Adrenaline parenteral 1:600, 1:1000 and 1:2000 (auto-injectors)
- Drugs List
- Therapeutic Indications
- Dosage
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Solution for injection containing adrenaline.
Drugs List
Therapeutic Indications
Uses
Anaphylaxis acute - emergency treatment
Dosage
Adrenaline injection for self-administration should only be used for patients clearly identified at risk of an anaphylactic reaction and should always be carried by such patients in situations of special risk. Patients or their carers must be thoroughly instructed how to use adrenaline injection for self administration and the circumstances in which it should be used. Patients should be advised to seek immediate medical attention following the self-administration of adrenaline.
Adults
300micrograms, administered intramuscularly, as soon as signs and symptoms of anaphylaxis develop.
Repeated after 5 to 15 minutes.
In patients weighing 60kg or more, 500micrograms may be required.
Children
EpiPen
Dosage may be 150micrograms or 300micrograms, depending on the body weight of the patient (10micrograms/kg body weight).
Bodyweight over 25kg
300micrograms, administered intramuscularly. Repeat after 5 to 15 minutes.
Bodyweight 7.5kg to 25kg
150micrograms, administered intramuscularly. Repeat after 5 to 15 minutes.
Emerade and Jext
Usual dose is 5micrograms/kg to 10micrograms/kg but higher doses may be necessary in some cases.
Children aged 12 to 18 years with a body weight of 60kg and above
500micrograms, administered intramuscularly. Repeat after 5 to 15 minutes.
Bodyweight over 30kg
300micrograms, administered intramuscularly. Repeat after 5 to 15 minutes. On the basis of a dose of 10micrograms/kg, 500micrograms may be more appropriate for some patients, depending on clinical judgement.
Bodyweight 15kg to 30kg
150micrograms, administered intramuscularly. Repeat after 5 to 15 minutes. On the basis of a dose of 10micrograms/kg, 300micrograms may be more appropriate for some patients, depending on clinical judgement.
Bodyweight up to15kg (unlicensed) 150micrograms, administered intramuscularly. Repeat after 5 to 15 minutes.
Additional Dosage Information
Each injector is for use on a single occasion.
Contraindications
None known
Precautions and Warnings
Children weighing less than 15kg
Elderly
Angina
Asthma
Atherosclerosis
Cardiac arrhythmias
Cardiac disorder
Cardiomyopathy
Cerebrovascular disorder
Diabetes mellitus
History of asthma
Hypercalcaemia
Hypertension
Hyperthyroidism
Hypokalaemia
Ischaemic heart disease
Narrow angle glaucoma
Parkinson's disease
Phaeochromocytoma
Pregnancy
Prostate disorder
Raised intra-ocular pressure
Severe renal impairment
Tachycardia
Advise patient not to drive or operate machinery until assessed
Not all available brands are licensed for all body weights
Not all formulations are suitable for use in children under 12 years
Patient and prescriber should be aware of risk minimisation material
Contains sodium metabisulfite. Caution,may cause allergic reactions
Do NOT inject into the extremities or penis
Self-admin. - only if adequately trained and have access to expert advice
Thick adipose layer may cause suboptimal effect - consider 2nd injection
When given by carer, immobilise patient's leg to reduce risk of laceration
Avoid administration in the gluteal region
Diabetic control may need adjustment
Consult brand information for relevant risk minimisation materials, including check lists and expiry date alerts.
Pregnancy and Lactation
Pregnancy
Use adrenaline with caution during pregnancy.
The manufacturer notes that this medication should only be considered if the expected benefit to the mother is greater than any risk to the foetus.
Adrenaline is teratogenic in some animal species, however human teratogenicity has not been studied.
Adrenaline crosses the placenta and may dramatically reduce placental blood flow; although anaphylactic shock will also reduce placental blood flow. There is an increased risk of adverse reactions in pregnant patients. Schaefer (2007) comments that the systemic use of adrenaline is restricted to emergency use.
Lactation
Adrenaline is considered safe for use during breastfeeding.
The manufacturer notes that adrenaline is not orally bioavailable.
The product also has a short half life and is readily destroyed in the gastrointestinal tract. Any adrenaline excreted in breast milk would not be expected to have any effect on the nursing infant. Hale (2010) suggests the breastfeed infant is observed for brief stimulation.
Counselling
Advise patients to check the product to ensure it is replaced within the expiry period and also to visually inspect the product to make sure the solution is clear and colourless.
Do NOT inject into the extremities or penis Avoid administration in the gluteal region Advise patient not to drive or operate machinery until assessed Patient and prescriber should be aware of risk minimisation material When given by carer, immobilise patient's leg to reduce risk of laceration
Side Effects
Allergic reaction
Anginal pain
Anxiety
Apprehension
Asthenia
Bronchospasm
Cardiac arrest
Cardiac arrhythmias
Cardiomyopathy
Cold extremities
Difficulty in micturition
Dizziness
Dry mouth
Dyspnoea
Glaucoma (closed angle)
Hallucinations
Headache
Hyperglycaemia
Hyperhidrosis
Hypersalivation
Hypertension
Hypokalaemia
Local infection at injection site
Metabolic acidosis
Mydriasis
Nausea
Necrosis (injection site)
Necrotising fasciitis
Nervousness
Pallor
Palpitations
Peripheral ischaemia
Pulmonary oedema
Respiration worsening
Restlessness
Sweating
Syncope
Tachycardia
Tremor
Urinary retention
Vasoconstriction
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: December 2013
Reference Sources
Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.
Medications and Mothers' Milk, 14th Edition (2010) Hale, T. Hale Publishing, Amarillo, Texas.
Summary of Product Characteristics: Emerade 150 micrograms solution for injection in pre-filled pen. Namtall AB. Revised September 2016.
Summary of Product Characteristics: Emerade 300 micrograms solution for injection in pre-filled pen. Namtall AB. Revised September 2016.
Summary of Product Characteristics: Emerade 500 micrograms solution for injection in pre-filled pen. Namtall AB. Revised September 2016.
Summary of Product Characteristics: EpiPen Adrenaline (Epinephrine) Auto-Injector 0.3 mg. Meda Pharmaceuticals. Revised September 2019.
Summary of Product Characteristics: EpiPen Junior Adrenaline (Epinephrine) Auto-Injector 0.15 mg. Meda Pharmaceuticals. Revised May 2019.
Summary of Product Characteristics: Jext 150 micrograms Solution for Injection in pre-filled pen. ALK-Abello Ltd. Revised October 2018.
Summary of Product Characteristics: Jext 300 micrograms Solution for Injection in pre-filled pen. ALK-Abello Ltd. Revised October 2018.
NICE - Evidence Services
Available at: www.nice.org.uk
Last accessed: 24 January 2023.
US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Epinephrine. Last revised: September 7, 2013
Last accessed: December 18, 2013
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.