Epinephrine dosage

EPINEPHRINE Refer to specific product labeling for detailed administration and dosage information. 

Alternatively, if the patient has been intubated, epinephrine can be injected via the endotracheal tube directly into the bronchial tree at the same dosage for IV injection. It is rapidly absorbed through the lung capillary bed. 

Patients treated with recommended dosages of epinephrine will complain of feeling nervous or anxious. Some will have tremor of the hand or upper extremity and many will complain of palpitations. Epinephrine is dangerous if recommended dosages are exceeded or if the drug is used in patients with coronary artery disease, arrhythmias, or hypertension. The inappropriate use of epinephrine has resulted in extreme hypertension and cerebrovascular accidents, pulmonary edema, angina, and ventricular arrhythmias, including ventricular fibrillation. 

In complete heart block with Stokes-Adams syncope, ephedrine may prove of value in a manner similar to epinephrine. In the attempt to increase ventricular rate and prevent ventricular asystole, an initial dose of about 8 mg of ephedrine sulfate orally may be tried. Later, the dosage may be increased to 25 mg three or four times daily. Syncope due to ventricular tachycardia can also be prevented in some cases with ephedrine. 

Tetracycline and its derivative, minocycline, are used for control of acne vulgaris. Conjunctival deposits similar to those seen in epinephrine-treated glaucoma patients have been observed in patients treated orally with these compounds. Dosages ranged from 250 to 1,500 mg daily of tetracycline and at least 100 mg daily of minocycline. 

Chlorobutanol is primarily used in ophthalmic or parenteral dosage forms as an antimicrobial preservative at concentrations up to 0.5% w/v see Section 10. It is commonly used as an antibacterial agent for epinephrine solutions, posterior pituitary extract solutions, and ophthalmic preparations intended for the treatment of miosis. It is especially useful as an antibacterial agent in nonaqueous formulations. Chlorobutanol is also used as a preservative in cosmetics [see Section 16) as a plasticizer for cellulose esters and ethers and has been used therapeutically as a mild sedative and local analgesic. 

Many therapeutically active ingredients are administered or applied to the body by means of the aerosol dosage form, including agents such as epinephrine, isoproterenol, antibiotics, antiseptics, steroids, and ergotamine. Oral aerosols have been used for the symptomatic treatment of asthma as well as for the treatment of migraine headaches, whereas topical aerosols find use in numerous dermatological manifestations. 

When used therapeutically, intravenous injection or infusion is the most common route of administration. Epinephrine is available in nebulized racemic dosage form for inhalation. 

Acute overdose probably would not result in toxicity. Should oral overdosage occur, standard emergency and supportive care procedures should be followed. If anaphylaxis should occur, epinephrine may be given as 0.3-0.5 ml of a 1 1000 solution for adults (children should receive 0.01 ml kg ). Mild anaphylaxis may be treated with antihistamines alone. If chronic toxicity should occur, it is important to reduce the dosage of corticosteroid to a minimal maintenance dose at the first sign of toxicity. 

Hypersensitivity to amide-type local anesthetics, Adams-Stoke syndrome, supraventricular arrhythmias, Wolf-Parkinson-White syndrome. Spinal anesthesia contraindicated in septicemia. Caution Dosage should be reduced for elderly, debilitated, acutely ill safety in children has not been established. Severe renal/hepatic disease, hypovolemia, CHF, shock, heart block, marked hypoxia, severe respiratory depression, bradycardia, incomplete heart block. Anesthetic solutions containing epinephrine should be used with caution in peripheral or hypertensive vascular disease and during or following potent general anesthesia. Sulfite sensitivity or asthma for some local and topical anesthetic preparations. Tartrazine or aspirin sensitivity with some topical preparations. Anxiety, insomnia, apprehension, blurred vision, loss of hearing acuity, and nausea CNS depression, convulsion and respiratory depression... 

The metered-dose aerosol inhaler is not only a most convenient system for the delivery of therapeutically active drugs but it has proven to be a life-saving device for many asthmatics. This system has made it possible for millions of asthma sufferers to lead normal lives. The convenience of self-administering a dose of drug accurately and quickly has made the metered-dose aerosol the dosage form of choice for the delivery of drugs to the respiratory system. From epinephrine to albuterol, from triamcinolone to flunisolide, from proteins and peptides to hormones, this dosage form has proven its value. 

Sciarra JJ, Patel JM, Kapoor AL. Synthetics and formulation of several epinephrine salts as an aerosl dosage form. J Pharm Sci 61(2) 219-223, 1972. 

The shrinking of mucous membranes decreases operative bleeding while improving surgical visualization. Comparable vasoconstriction can be achieved with other local anesthetics by the addition of a low concentration of a vasoconstrictor such as phenylephrine (0.005%). Epinephrine, topically applied, does not prolong the duration of action of local anesthetics applied to mucous membranes because of poor penetration. Maximal safe total dosages for topical anesthesia in a healthy 70-kg adult are 300 mg for lidocaine, 150 mg for cocaine, and 50 mg for tetracaine. 

Van Dongen and Sanchez (29) compared the antifibrillatory activity of hydroquinidine with a specially purified quinidine. They present the viewpoint that the activity of commercially prepared quinidine in auricular fibrillation is based entirely on its content of dihydroquinidine. They used the rabbit as a test animal and observed that dihydroquinidine produced an increase in the electrical stimulus thresholds required to provoke premature systoles, tachycardia, auricular fibrillation, and ventricular fibrillation. With dihydroquinidine there was also a decrease in the duration of fibrillation which occurs after the electrical stimulus is ended. Dihydroquinidine, they found, could prevent the heterotropic rhythms (largely ventricular arrhythmias) provoked by the intravenous injection of barium chloride or epinephrine. They also observed that hydroquinidine, at 8 mg./kg., prolonged the auricular conduction time by 50%, the AV conduction time by 30 %, and increased the refractory period by 15%. Pure quinidine was inactive at this dosage. 

Patients anaesthetised with inhalational anaesthetics (particularly cyclopropane and halothane, and to a lesser extent desflurane, enflurane, ether, isoflurane, methoxyflurane, and sevoflurane) can develop cardiac arrhythmias if they are given adrenaline (epinephrine) or noradrenaline (norepinephrine), unless the dosages are very low. Children appear to be less susceptible to this interaction. file addition of adrenaline to intrathecal tetracaine enhances the sedative effects of propofol. 

Mechanism of action. PCP may stimulate a-adrenergic receptors and potentiate the pressor response to epinephrine. There is some evidence that cholinesterase inhibition also plays a role. At high dosages, PCP induces respiratory depression by an unknown mechanism. 

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