloride solution in a ratio of 1: 10000;
Arterial hypotension: intravenous drip at a rate of 0.001 mg per minute, it is possible to increase the rate of administration to 0.002-0.01 mg per minute;
Asystole: intracardiac - 0.5 mg in 10 ml of 0.9% sodium chloride solution (or other solution). In resuscitation measures, the drug is administered intravenously, at a dose of 0.5-1 mg every 3-5 minutes, diluted in 0.9% sodium chloride solution. When the patient's trachea is intubated, the administration can be carried out by endotracheal instillation in a dose exceeding the dose for intravenous administration by 2-2.5 times;
Vasoconstrictor: intravenous drip at a rate of 0.001 mg per minute, the infusion rate can be increased to 0.002-0.01 mg per minute;
Prolongation of the action of local anesthetics: the dose is prescribed at a concentration of 0.005 mg of the drug per 1 ml of anesthetic, with spinal anesthesia - 0.2-0.4 mg;
Morgagni-Adams-Stokes syndrome (bradyarrhythmic form): intravenous drip - 1 mg in 250 ml of 5% glucose solution, gradually increasing the infusion rate until the minimum sufficient number of heartbeats appears.

Recommended dosage for children:

Asystole: newborns - IV (slowly), 0.01-0.03 mg per 1 kg of the child's weight every 3-5 minutes. Children after 1 month of life - IV, 0.01 mg / kg, then 0.1 mg / kg every 3-5 minutes. After the introduction of two standard doses, it is allowed to switch to the introduction of 0.2 mg / kg of the child's weight with an interval of 5 minutes. Endotracheal introduction is shown;
Anaphylactic shock: s / c or i / m - 0.01 mg / kg, but not more than 0.3 mg. If necessary, the procedure is repeated at intervals of 15 minutes no more than 3 times;
Bronchospasm: s / c - 0.01 mg / kg, but not more than 0.3 mg, if necessary, the drug is administered every 15 minutes up to 3-4 times or every 4 hours.

Solution for injection Epinephrine can also be used topically to stop bleeding by applying a tampon soaked in solution to the wound surface.

Side effects

Nervous system: often - anxiety, headache, tremor; infrequently - fatigue, dizziness, nervousness, personality disorders (disorientation, psychomotor agitation, memory impairment and psychotic disorders: panic, aggressive behavior, paranoia, schizophrenia-like disorders), muscle twitching, sleep disturbance;
Cardiovascular system: infrequently - tachycardia, angina pectoris, bradycardia, palpitations, decrease or increase in blood pressure (BP), against the background of high doses - ventricular arrhythmias (including ventricular fibrillation); rarely - chest pain, arrhythmia;
Digestive system: often - nausea, vomiting;
Allergic reactions: infrequently - skin rash, bronchospasm, erythema multiforme, angioedema;
Urinary system: rarely - painful, difficult urination in patients with prostatic hyperplasia;
Others: infrequently - increased sweating; rarely, hypokalemia.

Additionally, due to the use of solution for injection:

Cardiovascular system: rarely - pulmonary edema;
Nervous system: often - tic; infrequently - nausea, vomiting;
Local reactions: infrequently - burning and / or pain at the site of the IM injection.

The occurrence of these or other undesirable effects should be reported to the doctor.

special instructions

Accidentally injected epinephrine can dramatically increase blood pressure.

Against the background of an increase in blood pressure with the introduction of the drug, angina attacks may develop. The action of epinephrine can cause a decrease in urine output.

The infusion should be carried out into a large (preferably central) vein using a device to regulate the rate of administration of the drug.

Intracardiac administration for asystole is used if other methods are unavailable, since there is a risk of cardiac tamponade and pneumothorax.

Treatment is recommended to be accompanied by the determination of the level of potassium ions in the blood serum, measurement of blood pressure, minute volume of blood circulation, pressure in the pulmonary artery, wedge pressure in the pulmonary capillaries, urine output, central venous pressure, electrocardiography. The use of high doses for myocardial infarction can increase ischemia due to an increase in oxygen demand.

During the period of treatment of patients with diabetes mellitus, an increase in the dose of sulfonylurea and insulin derivatives is required, since Adrenaline increases glycemia.

The absorption and final concentration of epinephrine in plasma with endotracheal administration can be unpredictable.

In case of shock, the use of the drug does not replace the transfusion of blood-substituting fluids, saline solutions, blood or plasma.

Long-term use of epinephrine causes peripheral vasoconstriction, the risk of necrosis or gangrene.

It is not recommended to use the drug during childbirth to increase blood pressure, the introduction of large doses to weaken the contraction of the uterus can cause prolonged uterine atony with bleeding.

The use of epinephrine for cardiac arrest in children is allowed with caution.

Cancellation of the drug should be carried out by gradually reducing the dose to prevent the development of arterial hypotension.

Adrenaline is easily destroyed by alkylating agents and oxidants, including bromides, chlorides, iron salts, nitrites, and peroxides.

If a precipitate appears or the solution color changes (pinkish or brown), the preparation is not suitable for use. Unused product must be disposed of.

The doctor decides on the patient's admission to driving vehicles and mechanisms individually.

Drug interactions

Blockers of α- and β-adrenergic receptors - epinephrine antagonists (in the treatment of severe anaphylactic reactions with β-blockers, the effectiveness of epinephrine in patients is reduced, it is recommended to replace it with the introduction of salbutamol intravenously);
Other adrenergic agonists - can enhance the action of epinephrine and the severity of side effects from the cardiovascular system;
Cardiac glycosides, quinidine, tricyclic antidepressants, dopamine, inhalation anesthetics (halothane, methoxyflurane, enflurane, isoflurane), cocaine - the likelihood of arrhythmias increases (joint use is allowed with extreme caution, or is not allowed);
Narcotic analgesics, hypnotics, antihypertensive drugs, insulin and other hypoglycemic drugs - their effectiveness decreases;
Diuretics - an increase in the pressor effect of epinephrine is possible;
Monoamine oxidase inhibitors (selegiline, procarbazine, furazolidone) - can cause a sudden and pronounced increase in blood pressure, headache, cardiac arrhythmia, vomiting, hyperpyretic crisis;
Nitrates - it is possible to weaken their therapeutic effect;
Phenoxybenzamine - tachycardia and increased hypotensive effect are likely;
Phenytoin - a sudden drop in blood pressure and bradycardia (depending on the rate of administration and dose);
Thyroid hormone preparations - mutual enhancement of action;
Medicines that prolong the QT interval (including astemizole, cisapride, terfenadine) - prolongation of the QT interval;
Diatrizoates, iothalamic or ioxaglic acids - increased neurological effects;
Ergot alkaloids - an increase in the vasoconstrictor effect (up to severe ischemia and the development of gangrene).

Analogs

Analogues of Adrenaline are: Adrenaline hydrochloride-Vial, Adrenaline hydrochloride, Epinephrine tartrate, Epinephrine, Epinephrine hydrotartrate.

Terms and conditions of storage

Store at temperatures up to 15 ° C in a dark place. Keep out of the reach of children.

The shelf life is 3 years.

Terms of dispensing from pharmacies

Dispensed by prescription.

Adrenaline: prices in online pharmacies

Drug name

Price

Pharmacy

Epinephrine 1 mg / ml injection 1 ml 5 pcs.

RUB 63

Buy

Adrenaline solution for in. 1mg / ml 1ml 5 pcs.

RUB 85

Buy

Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!