Epinephrine adverse effects

Serious adverse effects of epinephrine potentially occur when it is given in an excessive dose, or too rapidly, for example, as an intravenous bolus or a rapid intravenous infusion. These include ventricular dysrhythmias, angina, myocardial infarction, pulmonary edema, sudden sharp increase in blood pressure, and cerebral hemorrhage. The risk of epinephrine adverse effects is also potentially increased in patients with hypertension or ischemic heart disease, and in those using (3-blockers (due to unopposed epinephrine action on vascular Ui-adrenergic receptors), monoamine oxidase inhibitors, tricyclic antidepressants, or cocaine. Even in these patients, there is no absolute contraindication for the use of epinephrine in the treatment of anaphylaxis [1,5,6]. 

Epinephrine has a narrow benefit-to-risk ratio. Along with its therapeutic effects, when administered in recommended doses by any route, it potentially causes transient anxiety, fear, restlessness, palpitations, pallor, tremor, and headache. Although usually perceived as adverse effects, such symptoms indicate that a pharmacologically active dose of the medication has been absorbed. The desirable pharmacologic effects of epinephrine cannot be separated from the undesirable pharmacologic effects [10]. 

Adverse effects. Cardiovascular crises are a possible risk emotional stress of the patient may cause sympathoadrenal activation with epinephrine release. The resulting rise in blood pressure can be all the more marked because persistent depression of sympathetic nerve activity induces supersen-sitivily of effector organs to circulating catecholamines. 

Its most important adverse effects are nephrotoxicity and ototoxicity. The risks for nephrotoxicity can be limited by adequate hydration. Marked nausea and vomiting are frequent. Only mild-to-moderate myelosuppression is seen. Pseudo-allergic reactions may occur which respond to intravenous epinephrine and corticosteroids or antihistamines. 

One of the most important uses of sympathomimetic drugs is in the therapy of bronchial asthma. This use is discussed in Chapter 20. Nonselective drugs (epinephrine), -selective agents (isoproterenol), and B2-selective agents (albuterol, metaproterenol, terbutaline) all are available for this indication. Sympathomimetics other than the 32-selective drugs are now rarely used because they are likely to have more adverse effects than the selective drugs. 

Maximal bronchodilation is achieved 15 minutes after inhalation and lasts 60-90 minutes. Because epinephrine stimulates 3i as well as receptors, tachycardia, arrhythmias, and worsening of angina pectoris are troublesome adverse effects. Epinephrine is the active agent in many nonprescription inhalants (eg, Primatene Mist) but is now rarely prescribed. 

Adverse effects Isoproterenol s adverse effects are similar to those of epinephrine. 

Adverse effects Dobutamine should be used with caution in atrial fibrillation, since the drug increases atrioventricular conduction. Other adverse effects are the same as those for epinephrine. Tolerance may develop on prolonged use. 

Endogenous biogenic amines in the brain include catecholamines [NE (noradrenaline, NA), dopamine (DA), epinephrine (adrenaline)] 5-HT, histamine, and the so-called trace amines (P-phenylethylamine, tyramine, tryptamine, and octopamine). These amines have in common a arylalkylamine stmcture, and all have been implicated in the etiology of one or more psychiatric disorders and/or in therapeutic and/or adverse effects of drugs used to treat such disorders. In this review on depression, the focus in the case of biogenic amines will be on 5-HT, NE, and DA, although epinephrine and histamine and trace amines have also been implicated (see the section on Other Antidepressant Approaches and Targets ). 

Cocaine (alkaloid) is used medicinally solely as a surface anaesthetic (for abuse toxicity, see p. 192) usually as a 4% solution, because adverse effects are both common and dangerous when it is injected. Even as a surface anaesthetic sufficient absorption may take place to cause serious adverse effects and cases continue to be reported only specialists should use it and the dose must be checked and restricted. Cocaine prevents the uptake of catecholamines [adrenaline (epinephrine), noradrenaline (norepinephrine)] into S5nnpathetic nerve endings, thus increasing their concentration at receptor sites, so that cocaine has a built-in vasoconstrictor action, which is why it retains a (declining) place as a... 

Have emergency medication such as epinephrine, Benadryl, and steroids on hand to counteract any adverse effect of the antimicrobial medication. 

Adverse effects of antimicrobials are treated with antihistamines (Benadryl), epinephrine (adrenalin), and steroids for anti-inflammatory response. 

Systemic adverse effects of epinephrine include headache, faintness, increased blood pressure, tachycardia, arrhythmias, tremor, pallor, anxiety, and increased perspiration. Epinephrine should be used with caution in patients with cardiovascular diseases, cerebrovascular diseases, aphakia, CAG, hyperthyroidism, and diabetes melhtus, as well as in patients undergoing anesthesia with halogenated hydrocarbon anesthetics. Using NLO with epinephrine and dipivefrin wiU improve therapeutic response and reduce the risk of systemic adverse effects. ... 

Because of their adverse effects, the Food and Drug Administration (FDA) has taken action to remove two over-the-counter products that have amphetamine-hke action ephedrine, an agent with actions similar to those of epinephrine and the main active ingredient in the herb ephedra, used for weight loss and in energy-enhancement cold medicines and weight loss... 

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