Adrenaline parenteral 1:1000
- Drugs List
- Therapeutic Indications
- Dosage
- Administration
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Injection formulation of adrenaline (1:1,000).
Drugs List
Therapeutic Indications
Uses
Anaphylaxis acute - emergency treatment
Unlicensed Uses
Acute stridor
Croup (acute laryngotracheobronchitis)
Priapism
Dosage
This monograph relates only to the specific use of the 1:1000 strength adrenaline injections in ampoules or pre-filled syringes. Different strength preparations of adrenaline are available and the separate monographs for other strengths and presentations (auto-injectors) should be consulted for further information.
Adults
Acute allergic reactions or anaphylaxis
500micrograms, administered intramuscularly. Repeat at 5 to 15 minute intervals, if necessary, based on individual response according to blood pressure, pulse and respiratory function.
The following unlicensed use may be administered by diluting 0.1ml of adrenaline 1 in 1000 injection to 5ml with sodium chloride 0.9%, if an alternate suitable strength is not available
Priapism associated with alprostadil, if other measures are unsuccessful (alternative to phenylephrine or metaraminol) (unlicensed)
10micrograms to 20micrograms, administered by intracavernosal injection, every 5 to 10 minutes, using 20microgram/ml solution.
The unlicensed dose may be administered by diluting 0.1ml of adrenaline 1 in 1000 injection to 5ml with sodium chloride 0.9%, if an alternate suitable strength is not available.
Maximum dose: 100micrograms per course.
Children
Acute allergic reactions or anaphylaxis
Children aged 12 to 18 years
(See Dosage; Adult)
Children aged 6 to 12 years
300micrograms, administered intramuscularly. Repeat at 5 to 15 minute intervals, if necessary, based on individual response according to blood pressure, pulse and respiratory function.
Children aged 6 months to 6 years
150micrograms, administered intramuscularly. Repeat at 5 to 15 minute intervals, if necessary, based on individual response according to blood pressure, pulse and respiratory function.
Children under 6 months
10micrograms/kg or 150micrograms, administered intramuscularly. Repeat at 5 to 15 minute intervals, if necessary, based on individual response according to blood pressure, pulse and respiratory function.
150micrograms of adrenaline may not be licensed for use in children under 15kg.
Croup when not controlled with corticosteroid treatment (unlicensed)
Children aged 1 month to 12 years
400micrograms/kg, administered by inhalation via a nebuliser. Maximum dose 5mg.
Administration
Emergency treatment of acute allergic reactions or anaphylaxis
For intramuscular injection into the anterolateral aspect of the thigh (not the buttock).
Priapism associated with alprostadil, if other measures are unsuccessful (alternative to phenylephrine or metaraminol)
For intracavernosal injection.
Contraindications
Breastfeeding
Precautions and Warnings
Elderly
General anaesthesia
Shock
Arteriosclerosis
Asthma
Autonomic dysreflexia
Brain damage
Cardiac arrhythmias
Cardiovascular disorder
Cerebrovascular disorder
Diabetes mellitus
Hypercalcaemia
Hypertension
Hyperthyroidism
Hypokalaemia
Narrow angle glaucoma
Parkinsonism
Phaeochromocytoma
Pregnancy
Prostate disorder
Psychiatric disorder
Pulmonary emphysema
Severe renal impairment
Spinal cord injury
Urinary obstruction
Not all available brands are licensed for all age groups
Not all available brands are licensed for all routes of administration
Contains sodium metabisulfite. Caution,may cause allergic reactions
Do NOT inject into the extremities
Avoid administration in the gluteal region
Monitor blood pressure
Monitor ECG
Monitor heart rate
Monitor pulse oximetry
Adrenaline is indicated in life threatening situations, therefore all precautions are relative.
In patients with Parkinsonian Syndrome, adrenaline increases rigidity and tremor.
Adrenaline should not be injected in to the fingers, toes, ears, nose buttocks or genitalia due to the risk of ischaemic tissue necrosis. Repeated local injection can result in necrosis at sites of injection from vascular constriction. Accidental intravascular injection may result in cerebral haemorrhage due to a sudden rise in blood pressure.
Adrenaline should be used cautiously, if at all, during general anaesthesia with halogenated hydrocarbon anaesthetics.
Pregnancy and Lactation
Pregnancy
Use adrenaline with caution during pregnancy.
The manufacturer recommends adrenaline is not used in pregnancy unless the potential benefit to the mother outweighs the potential risk to the foetus. Adrenaline crosses the placenta and there is some evidence of a slightly increased incidence of congenital abnormalities. Adrenaline may cause anoxia to the foetus.
Adrenaline usually inhibits spontaneous or oxytocin induced contractions and may delay the second stage of labour. For this reason adrenaline should not be used during the second stage of labour.
Lactation
Adrenaline is contraindicated during breastfeeding.
The manufacturer advises discontinuing breastfeeding whilst undergoing treatment with adrenaline. Adrenaline is distributed into breast milk.
Side Effects
Allergic reaction
Anaphylaxis
Anginal pain
Anorexia
Anxiety
Bowel necrosis
Bronchospasm
Cardiac arrhythmias
Cardiomyopathy
Cerebral haemorrhage
Cold extremities
Confusion
Decreased appetite
Difficulty in micturition
Dizziness
Dry mouth
Dyspnoea
ECG changes
Glaucoma (closed angle)
Headache
Hemiplegia
Hepatic necrosis
Hyperglycaemia
Hypersalivation
Hypertension
Hypokalaemia
Insomnia
Irritability
Metabolic acidosis
Mydriasis
Myocardial infarction
Myocardial ischaemia
Nausea
Necrosis (injection site)
Pallor
Palpitations
Peripheral ischaemia
Psychotic episodes
Pulmonary oedema
Restlessness
Sweating
Syncope
T-wave changes
Tachycardia
Tachyphylaxis
Tremor
Urinary retention
Vasoconstriction
Ventricular fibrillation
Vomiting
Weakness
Worsening of Parkinson's disease
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: September 2019
Reference Sources
Summary of Product Characteristics: Adrenaline (Epinephrine) injection BP 1 in 1000. Hameln Pharmaceuticals Ltd. Revised March 2019.
Summary of Product Characteristics: Adrenaline (Epinephrine) injection BP (1:1000) (ampoules). Martindale Pharma. Revised February 2019.
Summary of Product Characteristics: Adrenaline (Epinephrine) injection BP (1:1000) for anaphylaxis (glass prefilled syringe). Martindale Pharma. Revised December 2017.
NICE - Evidence Services
Available at: www.nice.org.uk
Last accessed: 27 October 2020
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.